Healing by Intention
By Gerard Clum, D.C.
Many years ago, while on the faculty of Life Chiropractic College I was assigned
to teach an introductory course titled “The Fundamentals of Pathology.”
The course was just that, the fundamentals, but what many people miss when approaching
the subject is that the fundamentals are the framework on which all the various
oddities of illness are hung. Conditions may vary by tissue involved but the
overall processes involved are remarkably similar.
During a presentation on wound healing I was, in my mind, taken back to my days
at Palmer when, rather than teaching a similar course, I was trying to pass
the course! An idea that struck me as odd from the first time I heard it was
the concept of “healing by first intention.” It seemed like an unusual
way to phrase something associated with wound repair. In the years since then,
the precise details of the repair process have gotten a bit fuzzier in my memory,
while the aspect of “intention” as it relates to living and healing
has become more focused.
Over the years I have had students who, for one reason or another, needed a
special project or assignment to make up for some deficiency or problem. On
occasion I would ask the more inquisitive ones to search for an origin to the
concept of “healing by first intention.” More often than not I got
back a detailed discussion of the healing process when what I was really in
search of was the origin of the language “by first intention” and
how the concept of “intention” came to be applied to wound healing.
The closest I have gotten to a meaningful answer came recently from a student
who went to the Oxford English Dictionary. In the OED it was defined as “the
concept came from a primary concept, formed by the direct application of the
mind to the thing itself.”
“The direct application of the mind to the thing itself” is first
intention. It is curious that the type of healing typified in healing by first
intention, or per primam intentionem, is neat, clean and without granulation
tissue-efficient and effective healing. Healing that is accomplished by the
direct application of the mind to the thing itself.
Over the years I have watched thousands of students begin the education and
training that led to being awarded a Doctor of Chiropractic degree. It has been
interesting and puzzling to watch those students in the classroom, in the clinic
and then in their offices. Students who were exposed to the exact same lectures,
completed the exact same laboratory experiences and were taught the exact same
adjusting experiences emerged as far apart conceptually and clinically as could
possibly be imagined. How could it be? If the building blocks given to them
were all the same why didn’t they conceive, construct and utilize their
“building” in exactly the same fashion? It isn’t the details
of the processes or the raw materials that define the outcome—it appears
that it is the application of the mind to the thing itself that shapes and creates
the end result.
Virtually every chiropractor I meet wishes something about the profession was
profoundly different. “Clinical approaches are all over the map-they should
be standardized, catalogued and systematically applied,” say some. The
next group says that the “clinical approaches are secondary to the conceptual
models that are the prime shapers of the profession”. Others suggest,
“conceptual models and clinical approaches are things that come and go.
What we really need is a cohesive political basis from which to function”.
When we stop to think about it, “intention” is very important to
us as individuals and as a society. On an individual level when we are offended
by the actions of another, that offense takes on far greater significance if
we conclude that the person intended to harm us in some. Similarly, on a societal
level we value intention at the most pivotal points in our system of justice.
A person who is found guilty of causing the death of another will suffer various
consequences if the matter was an accident, a crime of passion or premeditated
– an intended—act. Intention is a key concern of human nature but
also an aspect of human nature to which too little emphasis is offered.
The issue of intention—first intention, the process of applying the mind
to the thing itself—seems to be an important lynchpin associated with
understanding where we are as individuals, where we are as a discipline and
where we are as a profession. Furthermore it is an understanding of intention
that yields insights into why people behave as they do. The behavior itself,
removed from the intention, may seem absolutely nonsensical, but when viewed
within the context of the intention of the party or parties involved it begins
to make more sense.
As a group of people, with an interest in a particular subject, it appears that
while we have developed many strategies to apply to our discipline, we have
articulated our intent far less thoroughly than our strategies.
Our poorly defined intent is perhaps at the root of our present situation relative
to public perception of being associated with low back problems and musculoskeletal
pain. Did we make a strategic error – decades ago – for economic
reasons, social acceptance reasons, to avoid conflict, as a foot-in-the door
approach? Are we now suffering from the angst associated with realizing that
the greater contribution of the chiropractor and chiropractic care is being
overlooked or truncated as a result of this strategic error? Is that strategic
error why we are angered when we see approaches such as homeopathy or acupuncture
being more widely accepted and the appreciation of what we do being undervalued?
Was our intent to simply survive – not an unreasonable intent, I might
add! If that was the case is it now time to clarify our intention? Is it time
to see that greater good can now be served by altering our intentions and as
a result the strategies to see those intentions fulfilled?
We tend to find what we are looking for in life. Our experience tells us this
is so. Our researchers have indicated that this is so. Do we as individuals
and as a profession need to start looking for something different?
It appears that we are developing all forms of strategies to deal with the demands
of the moment. Some wish to clarify our identity, some wish to divide the profession
into multiple tiers, some wish to be fully embraced within the existing structures,
some wish to extricate themselves from all of the existing structures, some
wish to retire, some wish to change careers. These are all reasonable strategies
depending on the intention behind the action.
In the spirit of the ecology movement and the mantra of “thinking globally
and acting locally” it is clear that none of us can change the behavior
of the other. We can appeal to the matters that others hold important and in
doing so hope they will change their behavior, usually to be more along the
lines of our own. In the final analysis, “acting locally” means
each of us exploring what it is we want to accomplish through our efforts in
this life with the vehicle of chiropractic.
Is it too uncomfortable to entertain the idea that the present and historic
problems in and around the chiropractic profession are the products of knee-jerk
reactions produced by the lack of clarity about our intent—personally
and professionally? Do we as a community need to develop a clear and focused
intent about what we want to accomplish – following which the unessential
is abandoned, the essential clarified and magnified and the method of fulfilling
the intent is simply a matter of creativity.
Healing by first intention – by applying the mind to the thing itself
– may yield the neat clean, efficient and effective healing we would all
hope to see. The present course of action has not seemed to yield the outcomes
and advances we desire. Our repetition of the exercise with the expectation
of a different outcome does not seem very bright. If we examine the intention
we each bring to our professional activities, then perhaps we can change our
thinking from the level that yielded the current problems to a level that will
allow us to solve those problems and create others.
About the author: Gerard Clum, D.C., is the President of Life Chiropractic
College West in Hayward, California.
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