Vitalism and Structuralism: Two Sides of the Same Coin?

This post is a little philosophical, so I will apologize in advance and keep it mercifully short.

There are many ideas in manual therapy. Some are good, some are not so good. The subject of this post is ideas that are very obviously not good, but for some reason attractive, even in the face of good evidence of their wrongness.

These ideas seem to pop up everywhere, in different therapies that have different origins, like a weed that grows in any garden and always needs to be pulled. I will group these weeds into two basic patterns of thinking, and then reveal a deep philosophical connection between them. Try to control your excitement!


The first pattern is thinking of the body as a mindless piece of meat, while ignoring the brain’s role in giving the body all the qualities we actually care about, like how it moves and feels. This leads to treatment approaches that ignore the nervous system and focus exclusively on issues in the tissues. Eyal Lederman calls this the “postural structural model.” Paul Ingraham calls it structuralism, and Diane Jacobs calls it mesodermalism. I sometimes call it “all hardware no software.” Many physical therapists have expressed a lot of frustration that education for PTs remains mired in structuralism, and fails to incorporate new and interesting information from neuroscience and pain science.


A second common belief that is resistant to conflicting evidence (especially among massage therapists) is that clients can be treated with “energy” work. There are many different forms of this idea, but all embrace the philosophy of vitalism – the idea there is some essential force or energy (chi, prana, elan vital, the breath of life) that is unique to life, and that can be manipulated by a therapist to optimize health.

The belief in vital energy persists even in the face of massive evidence against its existence. Despite hundreds of years of looking, vital energy has never been discovered. And its discovery would be the most profound and shocking development in the history of science, requiring a major overhaul of physics, chemistry and biology. But  this stuff is routinely taught at massage schools, alternative medicine schools, and even universities.

Are we born dualists?

I have always wondered whether the tendency to think in structuralist or vitalist terms is due to some deep seated bias built into our thinking. So I was very excited to read a great quote the other day by Paul Bloom that helps explain the prevalence of both patterns of flawed thinking in one sentence.

Bloom’s quote is from this article, where he is attempting to explain why humans are very predisposed to create magical or supernatural explanations for observed phenomena.

According to Bloom, humans evolved separate cognitive mechanisms for understanding the physical behavior of inanimate objects, and the intentional acts of agents such as animals or humans. So humans have a built in hardwired intuitive sense of physics, and a completely separate intuitive sense of psychology:

[T]he separateness of these two mechanisms, one for understanding the physical world and one for understanding the social world, gives rise to a duality of experience. We experience the world of material things as separate from the world of goals and desires. The biggest consequence has to do with the way we think of ourselves and others. We are dualists; it seems intuitively obvious that a physical body and a conscious entity—a mind or soul—are genuinely distinct. We don’t feel that we are our bodies. Rather, we feel that we occupy them, we possess them, we own them.

And this means that:

we perceive the world of objects as essentially separate from the world of minds, making it possible for us to envision soulless bodies and bodiless souls.

This is a great description of why vitalism and structuralism are two sides of the same dualistic coin. Vitalism is essentially the belief in a “bodiless soul”: an animating force that exists outside the physical realm and is not reducible to it. And structuralism is the metaphorical flip side of the coin – the tendency to treat the body as a physical object, as opposed to an intelligent agent with feelings, thoughts and intentions.

For example, if we place our attention on correcting the biomechanics of a certain joint, we necessarily activate our intuitive sense of physics, which will tend to forget that the foot is animated by intelligence and intention. In this frame of mind, joint stiffness is the simple consequence of physically tight muscles, as opposed to an intelligent decision by the nervous system to protect the joint from perceived threat related to movement.

On the other side of the coin, when we place our attention on correcting the client’s conscious experience of suffering, we can’t help but activate our intuitive sense of psychology, which imagines a realm that is nonmaterial and outside the laws of physics. This frame of mind ignores neuroscience, which understands that conscious states are not determined by nonmaterial energies, but very real physical states of the brain, which can be predictably altered by subtle inputs.

You know what I like about Bloom’s way of looking at things? Both patterns of flawed thinking are cured by studying neuroscience and pain science. I think the reason we find these subjects so confusing, fascinating and illuminating is that they provide a way to understand how body is linked to mind, how psychology relates to physics, and to correct our natural tendency towards cognitive errors related to dualism.

There is a lot more I am tempted to say here, but I promised I would make this short, so I will leave it at that.

What do you think? Leave a comment and let me know. (But I reserve the right to not follow any comments that go too deep.)


If you enjoyed this post, here are some related posts on this blog:

Is the Mind Body Connection New Agey?

More Deepities: Energy

More Deepities: Does Intention Have Power?


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44 Responses to Vitalism and Structuralism: Two Sides of the Same Coin?

  1. Hi Todd,
    The link to the Bloom article appears to go back to your blog but to an empty page. Not sure if that was your intent or if the link messed up somehow.
    I love this post. Just wanted to say so.

  2. Awesome post. Great summary of these two ways of thinking, and what’s wrong with them. They are also the two things that frustrate me the most being a therapist. “oh you’re a physical therapist? What do you think of blah blah blah? My homeopath/osteopath/blah/blah says blah blah blah”.
    I never know what to say. I just want to say: “thats’s absurd”, because it’s always a situation in which I don’t have time to explain biology 101 to them. But if I say that, I’m being “close-minded”.

    • Thanks Tony. “That’s absurd.” I like it. We could shorten up a lot of our blog posts with that phrase.

  3. “Bloom explains that humans evolved separate mechanisms for understanding the physical behavior of inanimate objects and the intentional acts of agents such as animals or humans.” T.H. Reading Blakeslee’s book again, this reminded me of their description of affordances.

    thanks for the post

    • Chance,

      Blaskelee’s book is definitely worth another read, because I have forgotten what is meant by “affordances.” Can you give me a reminder?

  4. ” . . .why vitalism and structuralism are two sides of the same dualistic coin” — very insightful; thanks for this! As a massage therapist who is equally put off by BOTH sides of that coin, I’m often left feeling at a loss for how to explain how I do or even what I do — or why I think it’s relevant and useful work, except to say that I think it somehow affects the body (and mind) via the nervous system. Which is marvelously inexact.

    Thanks too for Bloom’s perspective, which will help me to reconcile my longstanding extreme skepticism re “energy work” with the fact that I’ve had some very interesting (even “profound”-feeling) experiences at the hands of such practitioners. However I’ve always been reluctant to attribute those experiences to the “reasons” outlined in the applicable model. Frankly I think the human nervous system is far more miraculous and mind-blowing than anything that polarity or craniosacral models (for example) can offer.

    • Katie,

      “I think the human nervous system is far more miraculous and mind-blowing than anything that polarity or craniosacral models (for example) can offer.” Well put. The reality is more interesting than the fable.

  5. Hi Todd. This blog is excellent and very interesting.

    I’d just like to say that your blog has inspired my dissertaion I am currently in the process of piecing together. Needless to say, my tutors are intrigued, if a little against it.

    I’m going to study physiotherapy next year, so I’m very interested in what my future Lecturers will think of my dissertation “Structural abnormailties: always the cause of pain?” I think I’m going to be the black sheep of the class!

  6. I understand why you felt the need to restrain yourself from going on at length about this, but I would have been happy to read more. Perhaps a part 2? Meanwhile, I’m honoured that my term “structuralism” got a mention.

    A cautionary note: I am careful not to define structuralism absolutely. It is a tendency to exaggerate and over-emphasize meat and symmetry, as opposed to “completely” ignoring or focussing “exclusively” on the physical. It may be a strong tendency, but only in the more extreme cases does it actually start to shut out other perspectives. Most structuralists are not suffering from an active bias against neurology and pain science so much as as an alarming shortage of education about it. They are trained and work in a structuralist tradition, and make structuralist assumptions as naturally as a fish breathing water, but they are generally still perfectly capable of appreciating other perspectives — they’re just less aware of them.

    Oh, and structuralism is also quite a lot easier to “sell,” because it gives therapists targets to therapize. Just a happy commercial coincidence, I’m sure. :-)

  7. Todd,

    Just wanted to let you know that MSE is indicating that the JS/BlacoleRef.AH trojan is loading from your site. Could well be a false positive, but…


  8. Todd:

    I love reading your posts, but it’s time to fix your grammatical error of how to use its and it’s. “arguments against its existence” is the right way to say it. “Its” is the possessive, “It’s” is a contraction of “It is.”

    sorry to point it out, but language is practical consciousness– it exists to form the bonds between us. So it matters to get it right, I think.

  9. Todd, you have nothing to apologize for and, in fact, I wish this had been longer. I’d love to hear what else you have to say.

    “This leads to a treatment approach that completely ignores the nervous system while focusing exclusively on the physical tissues of the body. Eyal Lederman calls this the “postural structural model“. Paul Ingraham calls it structuralism, and Diane Jacobs calls it mesodermalism.”

    I’m still looking for a set of words to describe the distinction between structuralists and those focused on the nervous system. I’m not satisfied with the current choice of words. Mesodermalist/ectodermalist, meatballs and neuronuts . . . what would be the contrasting match to “structuralist”?

    As for those who take a physical approach in contrast to vitalists, yes, it is difficult to speak across that chasm. I am finding out the impossibility of it lately in conversation with a particularly religious friend with whom I have a unique ability to dialogue without rancor. One of the great barriers is that they usually have an almost complete lack of science literacy and a mountain of religious education. It is impossible to find basic fundamental ideas upon which we can agree as a starting place. Although in my current conversation partner’s case, they operate from a particular religious point of view, it is not so different from trying to converse with a manual therapist who is steeped in vitalism. They usually lack even the most basic understanding of exactly what science is and is not and how the material world works. Meanwhile, they have steeped themselves for years in learning minutiae of imaginary systems. They do not acknowledge or try to explain the conflicts between the varying imaginary systems to which they subscribe or the conflicts between their imaginary world and day to day reality. They do not question or investigate that which they are told, no matter how unnatural. They are puzzlingly more skeptical of easily demonstrated facts than they are of supernatural claims. I often think it is hopeless to try to communicate with them at all. Are most people’s brains wired for one or the other and there is no point in us talking to each other? Am I a freak for having a foot in both worlds, yet coming down squarely on the side of science for an explanation of my interior life? How is it that they can live in our technological world and still retain beliefs of primitive, pre-scientific humans? I don’t understand this because it is not how I think.

    Bloom’s article brings up many of the points made in Anderson Thompson’s book why we believe in god(s). He argues that religion is a byproduct of evolutionarily advantageous adaptations. One is our ability to imagine someone not present to us. This is socially advantageous, helps us to cooperate and thus survive. It is not a far stretch to create a mental image of a person not present to imagining a deity or a component of that person that is not their body. After they leave us spatially or through death, we can continue to imagine their presence, talk to them, etc.

    Another is our ability to achieve ecstatic or transcendental states. When people achieve these states, particularly in groups, it fosters a sense of well-being and cooperation. It bonds the group and helps lubricate the friction that arises from living with other people.

    Pareidolia has advantages for survival and our desire for control (appeasing the deities) in a dangerous world all contribute to the almost universal religious pull. And vitalism is a form of religious expression, whether it is attached to a particular religion or is a more vaguely expressed belief in supernatural forces.

    I do believe that a greater understanding of how the brain works could bridge the gap between monists and dualists. In terms of manual therapy, current brain science very neatly explains the very real experiences of dualists. Embracing it would take their explanations out of the realm of the dubious and unprovable supernatural and put them squarely in a the realm of the rational. However, most of them resist this explanation and I don’t think it will happen any time soon. Myself, I live with a rich interior life and appreciate having an explanation for it that does not require belief which conflicts with my rational mind or my daily experience.

    I do think that the belief that we have magic power over unseen forces is hubris. I also think that this amazing material world is magic enough and learning how it works and to work within it continues to inspire me and produces a sense of wonder. It does not impoverish my experience but rather enriches it.

    Thanks for starting yet another thoughtful examination of the subject, Todd. It is one of the important issues in the world of manual therapy.

    • Alice,

      Thanks for taking the time to make so many great points. I find the evo psych behind religion very interesting, and have read stuff by Dawkins, Pinker, Dennett, and Atran on this subject. Totally interesting stuff but in my mind it doesn’t really give me any practical ideas about how to bridge the gaps you are talking about. In fact it makes me feel even more patient with people who have irrational faith based beliefs. Their brains are just set up to think that way, its asking a lot for them to come around to an “unnatural” way of looking at things.

  10. I bet Todd understands the its/it’s difference quite well, but — like me — simply types it wrong. I have understood the difference perfectly for about 30 years now. That hasn’t kept me from mis-typing it a few times a day that entire time! :-) “Its” maddening. “Its” like my keyboard has a (stupid?) mind of “it’s” own.

  11. Thanks for the editing Michael. I understand the difference, I just can’t be arsed to get it right every time!

  12. Terrific post! I encourage you to write that part 2.

    I will always be grateful to the trainer who told me how the nervous system is involved in exercize. My formal education about science ended in high school, so she just explained very basic things using simple analogies. It immediately helped me understand a little more about what was going on with my rapidly changing and healing body. I found it encouraging and motivating.

    So therapists, I know it is not your job to make up for the lack of science education out there, but it might be worth it to explain the basics to receptive clients.

  13. Hello Todd,
    A really good post and by the look of the comments there is plenty of interest in the neutral,thoughtful middle ground .
    I am doing a talk on chronic pain to Physiotherapists this week and as well as using some themes here I am going to start off with the 3 little pigs story. Spending time to dig good foundations will prepare the structure for the inevitable buffeting by the variable weather conditions out there.
    We now have a much better model to build a good base. Many people prefer concentrating on painting the render or doing some interior decorating.
    I can see why vitalism flourishes.Daily I see the result of thoughtless and uncaring ‘structuralism’ and I can see why body therapies which embrace ‘energy’ and emotional paradigms are attractive for example.
    Today however I don’t think there is any need for polarisation. Embracing pain/stress physiology is ‘the’ middle ground .
    However,personally I don’t see anything wrong with using ‘vitalistic’ ideas as metaphors (if they are understood in this way). ‘Soft limit’ and the body sensations that can be experienced in tai chi for example are something that I use daily and can easily be translated.
    Pauls comments re structuralism and the black belt marketing that goes with it are spot on . It is more difficult ‘selling’ greyness ,clinical reasoning and ideas around sensitisation/protection/threat evaluation than ‘fixing’ some imaginary torsional problem in a sacroilliac joint.

    • Ian,

      Thanks for the comments. Those are all excellent points. I agree about the poetic or metaphorical use of vitalistic language – it is a very easy way to communicate – especially since we are born dualists. I haven’t heard the 3 pigs story. Can you say more about that?

    • Ian,

      Ha! Whoops! Not the kids story, I know that! I mean your analogy to the story. What is the foundation? What is the paint? And who is the big bad wolf:)

  14. Hi Todd,
    this is a first attempt in trying to use analogies and something simple (and possibly stupid) to get across the point that a firm foundation may be more enduring than the fly by night structural technique obsession. This obession is all pervasive and dominates the inservice programme and practice in general.
    Eyal Lederman is attempting this in Osteopathy with the process model he is teaching I believe.
    I want to teach ‘neuro’ , link to Diane Jacobs work on an interactor process with an understanding of Melzacks neuromatrix.
    Practically this focus on interaction,teaching, ‘downregualting threat’ and generally looking at sensitvity rather than angles/isolated strength,and body posture makes more sense to me at least.
    This foundational platform has stronger roots I believe and the wolf would have a harder time mustering the wind to blow through it all?

  15. GREAT POST. Thanks for you honesty. I just got done teaching this in my Neuromuscular Class. I had to spend a little time on the subject because the book forced upon me by the administration is based in “structuralism” and “energy work”. After 16 years, I am definitively in the neuromatrix pain camp of Melzak and Wall. I told my students that the biggest challenge they will face with their profession is this: letting go of the old views and beliefs and accepting all the new research that is being done in the area of manual therapy and our understanding of fascia. That said, I pointed out how cool it is that for thousands of years man has done so much excellent work with something that really is not understood. Touch is a beautiful thing.

    • I too believe that teaching students these things is important. it’s like regrowing the leaves of a tree.

      most of the old, established folks hang on on their structuralism and sales tools that work. I so far have not seen a single doctor or therapist change his mind. .. and … how could they? changing their point of view would contradict their current one. they – per se – are not allowed to change their point of view, because that would mean brain plasticity is real.

  16. The trouble in dealing with people whom you hold to have “irrational faith-based beliefs” is that often times they have rational faith-based beliefs, as well, and being hyperskeptical can be just as crippling as being overly credulous. Sure, maybe Sam Harris is right that we are under no obligation to treat crystal-wavers as serious intellectuals, but then Dawkins comes out and says that it would have been better for my parents to sexually abuse me than to send me to Catholic school (complete with snarky aside about how both probably occured, in such a case). There is a difference between “superstition” and “the unknown”. Failing to respect the proper lines of agnosticism leads to bigotry and intolerance, just as much as any other religious belief. Saying “I don’t buy that, and this is why” is one thing, saying “That’s absolutely false and you’re an evil, stupid person for saying it” is how wars get started.

    • Bennett,

      I’m not sure what you mean by “rational faith based beliefs.” That sounds like a contradiction in terms to me, given that faith means believing without reason. And I am certainly not recommending intolerance or bigotry, I don’t know how you got there from my post.

  17. Todd,

    People have reasonable faith (heck, there’s a comprehensive volume on the subject, by the same name) about all sorts of things. If we were all Humeans, we wouldn’t even be able to function–even causality, the evidence of our senses, and so on can be questioned. I have reasonable faith that my girlfriend isn’t plotting to murder me in my sleep. Couldn’t prove it 100%, but I’ll take my “beyond a reasonable doubt” and sleep sound with it.

    As to the intolerance–that was not directed at you personally, and I shoulda been more clear. It’s the Dennet/Dawkins/Hitchens/Harris crowd. You cited them as references, but unfortunately they’re not a good source on how to deal with people whose beliefs differ from one’s own, given how belligerently condescending they can be, and their general posture of bellicosity posing as “skepticism.”

    This isn’t even a theism/non-theism question. Even serious atheist philosophers say that guys like Dawkins make them ashamed, because his reasoning is just so poor, and his attitude is so unwinsome. His entire ouvre of late is a combination of question-begging and ad hominem.

    So my concern is more for the quality of the reading list, especially vis a vis how to deal with folks who have seemingly kooky or unproven beliefs. The ability to work an MRI doesn’t excuse one from having terrible analytical skills or offensive rhetoric.

  18. Part of that confusion, by the by, might have to do with how we define “faith.” It doesn’t mean to believe without reason–quite the opposite. It means to have confidence, trust, loyalty, commitment, etc. (going off M-W here, not just my little soapbox). Without absolute proof? Certainly, sometimes. But there’s precious little absolute proof of anything. Verificationalism died a horrible death in academia before you or I were born.

    • Bennett,

      I see your point about reasonable faith.

      As to Dawkins, Dennett and Harris, I don’t always like their tone, or their strategy in winning coverts, but I agree with most of their substantive points. Everyone makes mistakes of course, but in general I have tremendous respect for the reasoning skills of this group.

  19. Fair ’nuff. I pretty much prefer to leave everyone to their religion, unless their religion is “Join or Die” (sorry, Wahabbis), so I extend that to them as well. Not that I’m all hippy-dippy “I’m okay, and you’re Okay” or anything; I just think it’s critical that a pluralistic, democratic society not rend itself to shreds making legal or scientific courts into playgrounds for philosophical or theological/metaphysical questions. I do have some fear that the religion of New Atheism attempts to smuggle itself in by the very same special pleading that some ID advocates use–claiming that it isn’t religious, it’s “just the facts and how we interpret them”.

    Your writings here, I want to underline, actually show a great respect and thoughtfulness. I would that they were more like you, rather than the other way ’round. This is really more of a sidebar, since ‘souls’ and suchnot got brought up, not something that I like to harp on ad infinitum.

  20. Interesting broader context, so far I was hooked on Paul Ingraham’s term “structuralism”, but indeed there are many names for the same evil.

    Just this week I went to a “holistic” dentist. She literally put me with my back against the wall and then told me that my teeth are badly aligned, my thoracic spine is off, one shoulder too low, and my pelvis not straight. She told me: as long as I don’t get my teeth alignment problem fixed nothing I will ever do will help. She even gave me a drawing of a twisted skeleton. I was inclined to also give her a short analysis (“and you are fat with a miserable facial expression”), but decided to just leave without signing up for expensive treatments.

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