What´s Behind Treatment? Essence and Context – Deepening our Perspective of the Shiatsu Project (Paul Lundberg)

Dear Colleagues, In the Autumn of 2005, Shiatsu Society News, our UK journal, published my “Open Letter to the Profession”. This was a rather lengthy reflection on the history and development of shiatsu as a profession in the United Kingdom. Its purpose was to question whether our professional outlook and especially our training standards have kept pace with the expanded range of applications and uses of shiatsu in our society, as well as the external image of shiatsu held by both the general public and other health professionals. I suggested that while we have done well in terms of regulating and promoting ourselves professionally, we have not been sufficiently bold, conscientious or creative in reassessing and developing shiatsu education, and so we have been disadvantaged in our approaches to government and other regulating bodies.

Although we have a good basic training, it is very general and should be seen as the minimum for any therapeutic work. Many graduates lack confidence due to inadequate grasp of even basic Oriental Medical diagnostic and treatment principles, because we have not allowed ourselves time for thorough comparative studies and so have not developed the required depth in our second and third generation teachers. A competitive commercial atmosphere among individual schools has not only limited opportunities for expansion, it has fostered an emphasis on, and development of, particular styles and methods which, if followed exclusively, narrow our horizons and move us away from a centred and confident position within the field of Traditional Eastern Medicine. The more serious consequence of all this is that we, as a body of practitioners, lack weight and confidence in negotiating our position, with government regulators etc., beside other professional bodies.

I pleaded that a review was urgently required to address the following: firstly, the discrepancy between current training standards and the needs of our graduates who wish to practise in a clinical medical context; secondly, the unfavourable comparison between the length of our average training and that of other “serious” alternative medical professions; thirdly, the possibility of more flexible, two-tiered training models, that respect the existing standards as adequate for many people’s needs and intentions, but which additionally permit more in-depth development with specified purposes and pathways, defined post-graduate options and appropriate qualifications. I outlined quite specific proposals regarding curriculum content at each level, but I do not think it necessary to repeat those here.

It is sufficient to say that this letter produced a considerable response, mostly in agreement with its basic arguments. In our Shiatsu Society the current board of directors have said that they will conduct a review, and in the Shiatsu College of which I was a co-founder there is a lively debate on new training initiatives.

I also wrote that this provided a good motive for renewed discussions and co-operation with our European colleagues who, even if working in different phases and circumstances, I felt sure would share an understanding and an interest in these important issues.

I have felt for a long time that we should look again at our basic situation, but it was indeed the experience of attending the first European Shiatsu Congress in Kiental that helped me focus on these questions. There I saw the potential that we have at the height of the profession and, equally clearly, how we must work to recycle this experience and nourish the roots of our professional training.

With all best wishes, Paul Lundberg.

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The accompanying article represents some further thinking regarding the parameters of our work. It treats the same theme as the letter but in a very different way. It examines the significance of contextual factors and the corresponding need for clear objectives at every stage of study and practice, concluding with a summary of what, in my view, are the unique and essential qualities that the shiatsu tradition holds for us and for the benefit of our society today. It was written as part of a “manifesto” for a Shiatsu Workshop in Wales this Summer with Carola Beresford Cook – a kind of celebration as we’ve been colleagues for twenty years.

If we were to ask ourselves “What is the essence of Shiatsu?“ we would surely come up with a variety of answers, but the word “essence” suggests that we must look deeply, penetrate to the core of the subject. Essence, in Chinese Medicine also has its particular significance. It is thought of as the primordial substance, the yin aspect of Qi, by which living things grow and develop; that is the material basis on which something is built. But Yin-yang law tells us that we should be careful because if we look too deeply, what we are looking at will disappear or become its opposite. In any case our perspective will determine the result, so we must be aware of our intentions, our position and point of view as well.

I might begin by saying that that the essence of shiatsu is treatment, and the essence of this treatment is touch. But we touch in many ways, so what is the essence of this touch? Shiatsu says this is finger pressure; Masunaga said this is a stationary, perpendicular, penetrating pressure that contacts our Ki and is based in Hara. But what is Ki, and what is Hara? We will need to look out as well as in to make any sense of this at all. We need to see the context. For this reason I want to examine context, not as a means of clarifying the “Essence” that according to TCM forms human beings, but the essence of Shiatsu itself and what makes it useful in the world.

Treatment is a term used throughout the medical, therapeutic and health professions, but also in the hairdressing, beauty, automobile and building trades, as well as in agriculture. It needs to be carefully considered to determine the exact nature of what is being offered in each case.

Shiatsu emerged in the context of traditional medicine in Japan in an effort to define related treatment aims more closely and to avoid the somewhat degraded popular uses and attitudes accorded to Anma, the established form of massage. Yet, in its short trajectory through the second half of the twentieth century and its spread through the Western world, the reputation and uses of Shiatsu have also become so widely dispersed that, arguably, it could be in a similar position to that of Anma a century before. (A corresponding dilemma has existed in relation to massage in many societies). Those of us who wish to preserve its status as a respected therapeutic modality need to question our own perception and understanding of what it is we do, or want to do, under this simple banner; where Shiatsu fits in the broader tradition of Oriental Medicine and Healing, and whether we can then clarify what is on offer, both to the public and to colleagues in related fields. We need to grapple a bit with the terms and conditions of the “New Age”, “Alternative” and “complementary” bandwagons to determine our position in the mainstream.

Shiatsu is a treatment that uses a wide range of techniques, any of which may be adapted to a variety of ends. So it is used for relaxation and pleasure, to generally ease pain, tension and tiredness and it may be offered by call-girls or rent-boys, as a pretext or as part of their service. It can be taught at an amateur level for people to use at home, treating their children and sharing with loved ones; equally it could form part of a beautician training and be given as part of any salon treatment programme or on visiting a good hairdresser; likewise with professional training it may be offered with various degrees of specialism in bona fide health centres, hospitals and clinics as a tried and tested medical therapy.

What is it then that makes the difference? It is not only a question of the refined physical skills and manual dexterity that we develop through training and practice, though these are important. It is as much a question of personal intent that leads us on with more or less integrity. Plainly, the degree to which we are prepared to study the related Oriental and modern traditions of medicine and healing, and integrate that knowledge with our acquired technical skills, will determine our fitness to practise the art in the context of our choosing, if medicine it is.

By this I want to say two things. Firstly that I think it important that Shiatsu Therapy (originally Shiatsu Ryoho) is seen and taught with the widest possible references, both to the Japanese and Chinese medical healing tradition from which it grew and to the contemporary range of clinical applications in which it can be applied. Secondly, I do not think that to focus on any narrow or single track training, even a specialism in shiatsu alone, let alone any of the many “styles” or types of shiatsu that have emerged, serves us very well as a profession. We would do better to maintain our shiatsu along with all its associated therapeutic techniques within the nourishing stream of the whole tradition, and to develop it respectfully in that context. If anything, Shiatsu itself is already too isolated from its roots and we should be all the more wary of the contemporary trend to develop and market new, improved and individual styles or methods of treatment, a trend that has generally resulted in a proliferation of bodywork and other therapists whose walls are covered with minor certificates but whose work lacks depth, range and continuity.

Now it is clearer that “context” as an aspect of what we do will always merit attention. If more consideration were given to the context in which it was intended that our work be focussed, and the reasons for aspiring to such work were brought out and aired, then decisions would be easier. Some people could avoid unnecessary stress and expense, choosing a more modest goal, and others might be encouraged to find the motivation and confidence necessary to pursue a longer and more demanding training. If we wish to understand and to justify the application of shiatsu techniques for the many and varied purposes listed above, we have only to recognise the different circumstantial needs that exist. Then we should make our own intentions plain and prepare ourselves well enough for our abilities and intentions to be recognised.

We should also consider the context of the treatment itself – an understanding, or a contract if you like, between two parties. The expectations of the client will have much to do with the nature of the offer. If this is not explicit then the client, or patient, will be left to imagine the limits and make the best use of it they can. But there must be some correspondence with the client’s needs for the process to have any validity.

If we advertise our shiatsu in a way that suggests particular therapeutic benefits then we should be able to answer to those needs and prepared for an ongoing, reflective and negotiable process. If we say there is an educational element to our work, then that permits another type of exchange that will be expected to move the client’s position to new skills and confidence over time. The more we couch our work in a medical context, the more we invite our patients to trust us with medical problems and the more it is our responsibility to deal with those problems as a priority. We may introduce deeper, therapeutic or educational elements later, if this is appropriate and agreed.

If we explicitly recognise the possibilities and limits of amateur or “home treatment” we can also develop this important aspect of the Shiatsu tradition.

The context will have further strong external or physical components – working in a hospital clinic, a health centre alongside doctors or other health professionals, will convey a different message from that given by a spa, beauty treatment centre, or a “new age” establishment that has gemstone therapy, Tarot readings and suchlike. I am not making value judgements here. I am saying that it is we who must determine the level at which we want to work and that healing extends across a vast terrain that we ourselves must explore before offering guidance to others. For this we need integrity and commitment – to ourselves as well as to the other people with whom we live and work.

We may want to develop shiatsu as a bodywork therapy that releases energy blocked through psychic or emotional suppression and helps people to access and integrate their feelings, but we would still need the experience of substantial training in both Oriental and Western disciplines to be able to authentically offer that in the public domain. If we see shiatsu above all as a most accessible form of relaxing, energy based “massage”, of general benefit to everybody, we can do a basic training and take our work where we like.

In all the senses so far discussed, we could see “context” as providing, or at least strongly implying, one half of the guarantee, as it were; the substance or essence of our skill obviously forms the other half.

But beyond this there is one last important contextual consideration, the internal condition of the client. The background givens of a person are so pervasive, yet their dimensions so intangible, that we might just miss the grand implication, even while we conscientiously pursue the diagnostic threads that lead to a more efficacious outcome. It is this: that in fact the receiver’s mind-body state will most determine the results of treatment. So strong are the natural self-healing forces, for one part, and sub-conscious regulating or inhibiting factors for another, that the treatment we give has less to do with the outcomes than we might think, or want to think from our ego’s point of view, though we address ourselves to the client in the most perceptive, holistic way. Even routine treatment will bring to a hundred different people, a hundred possibly quite different benefits over a range from insignificant to near miraculous. This could be a discouraging realisation and we could ask ourselves, “why study diagnosis and specific therapeutic strategies at all?”. The answer of course is that we should study and practise all the more to make what extra difference we can; and further, highly trained or not, we will always be of more use to others when we proceed in a humble spirit and respect their integrity.

So, what could our reasons be for studying Shiatsu, essentially?

When all is said and done, Shiatsu remains a Japanese word and that suggests a Japanese basis. Without that we are in a different frame completely. Perhaps, then, it is important for us to ask why we need the Oriental model. Plenty that is good and valid can be found in our own or in other non-oriental cultures. What does Shiatsu imply that is of such essential value that we cannot ignore it, bear to pass it over or expect to find its equivalent elsewhere? For me there are three parts to the answer.

A summary of the “contextual essence” of Shiatsu

  • From the Taoist and Naturalist schools in China and via Shinto and Zen in Japan, the Oriental tradition that gave rise to Shiatsu conveys a philosophical outlook that is holistic and never separated man from nature, body from mind, inside from outside or science from art to the extent that we have seen in the West, and which therefore offers a different spiritual vision.
  • Shiatsu, though its name only implies a simple range of techniques, is associated with a sophisticated system of empirical medicine and health-care. We can therefore draw on the unique vitalistic theories, energy mapping, and regulating techniques of the Eastern medical tradition to inform and guide our work with our fellow humans (and animals as well) from the grossly physical to the most subtle and refined of considerations.
  • Shiatsu pertains to a tradition of physical, mental, aesthetic and life disciplines that extends broadly through Eastern culture. The notion of harmony in relation to the alignment of subtle centres within the body is a fundamental of Chinese medicine also found in Taoist meditation practices, Tai Chi, the “Inner School” martial arts and Qigong.

In Japan these philosophical and practical elements were typically refined through the culture of Hara. Mental concentration, integrated awareness of posture and movement, elegance, economy and simplicity, are elements of creative mastery that run deeply through all modes of Japanese cultural expression. They are also the attributes of a way of spiritual power for which Hara is the focus. Connecting medicine and health, expressive arts and crafts, life ceremony and celebration, the Japanese Hara tradition contributes uniquely to the development of human potential and brings to shiatsu essential qualities without which it is a less authentic and weaker offering altogether.

In conclusion then, I think it is perfectly possible and valid to study and practice shiatsu in its most humble forms, as a simple way of healing, also to aspire to its more sophisticated uses and applications in medicine. But it is really defined by the third of our considerations above. With Hara, what we are talking about is essentially Shiatsu and without it, its not. If we want to develop it, let’s recognise and study the true nature of its extensive background. Then we can decide what we can authentically add from our own understanding.


© Paul Lundberg began his studies of Shiatsu in 1974, and of Acupuncture in the following year, graduating from The International College of Oriental Medicine in 1978. His interest in Taiji and Qigong dates from this same period. During more than twenty five years of practising and teaching these subjects he has studied continually both Chinese and Japanese healing systems and related contemporary Western psycho-physical dynamic therapies, working with many internationally respected masters. In particular, he has long been associated as a student and collaborator with Akinobu Kishi. Since 1981, when he first went to Japan to study Shinto healing and Seiki with Kishi, he has been concerned with integrating the vision and practice of Seiki into his own work. Co-founder of The Shiatsu College, UK (London, 1986), he later established a branch of the College in Brighton of which he was the director for five years. He is the author of The Book of Shiatsu (I992/2003), now published in twelve languages. He currently lives most of the year in Tenerife where he spends much of his time writing. He continues to teach courses and seminars in the UK., Spain and other European countries.