Chiropractors struggle with change

Dr. J Ronald Carter, DC, Calgary, Alberta

Whoever is stiff and inflexible is a disciple of death.

Whoever is soft and yielding is a disciple of life.

–Tao te Ching. No 76

Isn’t it amazing, that for more than one hundred years, chiropractors have struggled and become divided over change? Each chiropractor is seeking an identity between an all encompassing concept, perpetuated by loyalty, and left to them by the founder in 1895 or the contemporary, comprehensive approach that is current with today’s values of acceptance. This one hundred year struggle is better understood by knowing that one of the major historical obstacles blocking change is that this profession is, and always has been, paralyzed with fear. This deep fear has alienated the profession from the mainstream of science and limited it’s role in health care programs. Fear has divided individual chiropractors into a fear triad with groups adhering to identifiable labels of fighters, flighters or freezers. Struggling with change and the related fears can provoke an individual to dig in and hold or else quickly become adaptable and find suitable alternatives. The fear of change and challenge may best be seen in the following story that illustrates the chiropractic scenario well.

Phillip Yancey, in one of his nine Medallion award-winning books, tells this simple story; where he relates to us an experience from his college days. He and several of his classmates, all from the mid west, were attending university in a coastal city in Florida. As students, they needed inexpensive housing. This led them to live on an old houseboat. One particular day, storm warnings of an impending hurricane were issued. Phil and his friends prepared for the storm. The old boat was tied with every available cable and rope. Lines went to the dock, to trees and to whatever else might anchor the boat through the storm. The boat began to look like a fly caught in a spider’s web. Then, an old sailor walking on the beach stopped and said to them, “you boys have done about everything possible to assure the old boat will sink when the storm arrives.” Surprised, the inquiring boys questioned what the right approach might be. The sailor advised them that the boat should be taken out in the bay where a number of anchors could be dropped, and the houseboat would likely survive the storm.

This story speaks of change, changing our thinking, and about where we drop our anchors. Chiropractors, tied to tradition are fearful of change and are fearful of any accusations suggesting that they are ‘being unfaithful to the founding principles’. Their commitment to a single belief ties them to the dock rather than trusting the open waters and using a variety of available anchors. Their hopes are, that despite their fears and desperate struggles, they will successfully survive the storm. This may not be reality. Observers have noted this commitment to traditions of the past is so strong that they would likely allow a ship to sink just to prove that the deck chairs float. It is all a question about timing.

Few things in life do more harm than a single fixed idea. It is time that chiropractors examine the basis of their struggles. The fixed ‘single chiropractic concept’ that some struggle to keep alive has for them unfortunately past on, as has bloodletting, the wooden teeth and the Flat Earth Society. The World Chiropractic Alliance (WCA) Web Site claims; “to serve as watchdogs and to advocate for the subluxation-based chiropractors, the traditionalists anchored to the dock. The WCA claims to be able to take swift and decisive action when threats to the “philosophy based chiropractors” are detected whether they come from outside or inside the profession. They claim to share many important beliefs and principles with B. J Palmer, the son of the founder, including the tendency to be passionate and opinionated about issues.”¹ All chiropractors, at sometime in their lives, have worn the ‘freezer label of fear’. Each chiropractor has, some for short periods others for a lifetime, held to obsolete concepts that lack evidence or any real proof but each still insists on holding onto them. If a chiropractor wishes to be a part of this traditional subluxation group it requires a committed belief that chiropractic is above science and chiropractic is not required to provide empirical evidence. One would and must discount epistemology, which makes the struggle to be a chiropractor most difficult without the support of evidence-based science.

“Epistemology is the branch of philosophy that deals with the nature of knowledge, ways we know, ways in which we justify our conclusions and behaviors. The several conflicting epistemologies listed by Keating as adapted by chiropractors are:

1. Clinical science methods. This way of justifying your knowledge base and claims make use of deductive reasoning.

2. Uncritical rationalism. This validity of your theories and the effectiveness of clinical interventions are justified by consistency with some prior major premise or assumption. An example of this is Stephen’s 33 Principles premises about universal intelligence, postulated in 1927, and all based on challengeable major premises.

3. Uncritical empiricism. Cause and effect relationships in clinical practice, and conclusion about the value of chiropractic, are consider validated by unpublished, unsystematic and/or uncontrolled data. (Chiropractic works for patients because he didn’t come back and must have gotten better.)

4. Other fallacious reasoning. “Among these are appeal to authority (e.g. we know upper cervical adjusting works because B. J. Palmer said so) and illogical reasoning (e.g. we know chiropractic works because it has never been disproved.)”²

We choose are own battles and struggles through our beliefs. “D. D. Palmer, the founder of chiropractic, claimed that a Dr. Jim Anderson, a medical physician who died a number of years earlier, revealed the principles of chiropractic to him through a vision.³ Is this good science or a belief you hold to?

Some chiropractors believe that the ownership of the chiropractic principles belongs to chiropractic and come to us through our heritage. It was a gift given to us and no one else. Extreme thinking like this would dictate: Henry Ford created the first assembly line automobile and left his estate to his family, which, allowed only Ford’s descendants to produce assembly line cars. Does this make sense? If chiropractic science belongs to anyone it is the public, at best, chiropractors are only the guardians of the profession. To struggle to own something that is not yours to own is a questionable quest. To nurture its’ growth is a worthy endeavor.

In the text, Chiropractic Principles and Practice 3rd edition, University President, Reed Phillips provides a credible space, a new vision, for chiropractic. Phillips, Keating, Haldeman along with the 55 other contributors to this text will be the individuals in whom the chiropractic profession can begin to place their trust. In keeping with the hurricane story, these individuals will drop the many anchors from the boat, allowing it to survive in the open waters. This vision diminishes many of the fears of change.

“Phillips’ bottom line, attractive to me and the unifying in the profession, is that chiropractic should occupy the large and credible middle space between absolute vitalism and materialism, rather than being dogmatic for or against the absolute importance of either. The profession must espouse and explore reductionistic and holistic principles in its research and practice”.⁴

Ian Coulter, a former chiropractic college president and a chiropractic researcher for more than 30 years, delivers an important message to chiropractors today. Coulter notes that in today’s health care world, no particular element of chiropractic care is unique to chiropractic –neither philosophy, treatment methods nor conditions presented by the patient. He strongly suggests, “The uniqueness therefore must be located not in a single element of the encounter, but in all the elements taken together – the totality of the chiropractic health encounter”.⁵ The challenge is to struggle to be the best at perfecting those elements with a chiropractic encounter.

The exclusiveness of chiropractic philosophy, the all-encompassing concept of subluxation, and those early authority figures today are illusions in our minds. Being tied to one spot will certainly assure the final demise and extinction of chiropractic. “Whoever is stiff and inflexible is a disciple of death. Who ever is soft and yielding is a disciple of life.” (Tao te Ching No 76) The contemporary model of today is lacking. It was based on being a player on the health care team and providing those unique services to patients that no one else provided. It is comparable to making the football team only to be left sitting on the bench. The team agrees you should be on the team but no one knows what plays you should be sent in for, so you are left sitting on the bench.

Different struggles will continue to challenge chiropractic with the multiple anchors of chiropractic, which will form a new chiropractic paradigm. Scott Haldeman, editor of, Principles and Practice of Chiropractic, 3rd edition, 2005, includes 58 chapters of contributions from noted scientists. Haldeman explained how the chiropractic profession has grown and matured greatly since 1980⁶. In the text, historians explain that the history of spinal manipulation demonstrates that both chiropractic and osteopathy were part of a natural evolution. It may not have all started with vision revealed to D. D. Palmer.

Chiropractic has one outstanding chiropractic historian, Joseph Keating. He contributes to this text, with explanations that are helpful in understanding the problems that have prevented the profession ‘from achieving the culture authority for which it thirsts’ – that place where all chiropractors would choose to be.⁷

There are a few remaining chiropractors who believe that chiropractic can still continue to shape it’s own future as it has in the past. This is no longer a defensible position and their beliefs deter the profession from moving forward. Great wisdom is gained when looking at chiropractic through the informed eyes of someone outside the profession. R. A. Cooper, a dean of medicine, a leader in alternative care and a director of a multi-discipline clinic, speaks to chiropractors with clarity and honesty. His research findings, Chiropractic in the United States, dispel any illusion that either the traditionalists or contemporaries will resolve the hundred-year struggle. Cooper tells us,” that for previous decades, chiropractors did not want their profession to be considered as a form of medicine (Silver 1980). Even now, many chiropractors see themselves as practitioners of a distinct art. The critical point happened when the chiropractors crossed the chasm into the reimbursed world of health care. It was then, that they had to prove their quality, their effectiveness and their value. The profession is buttressed by satisfied patients, by sympathetic politicians and by the general longing for anyone who will listen and be supportive. But as our aging nation struggles to define the health care system that it can afford, it is uncertain whether this will be enough. The financial future of the profession is uncertain”.⁸ Unknowingly, this profession may have sold its rights when accepting what they expected was life long reimbursement for their services. The old adage, ‘you can only sell something once’ has become very meaningful. Some don’t realize this and continue to struggle for the model of the past.

The chiropractor’s fear of change is not too difficult to understand. During the early 70’s, Ian Coulter introduced concepts and paradigms of T. S. Kuhn to the chiropractors. For the first time chiropractors began to see who they are. We looked again to the wisdom of Kuhn to give us insights into the capacity of human beings to stick to points of view against all evidence. Kuhn stated; “that whatever a person has believed through the years becomes fixed, permanent, and unshakable, it is defended all the more strongly as the contrary evidence becomes greater. When anyone feels threatened, he or she will bring into play all the resources and skills to defend the belief.⁹

The nature of most chiropractors is to defend rather than to debate. Each chiropractor is caught up in the tendency to stick to a point of view. Carlos Valles, a priest and a scholar, could well be speaking to chiropractors when he explained fear and resistance associated with change. “The reluctance we all feel when there is a question of giving up customs, attitudes, or beliefs that have lost their value but that we continue to treasure and cling to because we feel more comfortable in the old routines, are lazy enough to avoid having to try anything new, need to adjust to the way of thinking and acting of the group we belong to in order to feel accepted, and are afraid of punishment that will ensue if we abandon tradition and embrace novelties. This reluctance, I believe and defend must be brought to light, must be looked at in the face, must be confronted squarely in order to decide later in a clear conscience and explicit determination whether we want to carry on with our practices, whatever the reason for or against it, whether we choose, rather, to change our attitude and face the consequence.”¹⁰ The first obstacle for the chiropractors to overcome is their struggles with learning to listen and learning to hear.

When we begin to understand the difficulty to change, we begin to understand the struggles of the chiropractors. The old identity issues that divided the profession for so many years are now non-existent. There is no choice left to make. The traditional philosophy and subluxation theories are no longer unique. The contemporary model is too narrow. A new paradigm is required. We live in a new era where evidence, where standards, where acceptability become the only remaining option for an assured future. Neither side of the hundred-year-struggle won nor lost. The profession has evolved and with it new challenges need to be met. Many of our traditions, our history and our misguided trusts should be put on the shelf to be viewed on occasion as reminders of how far we have come.