Salutogenesis, Chiropractic, and Medical Research

All I have to do these days is peek at a Facebook discussion group at 1am on a Friday morning, and, boom, I have enough content to write another blog post. The latest blistering critiques I observed involved one chiropractor poking fun at chiropractors’ use of the term “salutogenesis,” as if it was a new fad. This was responded to by comments referring to a “fringe” group in chiropractic and feigned ridicule that the term salutogenesis emerged from medical research, so there must be some paradox here.

This barely took me five minutes to read and the amount of error, illogical thinking, and shear confusion about the chiropractic paradigm was astounding. Forget about the obvious lack of any historical perspective.

Chiropractic and Medical Research

Let’s start with some perspective. The chiropractic paradigm and vertebral subluxation theory has integrated the best of medical research since the earliest days of the profession. Good science is good science. If research is undertaken that bolsters, supports, or leads to new valid hypotheses, chiropractors have always been at the forefront of integrating it. Here are a few examples.

It is well documented that D.D. Palmer was “into the literature.” In his 1910 book, Palmer demonstrated a mastery of medical textbooks on the topics of anatomy, physiology, and surgery. Historians were able to document the fact that he cited a wider range of textbooks than the average medical student of the time was required to read. He was even able to cite some earlier editions going back 200 years. His theory of neuroskeleton was a contribution to the literature on neurectasia and nerve-stretching.

In 1911, B.J. Palmer integrated the full text of a JAMA article on spinal cord tension. He included the entire article with 12 case studies of spinal cord surgery in order to expand his model of vertebral subluxation. This was so that he could account for the neurological distortions at the ends of the spine. He and his students expanded on and researched the cord pressure model well into the 1940s.

One instance of early chiropractic history is very interesting on this topic. O.G. Smith, who was D.D. Palmer’s 10th student, did extensive dissections of the IVF and intervertebral discs. He even took photos of microscopic ligamentous adhesions. Smith’s student, Harold Swanberg, wrote the first textbook on the human IVF. It was the standard work in medical schools for decades.

Other examples include the integration of Speransky’s textbook, Basis for the Theory of Medicine, throughout the profession in the 1940s, 50s, and 60s. Also, the chiropractors were amongst the first to integrate Selye’s research into subluxation theory. In fact, I concluded in a recently published research paper that it is impossible to discuss post 1950s vertebral subluxation theory without including Seyle. Homewood captured this well when he wrote,

“Selye may be said to have investigated the ‘physiology’ of stress, whereas the chiropractic profession has concerned itself with the ‘anatomy’ of stress.”

Homewood is a great example of how the integration of medical research into subluxation theory wasn’t just conducted at the “straight schools.” After all, he graduated under Budden at Western States (Budden bought Western after he left his position as dean of National), and became president of CMCC.

Another great example is the integration of Breig’s spinal cord surgery paradigm of adverse mechanical cord tension into vertebral subluxation theory. Breig’s research was integrated into the profession as early as the 1960s by Faye and in 1970s, 80s, and 90s, by several others including Joe Janse, Lowell Ward, J.D. Grostic, Donald Epstein, and William Ruch.

Salutogenesis

Is it any wonder that chiropractors are integrating salutogenisis into their models and research? I think not.

Even though Dr. Kent was writing about the term in 2002, the first time I heard it in conversation was at a lunch at John F. Kennedy University about ten years ago. My colleague and good friend, Joel Kreisberg (trained chiropractor and gifted homeopath), brought up the term when I was discussing the concept of Innate Intelligence to our mutual grad students. He said that he chose to use “salutogenesis” rather than the traditional chiropractic terminology.

I studied the term soon after and read all of the works of Antonovsky, as well as some of the more current research on the sense of coherence scale. This perspectives was included in some of the recent CVS papers.

The next time I heard the term in a public forum was an excellent presentation at IRAPS by Dr. Donofrio, Vice President for Academic Affairs at Sherman College of Chiropractic. Dr. Donofrio explained how the language and models of salutogenesis were congruent with theories put forth by Ralph Stephenson in 1927 and D.D. Palmer before him. Stephenson’s model of the momentum of health was Donofrio’s example. It was a great comparison.

Interestingly, Antonovsky used the term “dis-ease” with a hyphen in the 1970s to distinguish the philosophical approach towards the genesis of health and away from medical disease perspectives. As you may know, D.D. Palmer first coined the term “dis-ease” in an 1887 ad, when he was still a Magnetic Healer. It was at the core of his chiropractic paradigm and distinguished the overall outlook of chiropractic in respect to the pathogenic perspective of biomedicine.

The similarities to their outlooks on the creation of health are very similar. Antonovsky wrote,

“The important question, the fundamental question in scientific, humanitarian, and philosophical terms, became: How do some of these people manage to stay reasonably healthy? I was beginning to be freed from the pathogenic orientation.”

In a similar perspective, almost 80 years earlier, D.D. Palmer wrote,

“One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not. WHY? What difference was there in the two persons that caused one to have pneumonia, catarrh, typhoid, or rheumatism, while his partner, similarly situated, escaped? WHY?”

The Fringe

It is time we stop the doublespeak in the chiropractic profession. There is enough nonsense in the media these days in terms of “fake news” and the “post-truth” world. It is shear propaganda to keep shouting the same incorrect facts and expect it to catch on as a Meme or even worse, as a belief system.

It is well documented that a very small group of academic chiropractors have been stoking the fires of the chiropractic discourse, saying the same things over and over again, for years. Unfortunately, some of these things are incorrect and published in the peer reviewed literature. You know what I mean, the subluxation is not researched, philosophy is only a legal ruse, there is some divide between vitalistic and holistic thinking that cannot reconcile with science or evidence. The list goes on.

As you know, none of that is true.

The biggest lie in all of this is this idea of “the fringe” or “the minority” in the chiropractic profession. There is some research on how chiropractors think and practice. Most of it is methodologically flawed for various reasons or at the least, limited.

Interestingly, one paper noted a comparison between the views about subluxation between “All DCs” (based on a study) and a group of academic researchers surveyed at a conference. Ninety percent of “All DCs” felt chiropractic should keep the term “vertebral subluxation complex.” Only thirty-one percent of participants at the conference felt this way. Thus, we refer to the 70% of academic researchers at such conferences as, the fringe, the minority, and out of touch.

The Chiropractic Paradigm

The chiropractic paradigm, which emphasizes the correction of vertebral subluxation so that the neurologically mediated expression of health, from the body’s inherent source of intelligence, may be more fully expressed, is well supported in the medical literature. Scientific research is vital for us to establish this paradigm more fully in the literature. Salutogenesis and its Sense of Coherence Scale are important ways to move that agenda forward.

A Few References

Antonovsky A. Health, stress, and coping. San Francisco. 1979.

Antonovsky A. Unraveling the Mystery of Health-How People Manage Stress. 1987.

Antonovsky A. The structure and properties of the sense of coherence scale. Social science & medicine. 1993;36(6):725-733.

Donofrio J. Incorporating salutogenesis in a new chiropractic paradigm. Paper presented at: 9th Annual International Research and Philosophy Symposium2012; Sherman College of Chiropractic, Spartanburg.

Gaucher-Perslherbe, P., Chiropractic, an illegitimate child of science? II. De opprobira medicorum. European Journal of Chiropractic, 1986. 34(1986): p. 99-106.

Gaucher-Peslherbe P. Chiropractic: Early concepts in their historical setting. Chicago: National College of Chiropractic.; 1993.

Gaucher-Pelherbe, P., G. Wiese, and J. Donahue. Daniel David Palmer’s Medical Library: The Founder was “Into the Literature.” Chiropr Hist, 1995. 15(2): p. 63-69.

Kent, C. Salutogenesis. 2002.

Kent, C. Giving Birth to Health. Dyn Chiro 2011. 29(7).

Lindström B, Eriksson M. Salutogenesis. Journal of Epidemiology and community health. 2005;59(6):440-442.

McCoy, M., Kent, C. Vertebral Subluxation Research: An Agenda to Explore the Epidemiology of Vertebral Subluxation and the Clinical Outcomes Related to Management. A. Vert Sub. Res. Aug 5, 2013:29-32.

Rome, P. Terminology Relating to the Vertebral Subluxation Complex and the Manipulative Sciences. Part 2. Chiropr J Australia 2017;45:90-130.

Senzon, S. The Chiropractic Vertebral Subluxation Part 3: Complexity and Identity From 1908 to 1915. J Chiropr Humanit 2018;25C:36-51.

Senzon, S. The Chiropractic Vertebral Subluxation Part 5: The First Research Era From 1928 to 1949. J Chiropr Humanit 2018;25C:67-85.

Senzon, S. The Chiropractic Vertebral Subluxation Part 7: Technics and Models From 1962 to 1980. J Chiropr Humanit 2018;25C:99-113.

Smith D. Functional salutogenic mechanisms of the brain. Perspectives in biology and medicine. 2002;45(3):319-328.

Triano, J., Goertz, C., Weeks, J., et al. Chiropractic in North America: Toward a Strategic Plan for Professional Renewal-Outcomes from the 2006 Chiropractic Strategic Planning Conference..J Manipulative Physiol Ther 2010;33:395-405.