30 Nov Self-Indulgent, Touchy-Feely Communists, Spas and Sanitariums
My friend Greta was a fit, healthy active 42-year-old woman, a landscaper, mother of a five-year-old son and a wife. In October 2011, over the course of a few weeks following a Tdap vaccine (yes, but that is a topic for another day), her ability to walk and work was replaced by unthinkable pain. Her legs wouldn’t function and her body was wracked with extreme discomfort literally every minute of every day and night. Five visits to the emergency room later she finally had a diagnosis that started out as Guillain Barre Syndrome (GBS) and would later be revised to its chronic form, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). It would be a week in intensive care, weeks at a rehab hospital, and months before a consultation with a preeminent expert would set a course of treatment that would allow her to walk again, unaided. But it took spa treatments, the atmosphere and baths at Stoweflake Mountain Spa & Resort in Stowe, VT, and the loving, capable care of spa director and Ayurvedic therapist, Surinda Oberoi Cavanaugh, for Greta to experience her first pain-free, peaceful moments, and allow her to glimpse the possibility of life without pain. After one abhyanga (warm Ayurvedic oil massage) and shirodhara (Ayurvedic treatment where warm oil is poured over the forehead continuously for about 20-40 minutes), and a soak in the mineral baths, Greta observed, “the difference between healing and taking medication is…really different.”
Amen to that.
Stoweflake Spa has hosted my family and me on several occasions, allowing us space to sit in the mineral baths, unwind and finally have time to connect from replenished hearts. My family has a rule: no phones at Stoweflake. Well, maybe that’s just a rule I impose—but I recommend it. One time we had to stand outside Stoweflake for about 10 minutes for one of our party to get off the phone before we would enter the Space of No Phones.
Through emergencies and daily life, this spa has provided my family and friends with a space of healing. The role it has played has been so strikingly helpful, that I was inspired to so some research on spas—the role they can play in healing, the role they have played in years gone by. And the role they currently play in cultures other than the Americulture (a term I am just now making up).
What I have found was surprising, and could fill a book. But here are some highlights and reflections:
The History of Spas, Sanitariums and Sanatoriums
We have this idea, I think, that medicine should be yucky. That it doesn’t work unless it is. No pain, no gain.
Things have not always been like this. Even in Americulture.
As recently as the early 1900s, it was considered acceptable to rest when you were tired. More than acceptable. It was considered that rest rejuvenated the spirit and healed the body.
For example, President Warren Harding took five protracted visits to a sanitarium to rest and recover from fatigue and overstrain.
When a modern-day citizen of the US hears the word “sanitarium,” the following ideas and words might come to mind: “place you go when you’re having a nervous breakdown,” “tuberculosis,” “sunshine,” “insane asylum.” While all these connotations have a basis in some reality, there is definite emphasis on, “some.”
Sanitariums, together with spas of antiquity, are the parents of the modern day spa. So let’s look at the history of each.
While various natural healing treatments or regimens have often been incorporated in spas, the term “spa” has historically been associated primarily, with waters. It seems people have been keen to “take the waters” since prehistoric times. Offerings dating from the Bronze Age, for example, have been found at hot springs in the Czech Republic (formerly Czechoslovakia and, in prehistoric times, perhaps “Czechoprehistoria”) and France (whatever France was then called). The offerings are thought to have been given in exchange for the promise of healing.
It was the Greeks (formerly, “Greeks”) however, in the mid 2nd millennium BC, who set the example for modern day spas, with public baths and enhanced natural hot springs. Since then, with the exception of post-roman, pre-nineteenth-century pockets of anti-bathing sentiments in Europe, it has been common practice for either day or residential spas or spa towns to be built up around natural hot or mineral springs, or to include manmade mineral pools.
Spas became very popular in Europe and the US in the 18th through early 20th centuries. While they remained popular in Europe, they lagged in popularity in the US in the 20th century, and have lost much of their association with water and water therapies, relying more on massage, dietary, cosmetic or athletic and recreational programs.
Sanitariums and Sanitoriums
In sanitariums, clean food and, especially, clean air, were considered essential elements for health. While they may have included water therapies or springs, they did not share quite the emphasis on water features that were the hallmark of spas.
The word “sanitarium” is derived from the Latin, sanitas, meaning “health.” Sanitariums were often comfortable, sometimes luxurious, resorts located in pristine natural settings. To nurse guests back to robust health, they—the guests—were exposed to plentiful amounts of high altitude, fresh air, and good nutrition ([i]), and were expected to adopt healthy daily routines that included an early bedtime.
It seems in 1904, the term “sanatorium,” from the Late Latin sanatorius, meaning “curative,” was coined to distinguish facilities that were specifically focused on healing particular ailments, like Tuberculosis (TB)[ii] but, from what I can see, the terms sanitarium and sanatorium are often used interchangeably. Sometimes TB sanitariums changed their name to sanatorium, in fact, in accordance with changing conventional usage.
In the US, in the early 20th century, TB was the second leading cause of death, just behind pneumonia. In 1900, the death rate from tuberculosis exceeded the death rate from cancer and accidents combined.([iii]) Not surprising, then, that TB sanatoriums were common throughout Europe in the 19th century and early 20th century. Before the development of antibiotics, in the 1940’s([iv]), patients would go to a sanitarium and be prescribed a regimen of good rest, clean air, and nutrition to offer the best chance that their immune systems would “wall off” pockets of tuberculosis infection. Patients would take treatment, if they could afford it (and, until 1923, if they were not black) for sometimes five, 10 or even 20 years.([v])
The efficacy of nature therapy on TB is debated, but there is reason to believe it was helpful. It certainly was helpful for Dr. Edward Livingston Trudeau, the founder of the first TB sanitarium in the US, in Saranac Lake, New York in 1882. Trudeau, born in New York City to a family of physicians, in 1848, had nursed his own brother—a patient of TB—for 3 months before his brother succumbed. When Dr. Trudeau himself contracted the disease a couple years after he graduated from medical school, he left the city, and spent “as much time as possible in the open” in the Adirondack Mountains. He regained his health and subsequently treated thousands of TB patients before his death in 1915.
The last well-known sanitarium in the US may have been Kellogg’s Battle Creek Sanitarium, founded in 1866. Battle Creek served many thousands of “patients” over the course of its reign, including President Harding. At its heyday, in 1906, it hosted over 7000 patients. During WWII, it was purchased by the US Army and converted into a hospital. It seems the sanitarium wave was on its way out by the mid 1900s.
Why Did We Stop “Taking the waters”?
After the discovery of an antibiotic cure for TB, in the 1940s, the demand for sanatoriums declined dramatically.
Plus, after the Wall Street crash of 1929, fewer people could afford sanitarium stays. Finances are, of course, a concern for many of us.
That, and maybe guilt.
When Greta was receiving her treatments at Stoweflake, she confided in me that she struggled against the feeling of guilt, with every visit. Guilt over what felt like indulgence. This from a woman in the throes of a debilitating disease. In my experience, Greta is not alone in her experience of guilt. Taking time alone to let go and relax is a pursuit that does not garner great appreciation in our culture.
Pressing on, through anxiety and depression is almost a rule these days. If you feel like you’re on the edge of a nervous breakdown you are in, if not good company, at least plenty of it. Antidepressants are second most commonly prescribed medication in the US.[vi] In any given year, greater than 18% of adults suffer from a full-blown anxiety disorder. [vii] Anxiety and stress sometimes seem like badges we wear to, what? Justify our existence? To pledge allegiance to the hordes and legions that press on beyond what comfort level, energy and resources can sustain?
Has our glorification of busy eclipsed our healthy impulse for self-care, leaving in its wake… guilt?
Guilt Not Necessarily a Universal Meme: Enter the Communists
Before the communist revolution, it was called the, “zdravnichi.” After the communist revolution, the name was changed to “sanatorium.” In Russia, sanatoriums were hugely popular and continue to thrive today.
Why? Because the Communist era government paid 100% of the costs for each Russian citizen to undergo mandatory treatment at a sanitarium, every year. And not for, like, a Swedish-massage-Christmas-bonus kind of thing. No. The government would foot the entire bill for each Russian citizen to go to a sanitarium for 2-4 weeks per year, in addition to their regular vacation time. It was part of a government system (evil government scheme?) to utilize the work hours of workers more efficiently.
The Communists are rather well known for doing stuff that increases the productivity of workers, right? Most of us do not think of the pampered elite when we think of the Communist masses. Communism does not generally inspire images of touchy, feely, massagey (I know “massagey” is not a word, but it is funny) wellness.
But there it is.
My friend Anya, originally from communist era Moscow, told me that, when she was a child, she remembers going to the sanitarium every year with her family. Once admitted, each person would have a full physical, with blood work and tests. There was a team of health care practitioners on hand, available to oversee your treatment. There were immunologists, endocrinologists, and massage therapists. And, just by the way, massage therapists in Russia undergo a very rigorous training. In fact, their training is equivalent to that of a Nurse Practitioner in the US.
Not only that but, if it was thought that you might benefit more from going to a spa or sanitarium outside the country, then those costs would be covered as well. Anya’s Russian grandmother, for example, was given a voucher to “take the waters” in the Czech Republic (then Czechoslovakia) when it was considered that she could receive more benefit there than what was available in her vicinity.
I found this so intriguing that I asked to speak with someone Anya knew, who worked as a highly trained massage therapist at one of the more prominent sanitariums in Russia.
Enter Konstantin Leonidovich Popov, educated as a paramedic and nurse cum masseur, with 4 years of medical school. Popov took his job very seriously, even traveling around the world to learn various massage techniques to bring them back to Russia. He worked from 2005-2008 at the Sanatorium, “Tes” The full name of this sanatorium is something warm and fuzzy like, “Regional Government Autonomous Institution, Central Complex of Social Services.” “Tes,” I understand, is the one of, if not the oldest, most established sanitariums in Russia. It, like many of the Russian sanitariums, is located in a rural place of beauty, in the middle of the forest, rich in the essential ingredients of fresh air, water and food.
Often the Russian sanitarium is deliberately designed to make best use of the natural environment. For example, guests’ lodging may be located .5 km from the cafeteria, and 1 km from the waters, so guests are forced to walk through the forest quite a lot over the course of their daily activities. And their activities are highly regulated. And they are fully expected to comply. The various treatments and meals and events are so numerous that Popov even felt they might be excessive.
While it is no longer mandatory for Russian citizens to go to the sanitariums, the cost for treatment at a sanitarium is still at least subsidized by either the government or employers, and includes all meals, lodging, and treatments. Perhaps because of this assistance, sanatoriums are still very popular in Russia.
In fact, Popov told me, they are over-filled. And they have competition and pressure to drive them ever onwards towards the goal of providing the best medical care. The Russian government makes the sanatoriums compete for “tenders”—a monetary incentive. This is well and good but, when the government pays for guests’ treatments, they insist on dictating protocol. And that is not always best for the patient, in Popov’s opinion. He explained that sometimes the government regulations require more or different treatment than the guest might need—or the doctors might think is ideal—and, to avoid this over-regulation and over-treatment, there is a growing number of people paying that chose to pay privately.
If you are a Russian and chose to pay privately, you will pay about $60 per day to get treated at a sanitarium. That includes all treatments, meals, lodging, everything.
Popov told me there are strong statistics showing how these extended stays at sanitariums affect the health of the guests (though I have not yet followed up on getting those statistics). Considering that the communist era government was motivated by productivity and frowned on elitist pampering and, considering the post-communist government has maintained a practice of paying for this level of care and sabbatical for its citizens, I would have to guess that there are indeed strong statistics that support this practice.
Guilt doesn’t come into this picture. It makes sense for human beings to take care of themselves. Their work hours are more productive and efficient, and that is best for the country. That’s the idea anyway.
So you should feel guilty if you are not taking care of yourself. (This statement is made a bit tongue and cheek. Not to inspire guilt so much as to provide permission and inspiration).
The Return of the Sanitarium?
Towards the end of our conversation, I asked Popov whether he thought these statistics were so good—if the beneficial health effects on the guests were so good—because of the treatments at the sanitariums, or simply due to spending time in a beautiful natural environment. Without hesitation Popov replied that he felt that most of the good effects of the sanatoriums are due to the patient simply spending time in a natural environment, with clean air, food and water, and walking in the forest regularly.
This brings us back to the concern of finances.
Not many of us may afford 2-4 weeks a year, getting massages and therapies at a spa, but more of us can find a way to spend time on retreat in natural environments.
There is the case, for example, of Stephen Mather (1867-1930), founder of Borax and the first director of National Park Service. Mr. Mather would spend time, sometimes up to 18 months, and often alone, in the wilderness. And would come out of retreat to accomplish amazing feats, including preserving many wilderness areas as National Parks.
If we, as consumers, can recognize the value of time spent in natural places, the value of loving touch from therapies like massage, the value of soaking in mineral baths, the value of sacrificing guilt for improving our health, that might be a step in the right direction. And, if any of you budding entrepreneurs out there are wondering what to do, consider creating a spa in a beautiful, natural environment, where the organization of the place deliberately enhances movement and health; a place that heals just by being there. Then people can come, be healed by the environment and, if they can afford it, throw in a few massages or other treatments.
Suppose modern health care, politics, governments, we as individuals, and spas themselves, could recognize, maximize and take advantage of the health benefits spas and natural retreats have to offer? Perhaps we could have healthier bodies and spirits, be more efficient at work, and like our lives a little more.
Greta’s & Surinda’s Journals
I told you a little about Greta’s experience with Surinda at Stoweflake. Throughout their therapeutic relationship, they each kept a journal of their reflections and experiences. While it is too lengthy, and perhaps too personal, to include in entirety, I am moved to pull out some highlights of Surinda’s and Greta’s journals, as they so poignantly illustrate the significant support spa services can offer in the pursuit of health, when they are delivered by well-trained therapists. I think it is important to point out that, because Greta’s condition was complicated and severe, she needed a therapist, like Surinda, that was sufficiently trained in Ayurveda to be able to tailor, adjust, or even omit the treatments, according to Greta’s changing needs. These treatments were shamana treatments (dosha palliative) and not shodhana treatments (more complicated treatments designed to forcibly expel excess dosha from the body, requiring the careful supervision of an experienced practitioner), but still required oversight by a trained therapist. So, the highlights, in no particular order:
- I didn’t really realize how much I needed this kind of healing treatment, and just how battered my body was until I was being treated. My body totally drank it up.
- When I came in my feet and legs below the knee were very cold, and I was pretty tired. By the end my feet and legs were nice and evenly warm and almost pain free for the first time in a long time. I only remember a handful of times during my whole illness that I had so little pain. The foot massage felt especially good… they are probably the part of my body worse off. I was also able to get very relaxed and almost forget about my body, an amazing and relieving experience. I can’t even say how much this meant to me to feel this way. I realized how much I had really been fighting for my life with this disease, and to have some treatment that was supportive and healing on a different level than just fighting the disease was truly medicinal.
- I slept comfortably that night and didn’t need any medication to sleep. I still had the feeling of a sort of warming envelope around my body, retaining the good energy of life. I have the feeling that the oil from the massage creates a sort of permeable membrane that lets toxins out but keeps some of the body’s warm life energy in. It seems in life a lot of energy just plain escapes, and it feels so nice to hold some of that energy and just feel it there, quiet and warm.
- Surinda relayed something that she heard someone say about having to make space for healing. I felt that right away as a tiny warm white light in my body, like a seed. It wasn’t stationary like a pocket, but slowly moved around. The placement of it was actually hard to pin point, it was just somewhere and I could see it.
- I didn’t mention in the first entry how amazing the Shirodahra is. It is truly relaxing and disarming. I find it hard to keep from falling asleep and it somehow takes attention away from the rest of my body, including and especially my feet. It’s interesting how it’s a treatment involving your head and you’re not even focused on that. It’s almost an out of body experience, but in your body at the same time, grounding.
- I went into the hot mineral pool again afterward and it helped greatly again with my joints and muscles and my skin again felt clean and breathing.
- I think it’s harder to accept that I could receive such a gift than it was in the first treatment, but I’m working on it and am again so grateful.
- The thing I was able to hold onto for much of the week is the feeling of the tiny healing light in my body and the memory of the feeling of the warm protective envelope and feeling of evenness from the oil and mineral pool.
- When I was receiving the shirodhara, I was lying on my back palms down on the mat, and I started to feel a cycling energy going from my palms out through my fingers. It was very noticeable and made my fingers feel shivery as it went through. It cycled in that pattern a bunch of times then would stop for a little bit and then start cycling again. This happened for about 3 or 4 sets. This seemed like a great thing for me as my hands, (and feet) have suffered a bit of nerve damage and nerves conduct energy… it made sense to me and seemed very healing.
- It seems so hard to really relax in life, and I still was holding tensions, especially in my legs and neck. Surinda pointed out that you can get into a pattern of tension when you’re in pain a lot, and I was kind of bracing for muscle spasms and leg discomfort even though I didn’t need to in that moment. Once I let my muscles relax, I was really relaxed, and almost fell asleep a few times.
- I had lost the sight of that little white light from before a couple of days ago, but after this treatment it started to feel like an overall feeling of wellness, more of a saturation.
- I am really struck again by the difference between this healing, loving and health supportive treatment versus the medication treatment, which I need just as much, but it’s very different. I’m very fortunate to experience both.
- I feel as the treatments progress I am able to sort of make more of them, as my body can relax more and I’m getting a little more solid, I can receive the treatment better. I don’t know if that makes sense, but in the beginning I was an absolute husk and now there’s something there in my that’s [sic] a little more sustained.
- I really think that experience on the Biomat was a tipping point. Such a relief to have my hands feeling more normal.
- I feel so fortunate to have been able to experience this building support in my body.
- Towards the end of the treatment, instead of in my hands, both of my arms from my shoulders to my wrists had a sort of pulsing swelling feeling that cycled like with my hands the time before. It wasn’t a shivery feeling this time but more of a warm pulse. I thought that was really interesting and made sense somehow. The way it felt in my arms made sense to me that it would be that way for a larger, thicker part of my body. I really believe the Biomat could be a very effective healing treatment, especially for nerve related disorders.
- I was able to go swimming with my son the other day, which was just the most wonderful thing ever!
- Surinda took it easy on the massage to try and not get too much detoxing going. This was probably a good idea after all my body has been through recently. Actually, after this treatment I really felt invigorated and good, better than before the treatment. What a great feeling, just to feel good!
- During this treatment, I once again had the rare wonderful feeling of not being in pain and actually not being so aware of my body. Both the massage and the shirodhara help to relax my body and then let it rest, let my mind rest, and let me rest… so healing.
- I feel like I am finally getting to a place of health beyond survival again and I can tap into those feelings and visualizations of making a space for healing.
- Well, once again it was a wonderful experience getting the massage, shirodhara, and going into the mineral pool. I felt pretty good going in, and drove myself for the first time… a great feeling to get myself somewhere that far from home…
- It is such a treat for my body to use those pools! I think the amount of time I spent in the mineral pool was fine, and I may be getting more able to tolerate the heat again too.
- Another wonderful treatment! This treatment was interesting for me in two ways, and felt like a sort of turning point. One thing was that I felt more “normal” than ever, like almost a regular healthy person getting a massage treatment. My feet still had been bothering me a lot, but I didn’t feel so strugglingly [sic] sick. Except for my feet, I remember thinking to myself, “so this is what it feels like to have normal sensation… I remember this!”. I felt like it was easier to relax as well. In contrast, after the treatment I felt almost a growing panic to wash off what felt like a lot of toxins. I love the feeling of the oils on my skin and feel nourished, protected and evened out energetically by the oil and the treatment, and usually leave the oil on overnight. This time though I felt like so much toxin had surfaced that I needed to wash it off. I showered off with just a little bit of soap thinking that the excess surfaced toxins would get washed away and I would still have some of the benefit of the remaining oil. I then soaked in the mineral pool for about fifteen minutes. I felt kind of dazed and tired,… and relaxed after this treatment. I really think it was a good thing to feel that sort of expulsion of toxins. I had the distinct feeling that those toxins were no longer a stuck integral part of me, that they were separate and gone. I’m sure there are more, but maybe I’m healthy enough now to be able to get rid of some of them. It was nice to be able to take the time I needed after the treatment to sit still, drink tea and adjust to my detoxing self. My skin felt great leaving the spa.
- Two days after this treatment I had the most comfortable few hours in terms of foot pain that I’ve had since I got sick. That was amazing! Since then there’s been a lot of fluctuation, but other comfortable times!
Afterword: As of Summer 2017, Greta finally was able to discontinue western medical treatment, hopefully permanently, to require to manage her CIDP. While she has some discomfort in her feet, she is back working as a landscaper, able to mother her active, now 11 year old son, with her husband, and live her life the way she was accustomed. To this day Greta feels that the treatments and baths she received at Stoweflake made not only an emotional difference during her illness, but were an important factor in her recovery.
By Dr. Claudia Welch
- [i] McCarthy OR (August 2001). “The key to the sanatoria”. J R Soc Med 94 (8): 413–7. PMC1281640. PMID 11461990.
- [ii] JA Holbrook in “Mountain View”—Hamilton, Ontario, and was reprinted in the Valley Echo in 1955 [vol. 36(3), page 5].
- [iii] http://publishing.cdlib.org/ucpressebooks/view?docId=ft7t1nb59n&chunk.id=d0e1113&toc.id=d0e977&brand=ucpress
- [iv] http://publishing.cdlib.org/ucpressebooks/view?docId=ft7t1nb59n&chunk.id=d0e1113&toc.id=d0e977&brand=ucpress
- [vi] Original citation: http://www.mayoclinicproceedings.org/article/S0025-6196%2813%2900357-1/abstract Age and Sex Patterns of Drug Prescribing in a Defined American Population Wenjun Zhong, PhD, Hilal Maradit-Kremers, MD, MSc, Jennifer L. St. Sauver, PhD, MPH, Barbara P. Yawn, MD, MSc, Jon O. Ebbert, MD, Véronique L. Roger, MD, MPH, Debra J. Jacobson, MS, Michaela E. McGree, BS, Scott M. Brue, BS, Walter A. Rocca, MD, MPH (email) published online 21 June 2013.
[vii] Nerve: Poise Under Pressure, Serenity Under Stress, and the Brave New Science of Fear and Cool, Taylor Clark, Little, Brown & Company pp.10-12, 15. 2011