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The Thinking Practitioner Episode 19: What About Risk with Ruth Werner

Whitney Lowe:

Welcome to The Thinking Practitioner. Hello and welcome to The Thinking Practitioner. Today’s episode is brought to you by Books of Discovery so we have a quick message from Andrew Biel the author of Trail Guide to the Body.

Andrew Biel:

Books of Discovery might be best known for producing trail guide to the body, but we’re also a whole lot more. We bring you the clinical learning tools you need to inform your intentional bodywork. Check out our kinesiology, pathology and, AAP text. They not only build the foundation upon which great educators like Til and Whitney rely, but will also support you through your entire career. Books of Discovery is proud to support The Thinking Practitioner and are offering a 15% discount when a listener enters Thinking at the booksofdiscovery.com checkout page. Enjoy the show.

Whitney Lowe:

And thanks to Andrew Biel and Books of Discovery for the support, we really appreciate you supporting The Thinking Practitioner Podcast. Do be sure to check out their great offer as well. So Til, good afternoon, how are you doing today?

Til Luchau:

Doing great Whitney, really pleased to be here with you and with our guest.

Whitney Lowe:

We have a guest?

Til Luchau:

We do. We’ve got Ruth Werner herself with us today. How are you doing Ruth?

Ruth Werner:

I’m very well. And it’s a happy day to be here with you guys.

Whitney Lowe:

All right. We’re very happy to have you with us.

Ruth Werner:

Thanks.

Whitney Lowe:

So what do you want to talk about today Til? We’ve got some special things that we want to dive into here.

Til Luchau:

Yeah, I thought of you and I thought of Ruth both when I had this thought mulling around in my head and the thought is, how do we deal with the risks we face as manual therapists, as massage therapists certainly facing the coronavirus and all the safety concerns about that? But then how do we… It’s a bigger question of risk tolerance, risk mitigation, and the implications that has on say our ethical considerations, the practical implications, and especially what do we do with the fact that there’s so many different perceptions about what the risks are and how we need to respond to them?

Whitney Lowe:

Yeah, this is some significant things. I think we’re getting a little beyond too. There’s been so much information going out and Ruth, you have been so wonderfully sharing so much resources with everybody about dealing with, especially the pathology end of this too. So we want to delve into a little bit today on some other aspects and facets of these topics around how do we make some bigger decisions? I think not necessarily just the nitty-gritty of how do we keep our rooms clean, but some of the bigger picture issues around the issues of the risk associated with our new levels of practice.

Til Luchau:

Yeah. You were going to say something?

Ruth Werner:

Well, yeah. It’s an interesting question to ask a pathology teacher because everything I produce is about identifying potential risks and identifying ways to mitigate them. So back in the olden, olden days and Til I don’t know about your early massage education, but Whitney and I have had this conversation, we were taught some things are indicated and some things are contraindicated and you just have to memorize which is which and go from there. And of course, we know that’s not a realistic vision of the world and a more sophisticated and realistic education around the issue of client safety is about what is the worst thing that could happen in a given situation if I’m careless, if I’m undereducated, if I’m not paying attention?

Ruth Werner:

What are the best kinds of things that could happen in this given situation if I’m skilled and compassionate and present? And how can I create a session where I minimize those possible risks and I maximize those possible benefits so that my client can receive the best that I have to give them? And we make that decision for every single client every single day. And we did that pre-COVID and we will do that post-COVID. It’s just that with the advent of this virus, it’s added some new questions that are much harder to answer because it’s new.

Til Luchau:

And I want to back up a little bit, we owe you the chance to introduce yourself. I just assumed that you don’t even need an introduction we all know who you are, but maybe what would you want people to know about yourself in terms of introduction?

Ruth Werner:

Well, thank you. Pardon me. The first thing to know about me is that I live with a chronic cough and it will go away after I talk for a little while, that I do not have COVID-19, I just have a chronic cough. The second thing is that I have built a career out of gathering information about diseases and conditions and interpreting that in a way that is relevant for massage therapy clinical decisions. And the venue in which I’ve done that most completely is in the textbook, it’s called The Massage Therapist Guide to Pathology now in its seventh edition, published by our sponsor today, Books of Discovery, thank you very much. So I’ve been at this for a while because my first edition came out in 1998.

Ruth Werner:

And the thing that I like to emphasize about my background is that I am not formally trained in pathology. I was a massage therapist, I am no longer and I just developed a really deep interest for a bunch of reasons about where massage therapy fits in terms of working with people who are not completely healthy. And I was someone who was willing to pursue that question and really dig into it at a time when not that many people were interested in it. And my work ended up being very useful and got published and now the book is used in massage schools all over the world which is wonderful.

Ruth Werner:

But I like to share that little bit of origin story because it is inevitable that everybody listening to this will eventually have a client with some condition that they know nothing about and it’s not in the textbook. And that means we’re on our own, we have to find out what we can find out about it and make appropriate decisions about those risks and benefits. And that part of my goal is to present information so that people can make good clinical decisions, but also to present a pattern so that people can fill in some of those blanks on their own when the day comes that someone comes in with a condition that you don’t have a textbook that gives you specific guidance.

Til Luchau:

So that’s why I thought of you when I thought of this conversation because they’re really some questions that I’m thinking through for myself, and they are one step back from the specific how to’s and even specific pathology considerations. But I really did think of you and I really thought of Whitney and your input on these questions I got. Can I run some of them by you?

Ruth Werner:

Sure, absolutely.

Til Luchau:

So I get a lot of social media contacts, get a lot of emails, get a lot of questions, people are asking for me to help them with things, help them think through things. And the big one for a while was how can I eliminate risk? That kind of stuff, Ruth, that you’ve made some contributions to, what are the practical clear things that I can do to eliminate, they would say, risk to myself? And the questions have shifted to, if I can’t reduce risk to zero since it seems like COVID is going to be with us for a while, how do I manage the risk that I work with or live with?

Til Luchau:

And that gets me interested in the bigger question of what level of risk are people okay with and what are not okay with? I have a particular perspective that might be different from somebody else. And it’s particularly interesting that at this time in our cultural scenario, that we can’t even agree about what the risks are, that way it becomes a really wicked problem. As they say in coding, is a problem where we don’t even agree what the problem is. So it becomes really hard to address and hard to solve.

Whitney Lowe:

It seems too that we’re at a place where some of this is moving from being a strictly medically-based decision to also having some very gray areas on the ethics world of making those determinations and decisions. And I think that’s what makes it particularly more challenging for lots of people because there clearly isn’t right and wrong science-based answers to many of these questions.

Til Luchau:

Oh, that’s such an important point. And then it also blends into questions of individual responsibility or collective responsibility, our traditions and our cultural norms around that, individual freedoms and individual responsibility. So just thinking back, traveling and I was when COVID and being in Asia, it was such a clear collective response, in Taiwan say when we landed in Taiwan and we taught a class in masks and with 80 people there and they had it dialed in, they knew exactly what to do, they had door monitors, temperature checkers, total disinfecting a couple of times a day on and on. And they just clicked right into that, they’ve been through a couple of practice rounds before with other viruses. And it was reassuring. At the time, it’s like is this too much? But in hindsight they really had it dialed in. And then coming back to the US and seeing what a disparate set of approaches we’re taking it here, got this question high in my mind.

Ruth Werner:

And it’s such a weird combination of wanting to follow the science. But when you say I want to follow the science then you have to be willing to change on a dime because the information that we’re getting about the virus and about how it most easily spreads and all these different things, that changes quickly and we’re not good at making fast changes. And there are identity things, I got a huge, the biggest amount of pushback I’ve gotten in the material that I’ve produced is when I said that I can’t make an argument that massage therapy is an essential service because I cannot demonstrate that someone will die if they don’t get a massage. That doesn’t mean massage is not important, there’s a big difference between essential and important, right?

Til Luchau:

Right.

Ruth Werner:

And this is where I have a difference of opinion with a lot of people that I respect and that’s okay we can agree to disagree on some things like that. But there are, in addition to ethical considerations, there are considerations of identity, there are considerations of financial survival.

Til Luchau:

Huge.

Ruth Werner:

And then that all gets tied up in political identity as well and it becomes, in the United States, where we place this very high value on individualism and thinking for oneself, it becomes a particularly difficult problem and it has not been helped by the fact that the larger systems have not supported us in doing things like you saw in Taiwan or Hong Kong or places where the zeitgeist is. Yeah, we’re all in this together, here is our cultural standard, everyone wears a mask now.

Til Luchau:

Yeah, no, we don’t agree on that, that’s for sure.

Whitney Lowe:

Interestingly to what you were saying, Ruth, about the pushback that you got on that whole issue of essential services, one of the other trends that I’ve been seeing a lot, and this is watching a lot of the discussions on social media now, is we’re trying to dip our toes in the water of getting back to work, is a lot of clients saying I’m willing to take this risk because I need this. They’re the ones saying I need this for pain relief or I need this for stress management or I need this and I’m willing to take that risk. And a lot of the practitioners now are faced with this situation of saying, those that are not ready, no, I’m not taking that risk but even though you might want to. It poses a really interesting dilemma for many people out there I think.

Ruth Werner:

Yeah. And one of the things to think about is what happens when the massage therapist’s risk tolerance is different from a client’s risk tolerance, in either direction. But I think what we are going to see more often is clients saying, I’ll do anything, just get me on your table or clients saying, I really want to come in on your table, but there is no way I’m wearing a mask. And that just pushes right up against some interesting boundaries, which is why people are going to really need to be careful about conscientiously analyzing every decision they want to make about what they want from their clients when they step in the door of that office.

Ruth Werner:

And of course, the other thing that we’re dealing with here, which makes this different from any other kind of infection that we’ve seen in the past, is that the risk is not just between the two people in the room. The risk is between the two people in the room, plus everybody in the bubble of those two people in the room. So your client may say I’m in so much pain and I don’t want to get back on opioid pain relievers, that it is more important for me to get a massage so that I don’t have to go down this other route that feels really, really dangerous to me. And that’s a really compelling argument. But if that massage therapist has an autoimmune disease, lives with someone who is under treatment for cancer, or who has an autoimmune disease, or who is elderly and has a history of diabetes, or whatever, the risk goes outside the doors of the session room.

Til Luchau:

It’s not just about me anymore. It’s not just about me and you.

Ruth Werner:

Exactly. That’s exactly it. And that’s really different from the risks that we see say, such as they are. It’s really easy to mitigate risks for working with clients who are HIV positive although, I still encounter massage therapists who don’t want to do that. But even the risks for working with a client who has hepatitis B or hepatitis C, which is much easier to spread through casual contact, the risk is just between those two people. It’s not that you’re going to take it home and cough on your five-year-old.

Whitney Lowe:

Yeah. That’s one of the things that I think has been, excuse me, I was just going to say one of the things that’s been troubling to me watching this process is it seems the inability of so many people to think in those broader terms and to think outside that box of the number of potential people who are in that sphere of influence.

Til Luchau:

Okay, so you’re saying it’s frustrating or it’s difficult to see that people can’t think beyond their personal impact and how it spreads collectively, is that what you’re saying?

Ruth Werner:

Well, certainly some people are having a hard time with that, yeah.

Til Luchau:

And then there’s the question of objective and subjective differences or even the data we agree upon or don’t agree upon because I’d be curious to hear, Ruth, how is COVID similar or different than other say pathology considerations? You mentioned HIV, you mentioned hepatitis, the difference you highlighted already is that it has a contagion factor that might be different.

Ruth Werner:

It’s much more contagious surely. Is it-

Til Luchau:

Tell me more about-

Ruth Werner:

The natural comparison is to flu. And I think maybe one of the silver linings out of what we’re going through now is we may, as a culture and certainly as a profession, I hope, develop less tolerance for the risks around flu because who needs it. So if you can mitigate flu at the same time, the risk of spreading flu, in the same way that we mitigate the risk of spreading COVID, then that’s just bonus.

Til Luchau:

You’re telling me I need to get a vaccination?

Ruth Werner:

Til, that is your choice, you get to decide that. I will tell you if I were in practice, I would absolutely get the vaccine. And I do anyway and I’m not in practice. But I’ll stand on that hill. Yes, vaccines work. I think people who are engaged in public health should probably get a flu vaccine unless they have a really compelling reason not to, which is a wormhole that maybe we can skip today.

Til Luchau:

I’m sorry I brought it up, I couldn’t resist and resist that can of wormholes because it does get into that controversy or those strong feelings too where there’s debate around well, isn’t it my choice what I do? And that’s the same debate around vaccinations in some ways the collective impact versus the individual choice.

Ruth Werner:

Well, and then you come up in this argument between freedom and responsibility. So you have the freedom to make the choice, for instance, to skip your flu vaccine, that’s cool, but then I think you have a responsibility if you’re in a public health setting to say I have not had a flu vaccine, do you want to work together?

Til Luchau:

That’s right.

Ruth Werner:

I don’t know, that’s-

Til Luchau:

No, I’m with you.

Ruth Werner:

We’re going to get mail.

Til Luchau:

That’s was good. My goal is not to avoid mail on this topic, by the way, I wouldn’t have brought this up.

Whitney Lowe:

Til, I’ve got a question for you and I don’t want to necessarily ask you to be the expert on what’s happening in Asia. But since you were there and have a real-life person perception of what was going on as this virus was percolating in Asia compared to what’s happened here, what is your sense in terms of the way people get informed about these kinds of things? Because what I wonder is because we have such a rampant and open social media world in our current culture here that is so susceptible to all kinds of information. I was watching this video the other day of this argument at some city council meeting of people that didn’t want to wear masks and this woman was testifying and saying that she didn’t believe in the six foot distance between people because she knew that’s just something that the government was doing so they could start scanning us. And all these conspiracy theories of things that are out there, I wonder is that as pervasive in some of these other cultures which have been more consolidated in their response of doing this, what your take is on that?

Til Luchau:

I appreciate the question and the total disclaimer, I am not an expert, I was a traveler briefly, Taiwan and Thailand and I’ve spent a little time in Japan in the past, but that’s it. So just based on my personal guesses about the difference as well as my conversations and reading, it’s a very different consideration. Let’s say in Taiwan we got there, there were clear laws about what we need to do as foreigners coming in, we needed to wear a mask in public, we needed to have our temperature checked, it seemed pretty reasonable. And as I understand it, when I talked to people there, I’d say, how do you feel about wearing the mask? Are you concerned about COVID or are you scared? Most of them said, no, I’m not generally scared or concerned, our government really has this under control and is thinking about it and is helping guide us to make the decisions we want to for ourselves.

Til Luchau:

And why would I not wear a mask? That’s putting you and my family and my society at risk if I’m not wearing a mask. The people I talked to, that wasn’t even a consideration, the puzzle. Now, when I told that story to one of my neighbors back here in the US, I said, “It was really interesting, the differences between the Taiwanese people I talked to and people I talked to here.” And he said, “Oh yeah, there are a lot more conformist, aren’t they?” And I said, “Well, from a certain point of view, say here in America yeah, we could describe that as conformance, the government tells you what to do and you comply.” That word didn’t occur to me while I was there. Actually, it was more collectivist, that word occurred to me quite a bit. It’s like most decisions were referenced to how does this impact the group? How does this impact the other people around me? We’re not that… We’re good at a lot of good stuff here in this country, but that’s not one of our long suits really thinking about the collective you can say.

Ruth Werner:

Yeah, we are the rugged individualists. And we have, here’s another rabbit hole that you guys get to control, a lot of people have skepticism, healthy or not, of messages that come from the government.

Til Luchau:

There you go.

Ruth Werner:

And because the messages we’ve had from our local and national government in relation to this event have been inconsistent, it’s really hard to feel like your feet are on solid ground. But if we had one message, I’m trying not to swear, but wear the mask, keep your distance. It might be overkill, that’s cool. Stay inside if you can, limit your shopping trips, whatever. If we’d had one consistent message that the people in the system, the system meaning basically state and national governments, were willing to reiterate and enforce. Certainly there would still be pushback, certainly there would still be distrust, but I truly think that if we had more consistent messaging, we would feel safer and be safer if the messaging were in alignment with the science.

Til Luchau:

So you’re talking about a science-based authoritarian government would be a good thing right now.

Ruth Werner:

Oh, authoritarian is a hard word.

Til Luchau:

That’s where the conversation goes. I’m still in the rabbit hole with you basically. And I’m thinking of my son who is… It’s really hard to make the case to him that anything is reliable, that’s his point of view. It’s like, you can’t believe anything you read anymore. And as soon as I bring up a point, he says where did you read that the internet? There you go, your source itself is suspect. So that goes on everything.

Ruth Werner:

Not funny when the conversation is going that way.

Til Luchau:

Exactly. So it’s really rich, sometimes it’s been really hard with him because he is a skeptic about everything and he’s a skeptic about the government. Not that the government, as an entity, has done much to help its credibility at any level of our government and at least in this country. But at the same time, it’s a crisis of confidence, you could say, in sources of information. And that includes science for him, for him science is suspect even.

Ruth Werner:

Well, yes because scientists have been systematically discredited, not necessarily fairly. To in my mind, and again this is completely opinion, but you seem to be okay with that. One of the biggest casualties of this pandemic is whatever has happened to the Centers for Disease Control because that whole branch of government has become so heavily politicized and it’s been demonstrated that they are not collecting evidence in the way that is in accordance with the way epidemiologists believe it should be collected. And consequently, it’s not being reported in an accurate or fair way. And it breaks my heart to not be able to go to the CDC and say, okay, here’s what the CDC says about these statistics. But instead, I have to go to Johns Hopkins University and Worldometer and The University of Washington has a statistical project going and I have to try and piece together an understanding from multiple sources because my one source has been kneecapped.

Ruth Werner:

And it is both heartbreaking and it makes it so much harder because it is not supposed to be massage therapist’s job to figure out what’s the safest thing. That’s why we have laws, that’s why we have regulation, that whole purpose of that is client safety. And if we can’t rely on the social contract where we enter a licensed profession and then we get guidance about how to be safe within that profession, where does that leave us? It’s not fair. And I totally get how upsetting this is. And that leads people to feel angry and scared and looking for narratives that suit their understanding of the world, that they need to be true because otherwise, they’re going to lose their house.

Ruth Werner:

And none of this should be the way we make decisions. And it’s all very easy for me to say if you’re living in a place where the positivity rate is going up and your hospitalizations are going up and your hospitals are approaching capacity, this is not the time to reopen your practice. But I’m not going to lose my house because of this epidemic. And there are people who are really, really at risk for losing everything that they put into their careers.

Til Luchau:

You’ve named a really important rabbit hole that I want to dive into next. And that is where does self-interest play into our risk tolerance or does our perspective influence the way we perceive risk? But we got to do a halftime sponsor break first. And our halftime sponsor today is Handspring Publishing, which was the publisher I chose for my book. When I looked for a publisher for the book I wanted to write, I was lucky enough to have had two offers, one from a huge international media company and the other from Handspring, a small publisher in Scotland run by four great people. I’m glad I chose them because not only did they help me make the books, I wanted to share The Advanced Professional Techniques series, but their catalog has emerged as one of the leading collections of professional level books written, especially for body workers, movement teachers, and as they say, all professionals who use movement or touch to help patients achieve wellness. Amazing to have them as a sponsor along with our other sponsor today. Whitney, you want to add anything to that?

Whitney Lowe:

Well, I would say, Handspring has a new instructional webinars series called Moved to Learn. It’s a regular series, each 45 minutes segments featuring some of their amazing authors there. So head on over to their website at handspringpublishing.com to check those out and have a look at that excellent catalog of resources that are over there. And be sure to use the code TTP, like The Thinking Practitioner at checkout for a discount. So we thank Handspring again very much for their sponsorship of the podcast here. So Til I’m going to go back down that rabbit hole that we started to open up here.

Whitney Lowe:

But one other thing I just wanted to also ask about or reflect on here is that, and again, this is a curious question looking at us compared in a cultural comparative way to other cultures that are having to deal with this in different ways. It seems like in this culture here in the United States, we have become so susceptible to spin on stories. And you have one piece of a story, so for example, the groups of individuals who really want to say this thing is going away, it’s getting better, will tack onto the statistic that the overall death rates from COVID-19 are appearing to decrease in terms of the rate.

Ruth Werner:

That is true.

Whitney Lowe:

And that’s what gets just promulgated extensively. Those people on the other side of the fence, they want to talk about how bad this is getting, will focus on the infection rates, it seems to be just exploding out of control right now. And so again, it becomes very difficult to know, if you’re not thinking critically and looking at a whole big picture, how to interpret the different facets of those kinds of things because each group or individual will try to spin that to their own perspective so much.

Ruth Werner:

Yeah, that’s true. And that speaks to what I was saying about we look for the narratives that support our needs. And the thing about statistics lies, damn lies, and statistics… I’ve lost my train of thought because I love that.

Til Luchau:

No, I’m with you.

Ruth Werner:

But the thing about… Oh, I know where I was going. What we read in the headlines and what we look for to read because it might suit what we want to understand, so we’re just reinforcing our echo chambers, is that we must rely on journalists to interpret the science for us. And because of the world we live in, journalists will do that in the way that writes headlines that get the most clicks. A couple of weeks ago we had two very public announcements about asymptomatic spreading that were in diametric opposition to each other. And one was from the World Health Organization that said our studies suggest that asymptomatic shedding and the ability to catch the virus from someone who has no symptoms is very low. And the Annals of Internal Medicine said something exactly the opposite. And that is just so unfairly confusing to consumers. And I’m not saying we should limit journalist or be authoritarian about what journalists are allowed to publish, not at all. But it’s that kind of thing that makes our lives really difficult.

Ruth Werner:

And I’ve had the opportunity and the honor to try to be an interpreter for some of this, with the understanding that everything comes through my personal bias about where we are with the virus and the association between freedom and responsibility that feeds into my bias a lot. But just for people who are in healthcare, it makes it very difficult for us. I want to say another thing too before we go if you don’t mind.

Til Luchau:

No go for it.

Ruth Werner:

I have another train of thought that might open up another branch here. I was on a panel yesterday and answering some questions and my panel partner was an epidemiologist and immunologist who’s doing research on COVID. So that was really exciting. And one of the questions had to do with safety and reopening and should we wait for a vaccine. And his response was don’t put your eggs in that basket. He said, “We might get to a vaccine this year, maybe it will not be widely available, it won’t be the right choice for lots and lots of people. And because of the odd ways that this virus affects immune system reactivity, it may take several vaccines in order to really have long lasting effect. And we won’t know that for a long time.”

Til Luchau:

That’s my understanding too. Even the best case scenarios are medium to longterm scenario.

Ruth Werner:

Yeah, exactly. Because we’re seeing antibody degradation, but it’s even more complicated than that. And I learned a lot, it was great. So there’s another branch of push in the medical community, which is to really work hard on finding treatment options that work. So that if someone gets sick-

Til Luchau:

How can we help people survive COVID?

Ruth Werner:

…yeah, they have a better chance of recovering. And there’s all kinds of nuance and other things that we’re not considering in this longterm effects and what are COVID survivors going to look like in 30 years who develop pulmonary fibrosis at age 40. That’s a really, really crappy disease.

Til Luchau:

And musculoskeletal conditions and neurological conditions.

Ruth Werner:

Neurological things, all kinds of things. And we have no idea what those repercussions are going to be like.

Til Luchau:

Which not to find a silver lining, but maybe it is, there’s a role for our work in the future. And the learning we need to do about the longterm effects of this virus on survivors, there’s going to be a role for us in the picture.

Ruth Werner:

And I have been working on some material about working with COVID survivors and at least in the short run, things we need to be looking out for. But certainly plans on going back to revisit that when we see what that looks like in the long run.

Til Luchau:

Well, I want to make sure we have time to talk about this idea of a new normal too. Because that’s been a phrase that’s been thrown around a lot as we get used to things as they are and as we deal with our fears and our cautions around risk and we start to think about how do I want to operate. Essentially, it’s like a new ball game and it’s a ball game that’s happening, as you’ve alluded to, in the absence of surety, there’s so much uncertainty that most of the adaptation that we do is around unknowns as opposed to things that we could fix. And I ran across this idea of hedonic adaptation that I wanted to run by you guys.

Ruth Werner:

Yeah, I’m eager to hear you explain that.

Whitney Lowe:

I’ve heard you allude to that before [crosstalk 00:35:43].

Til Luchau:

Yeah, maybe I’ve already told you about it. But it’s pretty simple, it’s the idea that we get used to things and that we return to a baseline state of happiness or a hedonic set. Irregardless of what’s happening outside of the external circumstances, we tend to gravitate toward a certain set point of happiness. And that’s good news and bad news. The good news is that when something really challenging and awful happens, like an epidemic, and eventually we find ways to make that normal. And there’s so many stories of that from life circumstances, from war, from strife, from other epidemics, from personal health crisis, where people get to a place where this is just what is and I still have a satisfying life given the scenario.

Til Luchau:

The downside is well, no, it’s the same phenomena that happens when something really good happens to us. Falling in love as the classic example, the first kiss, the first date, the first whatever has a specialness that fades because we return to that baseline of usual experience. So the good ones-

Ruth Werner:

Til.

Til Luchau:

Yeah.

Ruth Werner:

I’m sorry. But I’ll push back and say there’s a downside as well in terms of people being willing to get used to things that really they should not be getting used to.

Til Luchau:

Yeah, right. You were thinking of what? Tell me what you mean.

Ruth Werner:

Oh, let’s say, and you’ll see this argument, COVID might affect 5% of the population, it might kill 1% of those people, that’s a risk I can live with. Well, if that adds up to 800,000 to a million people in the United States dying, give me your list of who it’s okay to put in that category. That’s the thing, if it’s avoidable through the systems that are supposed to be creating structure for us to live in, then it’s an unacceptable risk.

Til Luchau:

You’re saying you don’t want people to get used to the idea of other people dying, you don’t want that to become the norm?

Ruth Werner:

Unnecessarily.

Til Luchau:

Unnecessarily.

Ruth Werner:

And in a certain way, we’ve done that with flu. So, flu kills, in a good year, 20,000 to 35,000 people, in a bad year, upwards of 60,000 people. And an early thing that we heard in this pandemic was well, flu kills more people, that’s no longer true, why aren’t we fussing about flu? And I’m fussing about flu, these are unnecessary deaths too.

Til Luchau:

Yeah, okay. So the other side of that conversation is where do you place this in the level of threat from all causes? So there’s the arguments say that economic disadvantage also causes deaths and disability and harm. And for every, I remember seeing this statistic, every 3% increase in unemployment results in a tripling of the alcoholism deaths.

Ruth Werner:

Right, alcoholism, drug abuse, domestic violence, all of these things are things that need to be weighed in balance for sure. I’m absolutely not denying that, it’s not an all or nothing kind of weight but I would say that’s not supposed to be-

Til Luchau:

[crosstalk 00:39:11]. Always Trump and if it does, how do we weigh the direct deaths from COVID infection against the follow on deaths that might happen from other course of action too?

Whitney Lowe:

And I think one of the most or one of the more challenging facets of this that Ruth you alluded to earlier too in terms of the spread and the contagion of this particular disease, and this is where something that I think we’re watching right now in the United States with the shift of cases moving towards younger people because of the increased or let’s say decrease the tolerance to staying home amongst many of these young people. And we’re talking mainly especially quite young people, meaning the college-age individuals, the 18 to 25-year-old age group. And in particular, we know that the level of cognitive development has not finished in many of these people. We just know that scientifically they don’t have the same capabilities to think complex analytical perspectives about [crosstalk 00:40:26].

Til Luchau:

I’m going to quote you to my 21-year-old son.

Whitney Lowe:

He’s not in the room. So we know that there are difficulties in seeing those kinds of perspectives. I heard this crazy story this morning about, I won’t say what state this was occurring in, but a bunch of college-aged kids having COVID-19 parties, getting together to see who’s going to get sick.

Ruth Werner:

And then there’s a cash payout or something.

Whitney Lowe:

Yeah.

Til Luchau:

Really?

Whitney Lowe:

Really.

Til Luchau:

Take a kitty for the guy that loses?

Ruth Werner:

Yeah.

Whitney Lowe:

Yeah. And so-

Til Luchau:

Well, there’s been an uptick here in Boulder from frat parties.

Whitney Lowe:

And this is the summer and is not the school learning session.

Ruth Werner:

And to be fair, this is a population of people who are less likely to die, but they are still going to hospital and they are still consuming… To be sick means to not be adding to our societal wellbeing. They may be consuming resources that, in terms of medical care, that they wouldn’t otherwise need to consume. And so we all end up paying for that in one way or another. I think it’s great that younger people usually don’t die, but that-

Til Luchau:

Doesn’t make it easier to manage as a [crosstalk 00:41:59].

Ruth Werner:

Doesn’t make it easier to manage. And it usually-

Til Luchau:

When do 21-year-olds ever make risk calculations?

Whitney Lowe:

Well, that’s the thing, they’ve been bulletproof for all kinds of things, alcohol problems and crazy things that we do at that age that are life threatening. So we know that lack of frontal lobe development has been going on for a long time and it’s had other kinds of negative impacts as well.

Til Luchau:

Two topics I want to make sure we hit on before we run out of time. How do we communicate or create or help our clients with their perception of risk in coming to us? Because like you mentioned, there’s differences, some of us are getting calls from clients who are ready to come before we are, other clients like one of my friends went to a therapist, it was open and following the guidelines, but he said he got the impression that she was watching him for cues more, the therapist was watching the client more for cues. And that she was okay either way, she could not have her mask on, she could, but she was making sure that he was comfortable, which he perceived as her not quite… Of course, then he wonders, okay, so what did she do with the last client? Did she let the last client have no mask on? It was complex questions too.

Til Luchau:

And he said, he’s been seeing her for years, my friend, the client said, “I got the sense that she’s a little bit desperate for work, that she was really willing to make it work. Which didn’t reassure me in terms of my concerns about COVID.” So what’s eyes about that?

Whitney Lowe:

This gets into something that you and I touched on in one of our previous episodes talking about the divisions in our profession about, are we a healthcare practice or are we some other facet of this? Because now, every single massage and manual therapy practitioner has to act like a healthcare professional to a significant degree, no matter where they work, no matter what they’re trying to do because they have a lot more things that they need to think about along healthcare practices than they might have thought about before.

Til Luchau:

Are you talking like even the way my hair cutter needs to act like that? Is that what you’re referring to?

Whitney Lowe:

Absolutely.

Til Luchau:

Okay.

Ruth Werner:

Oh, oh, oh. Hang on though because, well, I don’t know necessarily, but I haven’t clearly have not been to get my hair cut in several months. But estheticians, the people who are doing skincare, in many ways are way ahead of us and the good ones have been for years.

Til Luchau:

Do tell.

Ruth Werner:

Well, in terms of the way they manage hygiene and the way they manage crowding or distance or whatever. I understand this from my work with ABMP and their whole reach into the esthetician world. So that’s an interesting thing, but I will share that in the past week, I have had communications with people who are back to work, who are nervous but use the guidelines that are available and felt like the parameters in their local area were okay for them, in terms of what made them feel safe, and they describe what that was like. And by and large, people are doing fine. You learn how to work with a mask. If you’re in a place where you need to wear gloves, you learn how to use gloves. You bump the temperature down in your room because everybody’s got a little more gear on. You clear out all the chotskies from your room and that makes it easy to clean fast. And so I’ve been reading some really nice, positive, it feels so good to be back at work stories that may…

Ruth Werner:

And what I want to add to that Til, and this gets back to where we started today, which is how do you assess risk levels? There’s not a one size fits all answer to this. And so for someone living in an area where local infection rates and hospitalization rates and death rates are down and have been on a downward trend for a couple of weeks, might feel okay about opening their doors with the caveat that they may have to step away again if something weird happens. But given guidance that feels trustworthy and that is evidence-based, they feel pretty confident. And we’ve talked about the value of ritual, that the ritual of coming in and doing your hand sanitizer, maybe the therapist and the client does their hands together, the ritual of here’s the mask I’m going to give you for your time in our room together today.

Ruth Werner:

The ritual of the prescreening questions and the temperature taking, if that’s what you do, all of that helps to create the experience of being able to feel like you are being well tended. And I think that can serve us really, really well. I would love to see massage therapists take our rituals, which we may not even have noticed or realized that we had and be really more conscientious about them in terms of creating the sense of safety and care.

Til Luchau:

We do that anyway. Even before COVID, we were creating that sense of safety of receptivity, comfort, being willing to trust and relax.

Ruth Werner:

Unconditional positive regard.

Til Luchau:

Yeah. And just in their manner, but also in the whole way we set up the logistics of our practice, all these things that we thought about, talked about, worked with for years. And yeah, I like what you’re saying, this is supercharging that function into an area that’s crucial and this is a make or break situation for people.

Ruth Werner:

And it’s not going to be the right time to go that route for everybody. Right?

Til Luchau:

Yeah. I think that was my original question is one, if I accept that there’s some level of risk in going back to work, how do I work out for myself, my own level of risk tolerance? Since there’s no way to objectively assess or calculate the actual cost or benefit you could say of this action or that one, what do I do to work with my own tolerance of that risk that’s going to exist? We’ve talked about some really clear measures you said, or are we talking about the difficulty finding things to trust, but how important that is, is to find things that do make sense to us and reassure us. We’ve talked about the impact that our choices might have on our clients, how they might perceive our choices in their own level of comfort. I like what you said about ritual. Anything else you want to say about, Whitney or Ruth, about that thing, how we go back to work before I bring in our last topic that I wanted to talk about?

Whitney Lowe:

No, go ahead. I think this is a big, deep thing that we didn’t probably… We certainly don’t have an easy answers for. But it is interesting to me, in particular, to watch and try to grapple with or watch people who are grappling with this question of I’m okay… For example, at the beginning of the problem, it’s like, okay, I’ll be off work for a while, I can take that, I can deal with that. And then there comes a point at which right now, my bank account is empty. I have to take on a greater degree of risk now and go back to where I don’t want to, I’m not ready, I don’t think it’s safe, but I don’t have a choice. I have to go back and do something or whatever they’re faced with.

Whitney Lowe:

Lots of people are finding themselves, an increasing number of people are finding themselves in that boat of really having to make that decision about what risks am I willing to take. But, economics begins to, it’s like the scales begin to shift, economics begins to take a bigger perspective than it initially had because your resources are gone, the rainy day fund is gone, the borrowed money is gone, unemployment benefits are running out, or whatever it is.

Til Luchau:

That’s right.

Ruth Werner:

And in an ideal world, that would not be a major factor in making this decision, but this is the world that we live in. The other thing I want to point out is, the massage therapist I’m seeing in my head, as we’re talking about this decision making process, is a self employed person. And there’s a huge population in our field of people who don’t have the freedom to make the choice about when they go back to work. And they have only limited freedoms if, you like, about the conditions of work that they’re in.

Til Luchau:

Scheduling.

Ruth Werner:

And I’ve had communications with people who are in other health provider offices or franchises or whatever, where they have not been thrilled at the mitigations that are being used in those settings and they feel like they don’t have a lot of options and it’s heartbreaking.

Til Luchau:

It is, it’s really difficult. And a lot of these issues we could translate to the things you have to think through as a clinic owner or a spa manager, the same considerations and questions are there, maybe on a bigger scale because there’s people that you’re responsible for.

Ruth Werner:

Exactly.

Til Luchau:

So the one I want to make sure that at least we touch on is this idea of the diversity and disparity and divisiveness in our views of what is true. And again, it’s a huge topic, but that’s part of the moving ground that we’re standing upon. So we can’t even agree on what the risks are, we can’t even agree on if the measures are even needed, you could say you’re going to have clients that feel differently than you do. And we’re going to have colleagues, we have office mates, that’s another one. I got a note from someone who says my office mate isn’t wearing a mask, what should I do? So this diversity or disparity that we have between us. Do you want to say something or do you want me to share my latest thinking on that?

Ruth Werner:

I’d love to hear what you have to think, what you have to say about that.

Til Luchau:

Okay, Whitney.

Whitney Lowe:

Oh, go for it.

Til Luchau:

This came to me and I loved it, I laughed out loud. I’ve been heartbroken actually for maybe three and a half years now, maybe longer, about the divisiveness and disparity and difficulty that I have. I’ve taken it on as my own personal project to try to understand points of view outside of my personal bubble, outside of my echo chamber. And I really valued some those conversations, but there’s some point I got the opportunity to sit with the pastor of some high ups in Washington. He has a congregation in Washington DC and has government officials in his congregation. So it was an interesting opportunity to really get a sense of a different world that I’m not usually a part of and has a different political point of view.

Til Luchau:

It was so valuable, it was so eyeopening, it helped me understand things in a helpful way. And then at some point, I was like, okay, I might need to go back to Boulder now, can I just go back to my bubble for a little bit? Can I just go… This is almost too upsetting, the fact that we see things so differently. So this is what I’ve been grappling with for a while, here’s the one that made me smile the other day. I realized what if that isn’t in its nature a problem? What if that is our tradition as a country? What if that diversity, that disparity, even that divisiveness is what we’ve had from the beginning and what we’ve adapted to try to work within? This is a big one, we’re straining at the seams, we’re having some difficulty, but what if this individualism and this tension between individual freedom and collective responsibility is the very thing that we’ve been working with the whole time and the thing that our country’s built around? I felt like an instant patriot came into me.

Whitney Lowe:

Yeah, I like that perspective.

Ruth Werner:

I do too. And there’s something that’s very enriching about certainly recognizing differences of opinion and different worldviews that can make you a more full, make me at least, a more full person. Which is why I take comfort in my echo chamber, but I try to have permeable walls in it. And the question for me is as you are… I’m going down two roads here. One is, as you are trying to expand your horizons about people’s points of view, can you do that without damaging yourself? There’s a reason we avoid spending time with people who make us feel really upset. And it’s good to look at why we’re upset. For me if the why I’m upset is because I feel like this person is blind to the science and is unwilling to open their eyes to that, then I can step away from that and not feel terrible about it other than saying, God bless you, I hope things work out for you.

Til Luchau:

I’m looking for a next level, I’m with you on that, by the way. But I think… And it’s not like I want everything to be okay. It’s not a nihilism of everything’s relative at all. It’s so important to disagree and it’s so important to know. And I know that three of us are science-based and have that as a value for ourselves but there’s a way that I want to understand why other people wouldn’t and even understand that I’m going to be in the same country as them and I’m going to be neighbors with them and I’ll be in the same families as them. And so how do we go from here, even with those strong disagreements and completely different maps?

Ruth Werner:

I’m filled with admiration. I’d love to share just a little anecdote and it doesn’t even go anywhere. But my son is a paramedic, so he’s working in that field and he’s working with the police and with firefighters. And what that means is he’s working with people who are of a really different political persuasion than him. These are people who believe that COVID is a hoax or who believe that it’s not nearly as dangerous as the media makes it out to be. And his life is in their hands and so he has to figure out a way to feel okay about his partnerships, his real, deep, important partnerships with these people whose attitude about how the world works is so radically different from his. And I’m not sure I could do it. I give him all kinds of credit.

Ruth Werner:

And another place where I find this in my own life right now, Til, is I’m actually engaged in a book club we’re reading How to Be an Antiracist by Ibram Kendi and it is making me fabulously uncomfortable and I’m trying to do podcasts and consume media that show me where my tunnel vision has been, where my blinders have been. And I hate it, it’s really, really hard and I feel a responsibility as a loving human on the planet that this is my job. But boy, it is really hard.

Til Luchau:

And so then can we take that same discomfort and that same drive to the political spectrum? Could we look at diversity in a bigger sense, in the sense that we were in a country with people that are really different from us?

Ruth Werner:

Now we get into some ethical things and I don’t know how much this is going to apply to your webcast. I am completely at home with people who are politically different from me if I feel like they aren’t evil. But for people whose political difference from me manifests as a sense of white supremacy or manifests as a sense of xenophobia, that is intractable. It’s a lot harder for me to want to understand them.

Whitney Lowe:

I think that gets back to some things that we had mentioned in one of our earlier podcasts about at least the ideal distinction between academic debate and personal attacks that happens so much in the social media world. It would be great if, on all of these various different subjects, we could approach them from the perspective of academic debate of recognizing that individuals have different perspectives and different opinions, but look at the evidence and the presentation and the arguments that they present and actually really look at that and say okay, let me see if I can get in your shoes and see that from your point of view. But we have just become such a culture of divisiveness that is it seems like that becomes just almost impossible now.

Til Luchau:

That’s right. And this is Ruth, I like what you said, I like that we get to a place where we probably disagree too because the argument is not, let’s tolerate everything.

Ruth Werner:

No.

Til Luchau:

…on my side at all. It’s not like everything is okay, white supremacy, you named, for example. For me, it’s can I take the same value I have toward diversity and apply it to places that really I find objectionable or find ways that are really different ways of seeing things than I have before I go to the evil place, just because of the difference there.

Ruth Werner:

Yeah. I’d say for me it has to do with whether I feel like… I’m happy to try to be teachable if I feel like the person I’m working with is also happy to try to be teachable. And if they’re not, I am not as big hearted, I guess. I don’t know, I’m not there yet. I’m not that evolved.

Til Luchau:

No, I understand that point of view too. We’ve got to wrap it up for the day.

Ruth Werner:

Yeah. we really do. We went way down a rabbit hole.

Til Luchau:

It’s good. No, the last thing is this idea of cultural norms as our cultural immune system. So this question of trying to decide what’s okay and what’s not okay is a way that our culture tries to sort that out as well. It’s for the next discussion.

Ruth Werner:

And what’s interesting in the immune system, is essentially what the immune system does is decide who’s in and who’s out.

Til Luchau:

That’s right. [crosstalk 01:01:09].

Ruth Werner:

Who’s in the club.

Til Luchau:

All right, Whitney.

Whitney Lowe:

Well, we want to thank you, Ruth, very much for joining us today. It’s always great to have these discussions with you. And as we said, we can go on and on about this but thank you so much for your insight and insightful comments there today. And we would like to thank all of our listeners again, as always thank you so much for tuning into the show and I hope you get some interesting things out of it. You can stop by the site for show notes, transcripts, and extras over there at thethinkingpractitioner.com and Til, where can people find you on the interwebs?

Til Luchau:

advanced-trainings.com or in social media just type my name to Til Luchau. How about you, Whitney?

Whitney Lowe:

I can also be found over the academyofclinicalmassage.com and on social, under my name as well. And you can send us questions over to [email protected] We’d love to hear from you. Thank you very much for the folks that have been sending us some mail and-

Til Luchau:

Questions, love letters, hate mail, all welcome.

Whitney Lowe:

We want it all. I’m going to make a separate domain that goes to [email protected] for hate mail at the thinking Practitioner, I’ll him over.

Til Luchau:

I know how to set up a forwarder that bounces that right back at you. Thank you. Follow us on Spotify, rate us on Apple Podcasts or wherever else you listen and tell a friend about the show. Thanks, Ruth. Thanks, Whitney.

Whitney Lowe:

Absolutely.

Ruth Werner:

Hey, thanks you guys.

Whitney Lowe:

Thank you both. And we’ll do it again sometime soon I hope.

 

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