massage and bodywork professionals
a community of practitioners
Is Massage Therapy a respected field of health care?
I watched the documentary DOCTORED and wondered if the bodywork field has an uphill battle too.
Free viewing available for a short time here:
http://articles.mercola.com/sites/articles/archive/2012/11/10/consp...
As valuable as bodywork is to our health, our pay scales don't necessarily reflect the value we bring to the health profession as seen in the rise of chains/franchises which possibly sends the wrong message to the public.
Your thoughts?
Views: 377
Replies to This Discussion
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Permalink Reply by Chris on
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I think the presupposition of the comparison you are making is that Western medicine has some type of hegemony over holistic models, and that pay standards ought to reflect confluence between the two. I don't compare or compete with massage mills like Elements, Massage Envy, or the plethora of For Profit business owners who exploit their workers skills for personal gain and profit. Instead, I see my role as filling a spiritual function. My fees are set to meet the financial situation of my clients, rather than my clients meeting some arbitrary standard I set in advance.
The larger picture of the issue of your post, however, is that we are influenced by our belief systems. In fact, behind many of our chronic conditions lies a wall of unshakable cultural superstitions -- opinions and ideas shared and supported by our Western model of health care -- which may entrap us in illness precisely because we cannot or won't question them. Like it or not we are bound by scientific hegemony in that health practitioners are always searching for the elusive 'cause' of chronic conditions. Reason dictates that where there is an 'effect,' there must also be a 'cause.' And even though we have exhausted all the possibilities, we seem incapable of reckoning that there may be no cause -- at least not of the sort we are seeking.
It seems that we are asking the wrong questions. Once we understand that illness is a part of our selves; and our 'selves' are a complex, a mystery that is unfathomable, and a paradox we come face-to-face with a different set of cultural glosses that we were previously indoctrinated into. In other words, if dis-ease is disease, and disease is dis-ease, we will always find ourselves asking "why?" The better question might be "Who am I" or "Why do I hurt?" Or perhaps the most important question might be "What are my symptoms trying to tell me?" If we do not know who we are, we have little chance of knowing why we are sick.
It is the brave souls who defy the model of sickness and instead set out on a quest for understanding. And understanding is more of a subjective attribute than an objective one. And this includes how we define success and failure in the profession. If one's measure is entirely based on material consequences then their answers will remain mired in the scientific model and thus limit a new set of glosses that might free them to another possibility.
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Permalink Reply by Gordon J. Wallis on
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Gosh almost everyday I'm helping people with rotator cuff problems, hip problems(sciatica), low back pain, carpal tunnel and so on that these people have had for days, weeks, and even years.. Even though they have gone to medical doctors and other types of health care people...One guy told me he spent thousands of dollars...And Ive helped them in one or two sessions...Just the other day I had a client with a rotator cuff injury she had for a month. Obviously the medical person she saw before me didnt know anything about trigger points.. I palpated trigger points in her Infraspinatus, Supraspinatus, and Levator Scapulae... Within a few minutes those were gone, and so was her rotator cuff injury...I know that once any underlying pathology is ruled out( for structural problems), its soft tissue work all the way... And when I meet people I often here comments like.. " Oh I believe in massage"... Its like we are in the same category as Big Foot, UFOs, and the Lock Ness Monster. lol And pay scale is interesting... Not too long ago this young man came in to see me because his back and neck hurt...it had been hurting him for two months... He went to another type of health care professional twice a week for a month, and had two more weeks left on his treatment plan.. All he had was a trigger point in his Rhomboids..that was gone in a minute, and so was his back pain...So withing ten minutes of meeting him, his problem was over...I charged him for 15 min.,, he came in on a follow up a few days later, and he was fine...I saw him drinking a beer in a bar a few days after that , and he told me that his back is fine and that the other health care provider is still calling him to come in and finish up the treatment plan...And that health care provider drives a very expensive car...I think I made $40.00 total for fixing his problem. One of the thing thats been a hard lesson to accept is.. Life is not fair. But things can and do change...And the other thing. And Ive said this many times...Our massage text books tell us to run to a medical doctor if we think we might have carpal tunnel...When massage is the best therapy for carpal tunnel.. So right from the beginning , even massage therapists, are culturally conditioned...
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Gordon J. Wallis said:Gosh almost everyday I'm helping people with rotator cuff problems, hip problems(sciatica), low back pain, carpal tunnel and so on that these people have had for days, weeks, and even years.. Even though they have gone to medical doctors and other types of health care people...One guy told me he spent thousands of dollars...And Ive helped them in one or two sessions...Just the other day I had a client with a rotator cuff injury she had for a month. Obviously the medical person she saw before me didnt know anything about trigger points.. I palpated trigger points in her Infraspinatus, Supraspinatus, and Levator Scapulae... Within a few minutes those were gone, and so was her rotator cuff injury...I know that once any underlying pathology is ruled out( for structural problems), its soft tissue work all the way... And when I meet people I often here comments like.. " Oh I believe in massage"... Its like we are in the same category as Big Foot, UFOs, and the Lock Ness Monster. lol And pay scale is interesting... Not too long ago this young man came in to see me because his back and neck hurt...it had been hurting him for two months... He went to another type of health care professional twice a week for a month, and had two more weeks left on his treatment plan.. All he had was a trigger point in his Rhomboids..that was gone in a minute, and so was his back pain...So withing ten minutes of meeting him, his problem was over...I charged him for 15 min.,, he came in on a follow up a few days later, and he was fine...I saw him drinking a beer in a bar a few days after that , and he told me that his back is fine and that the other health care provider is still calling him to come in and finish up the treatment plan...And that health care provider drives a very expensive car...I think I made $40.00 total for fixing his problem. One of the thing thats been a hard lesson to accept is.. Life is not fair. But things can and do change...And the other thing. And Ive said this many times...Our massage text books tell us to run to a medical doctor if we think we might have carpal tunnel...When massage is the best therapy for carpal tunnel.. So right from the beginning , even massage therapists, are culturally conditioned...
Gordon, Given your last sentence, I am assuming your response was directed at me. If I am off base here, please forgive. I understand the value of NMT, and myofascial release; my own practice is in confluence with everything your wrote in your anecdotal story. I love NMT, and I agree that it far exceeds anything the medical model can provide; I've seen this over and over again. Furthermore, I studied under two of the best. But my response had nothing whatsoever to do with the value or merit of therapeutic massage using advanced clinical work. I was responding from a different perspective based on my own questions on the mystery of the human enterprise, and questions that drive my own work. I was not trying to suggest that everyone comply or conform; it was just a pondering from the precipice. Keep the fire alive, bro....
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Oh hey,,, Im just responding to myself....Im just expressing my opinion on the subject... Not directing anything to anyone... so no problem ... I like people in here expressing themselves instead of just repeating what they have been told. lol You're cool... ....
Chris said:
Gordon J. Wallis said:Gosh almost everyday I'm helping people with rotator cuff problems, hip problems(sciatica), low back pain, carpal tunnel and so on that these people have had for days, weeks, and even years.. Even though they have gone to medical doctors and other types of health care people...One guy told me he spent thousands of dollars...And Ive helped them in one or two sessions...Just the other day I had a client with a rotator cuff injury she had for a month. Obviously the medical person she saw before me didnt know anything about trigger points.. I palpated trigger points in her Infraspinatus, Supraspinatus, and Levator Scapulae... Within a few minutes those were gone, and so was her rotator cuff injury...I know that once any underlying pathology is ruled out( for structural problems), its soft tissue work all the way... And when I meet people I often here comments like.. " Oh I believe in massage"... Its like we are in the same category as Big Foot, UFOs, and the Lock Ness Monster. lol And pay scale is interesting... Not too long ago this young man came in to see me because his back and neck hurt...it had been hurting him for two months... He went to another type of health care professional twice a week for a month, and had two more weeks left on his treatment plan.. All he had was a trigger point in his Rhomboids..that was gone in a minute, and so was his back pain...So withing ten minutes of meeting him, his problem was over...I charged him for 15 min.,, he came in on a follow up a few days later, and he was fine...I saw him drinking a beer in a bar a few days after that , and he told me that his back is fine and that the other health care provider is still calling him to come in and finish up the treatment plan...And that health care provider drives a very expensive car...I think I made $40.00 total for fixing his problem. One of the thing thats been a hard lesson to accept is.. Life is not fair. But things can and do change...And the other thing. And Ive said this many times...Our massage text books tell us to run to a medical doctor if we think we might have carpal tunnel...When massage is the best therapy for carpal tunnel.. So right from the beginning , even massage therapists, are culturally conditioned...
Gordon, Given your last sentence, I am assuming your response was directed at me. If I am off base here, please forgive. I understand the value of NMT, and myofascial release; my own practice is in confluence with everything your wrote in your anecdotal story. I love NMT, and I agree that it far exceeds anything the medical model can provide; I've seen this over and over again. Furthermore, I studied under two of the best. But my response had nothing whatsoever to do with the value or merit of therapeutic massage using advanced clinical work. I was responding from a different perspective based on my own questions on the mystery of the human enterprise, and questions that drive my own work. I was not trying to suggest that everyone comply or conform; it was just a pondering from the precipice. Keep the fire alive, bro....
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Permalink Reply by Jeffrey Bergey on
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My very first introductory class the instructor posed the Question "Why have you chosen massage therapy?" answers were to make money, I want to work on a cruise ship, I want to be my own boss. My answer was to help returning vets to help them find their way back to there selves. The room fell silent and I got the stares of disbelief. Being a vet and finding that inner-self has been a struggle but I find I have gained a sense of balance. When we are out of balance physically and mentally we invite dis-ease. I have a friend who is a therapist who helped me back to balance that sold me on becoming a therapist in order to help these young men coming back. I find it appalling that we send men (boys) into hams way and discard them like a used up tool! Enough of my bantering! I'm just in it to help
Chris said:I think the presupposition of the comparison you are making is that Western medicine has some type of hegemony over holistic models, and that pay standards ought to reflect confluence between the two. I don't compare or compete with massage mills like Elements, Massage Envy, or the plethora of For Profit business owners who exploit their workers skills for personal gain and profit. Instead, I see my role as filling a spiritual function. My fees are set to meet the financial situation of my clients, rather than my clients meeting some arbitrary standard I set in advance.
The larger picture of the issue of your post, however, is that we are influenced by our belief systems. In fact, behind many of our chronic conditions lies a wall of unshakable cultural superstitions -- opinions and ideas shared and supported by our Western model of health care -- which may entrap us in illness precisely because we cannot or won't question them. Like it or not we are bound by scientific hegemony in that health practitioners are always searching for the elusive 'cause' of chronic conditions. Reason dictates that where there is an 'effect,' there must also be a 'cause.' And even though we have exhausted all the possibilities, we seem incapable of reckoning that there may be no cause -- at least not of the sort we are seeking.
It seems that we are asking the wrong questions. Once we understand that illness is a part of our selves; and our 'selves' are a complex, a mystery that is unfathomable, and a paradox we come face-to-face with a different set of cultural glosses that we were previously indoctrinated into. In other words, if dis-ease is disease, and disease is dis-ease, we will always find ourselves asking "why?" The better question might be "Who am I" or "Why do I hurt?" Or perhaps the most important question might be "What are my symptoms trying to tell me?" If we do not know who we are, we have little chance of knowing why we are sick.
It is the brave souls who defy the model of sickness and instead set out on a quest for understanding. And understanding is more of a subjective attribute than an objective one. And this includes how we define success and failure in the profession. If one's measure is entirely based on material consequences then their answers will remain mired in the scientific model and thus limit a new set of glosses that might free them to another possibility.
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Permalink Reply by Maryshka on
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Very profound Jeffrey. That is one of my reasons also although I am not a military veteran so it's difficult finding my way into a veteran environment. Disaster response is another one of my reasons.
Regarding my original post, I'm not ashamed to say that I want to make a livable wage/living in this new chosen career. If MTs have to work 2 or 3 jobs along with performing MT to make ends meet, then something is wrong. It seems that MT chains are knowingly undercutting a valuable service at a low rate. I read a recent article about a local massage chain and the owner stated that 25 years ago, she was making $25 per hour, when she left to start her enterprise, the rate was $85. Now, her franchise rate for custom massage is $39.95. With the rise in chains/franchises at that rate, there is not much wiggle room for a therapist to earn a livable wage considering insurances, etc. I understand that altruism is a noble thing but reality stares us in the face everyday.
If a franchise says a no-compete contract has to be signed in order to be employed, that can seriously cut into a therapist's bottom line too.
I equate the massage chains to something similar I noticed in 2005 or so when skilled trade workers once making $25+ per hour taking scale reductions to $9-$10 per hour while working alongside undocumented workers willing to work for $9-$10. In today's world, $9-$10 per hour is not a livable wage (gasoline at $4+ per gallon) even if one lives spartanly. Is the same happening in the massage field -- a forced reduction in MT wages because of the "prevailing" wages at chains/franchises?
Back to the $25-then $85 per hour massage article... the owner of the franchise admits that massage therapy is worth at least $85 per hour but will charge customers $39.95 for a custom massage. So what is she telling the public (via newspaper article) about massage therapy and massage therapists?
Hopefully some of you more seasoned bodyworkers could offer more insight into this growing trend because I see it happening with chiropractors too.
Thanks for all the replies; they are very helpful.
Jeffrey Bergey said:My very first introductory class the instructor posed the Question "Why have you chosen massage therapy?" answers were to make money, I want to work on a cruise ship, I want to be my own boss. My answer was to help returning vets to help them find their way back to there selves. The room fell silent and I got the stares of disbelief. Being a vet and finding that inner-self has been a struggle but I find I have gained a sense of balance. When we are out of balance physically and mentally we invite dis-ease. I have a friend who is a therapist who helped me back to balance that sold me on becoming a therapist in order to help these young men coming back. I find it appalling that we send men (boys) into hams way and discard them like a used up tool! Enough of my bantering! I'm just in it to help
Chris said:I think the presupposition of the comparison you are making is that Western medicine has some type of hegemony over holistic models, and that pay standards ought to reflect confluence between the two. I don't compare or compete with massage mills like Elements, Massage Envy, or the plethora of For Profit business owners who exploit their workers skills for personal gain and profit. Instead, I see my role as filling a spiritual function. My fees are set to meet the financial situation of my clients, rather than my clients meeting some arbitrary standard I set in advance.
The larger picture of the issue of your post, however, is that we are influenced by our belief systems. In fact, behind many of our chronic conditions lies a wall of unshakable cultural superstitions -- opinions and ideas shared and supported by our Western model of health care -- which may entrap us in illness precisely because we cannot or won't question them. Like it or not we are bound by scientific hegemony in that health practitioners are always searching for the elusive 'cause' of chronic conditions. Reason dictates that where there is an 'effect,' there must also be a 'cause.' And even though we have exhausted all the possibilities, we seem incapable of reckoning that there may be no cause -- at least not of the sort we are seeking.
It seems that we are asking the wrong questions. Once we understand that illness is a part of our selves; and our 'selves' are a complex, a mystery that is unfathomable, and a paradox we come face-to-face with a different set of cultural glosses that we were previously indoctrinated into. In other words, if dis-ease is disease, and disease is dis-ease, we will always find ourselves asking "why?" The better question might be "Who am I" or "Why do I hurt?" Or perhaps the most important question might be "What are my symptoms trying to tell me?" If we do not know who we are, we have little chance of knowing why we are sick.
It is the brave souls who defy the model of sickness and instead set out on a quest for understanding. And understanding is more of a subjective attribute than an objective one. And this includes how we define success and failure in the profession. If one's measure is entirely based on material consequences then their answers will remain mired in the scientific model and thus limit a new set of glosses that might free them to another possibility.
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When we work where our spirits are happiest and fulfilled (being nurtured), dis-ease will lessen -- as I have learned and am constantly learning. Being in balance with our true selves is a difficult path to travel for many people because it means self-evaluation and discovery. Something I'm learning later in life and something some people never learn I guess.
Good reply Chris. Thank you for thought-provoking words.
Chris said:I think the presupposition of the comparison you are making is that Western medicine has some type of hegemony over holistic models, and that pay standards ought to reflect confluence between the two. I don't compare or compete with massage mills like Elements, Massage Envy, or the plethora of For Profit business owners who exploit their workers skills for personal gain and profit. Instead, I see my role as filling a spiritual function. My fees are set to meet the financial situation of my clients, rather than my clients meeting some arbitrary standard I set in advance.
The larger picture of the issue of your post, however, is that we are influenced by our belief systems. In fact, behind many of our chronic conditions lies a wall of unshakable cultural superstitions -- opinions and ideas shared and supported by our Western model of health care -- which may entrap us in illness precisely because we cannot or won't question them. Like it or not we are bound by scientific hegemony in that health practitioners are always searching for the elusive 'cause' of chronic conditions. Reason dictates that where there is an 'effect,' there must also be a 'cause.' And even though we have exhausted all the possibilities, we seem incapable of reckoning that there may be no cause -- at least not of the sort we are seeking.
It seems that we are asking the wrong questions. Once we understand that illness is a part of our selves; and our 'selves' are a complex, a mystery that is unfathomable, and a paradox we come face-to-face with a different set of cultural glosses that we were previously indoctrinated into. In other words, if dis-ease is disease, and disease is dis-ease, we will always find ourselves asking "why?" The better question might be "Who am I" or "Why do I hurt?" Or perhaps the most important question might be "What are my symptoms trying to tell me?" If we do not know who we are, we have little chance of knowing why we are sick.
It is the brave souls who defy the model of sickness and instead set out on a quest for understanding. And understanding is more of a subjective attribute than an objective one. And this includes how we define success and failure in the profession. If one's measure is entirely based on material consequences then their answers will remain mired in the scientific model and thus limit a new set of glosses that might free them to another possibility.
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Jeffrey, thank you for your service and welcome home, bro. I am a combat vet as well, serving two combat tours. Like you, I got into it because I considered it to be a 'calling.' I was dating a massage therapist, and she started teaching me; I discovered that there was something for me in the work, and twelve years later, I cannot imagine doing anything else. I understand the economics of the profession. But at the same time, I wanted to make the work available to everyone, not just wealthy elites. I volunteered at a Soup Kitchen giving chair massage to the guests, and made my money working at a spa in Big Sur. Afterwords, I did my own thing, now going on ten years. I work with the financial situation of each person taking whatever they can fit into their budget. I stay busy, and never advertised, and all my clients are word of mouth. Further, the universe provides. I am not rich, but I take off a couple of months every year and go to South America to work with indigenous elders.
Mary, thanks for the kind words.
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Just to add to my comment.. I think massage therapy is respected now.. But not for its true potential. I mean there are spas and clinics all over the place now.. And I believe more people are getting massage more then ever.. But it is not respected for its true medical potential.. Not by a long ways..I had another example just the other day.. A women, sixty years old came into the spa to celibate her birthday. When I asked her what she needed from this massage she told me just to relax. So it is respected for that.. Relaxation...Everybody agrees with that... and it is very very good for that.. Perhaps the best therapy out there for those wanting to unwind and relieve stress...But its not recognized for its full potential... And she is a perfect example of what I mean....On palpation she had a nocioceptive( pain, flinch response) movement when I touched her left hip... Then she told me that she just has to live with that pain. She has been dealing with it for years...She went to a medical & physical therapy clinic in the past for several weeks without relief.. They finally told her that she needed cortisone injections, and if that didn't work , they described to her a specific surgical procedure . She didn't like the sound of that and finally quit seeing them on her own.. Figuring she would just have to live with it... NOW NOBODY PALPATED HER HIP.. Nobody. I did of course... It was a trigger point in her Gluteus Medius.. The TrP2 in the attachment.. Thats it. That was her hip pain. ...She left my massage table with no pain in her hip. She also left a big tip. So is massage therapy recognized.. No it is not. Not for its full potential anyway.. Not even close. Only a very few medical professionals know the true value of soft tissue work.
Gordon J. Wallis said:Gosh almost everyday I'm helping people with rotator cuff problems, hip problems(sciatica), low back pain, carpal tunnel and so on that these people have had for days, weeks, and even years.. Even though they have gone to medical doctors and other types of health care people...One guy told me he spent thousands of dollars...And Ive helped them in one or two sessions...Just the other day I had a client with a rotator cuff injury she had for a month. Obviously the medical person she saw before me didnt know anything about trigger points.. I palpated trigger points in her Infraspinatus, Supraspinatus, and Levator Scapulae... Within a few minutes those were gone, and so was her rotator cuff injury...I know that once any underlying pathology is ruled out( for structural problems), its soft tissue work all the way... And when I meet people I often here comments like.. " Oh I believe in massage"... Its like we are in the same category as Big Foot, UFOs, and the Lock Ness Monster. lol And pay scale is interesting... Not too long ago this young man came in to see me because his back and neck hurt...it had been hurting him for two months... He went to another type of health care professional twice a week for a month, and had two more weeks left on his treatment plan.. All he had was a trigger point in his Rhomboids..that was gone in a minute, and so was his back pain...So withing ten minutes of meeting him, his problem was over...I charged him for 15 min.,, he came in on a follow up a few days later, and he was fine...I saw him drinking a beer in a bar a few days after that , and he told me that his back is fine and that the other health care provider is still calling him to come in and finish up the treatment plan...And that health care provider drives a very expensive car...I think I made $40.00 total for fixing his problem. One of the thing thats been a hard lesson to accept is.. Life is not fair. But things can and do change...And the other thing. And Ive said this many times...Our massage text books tell us to run to a medical doctor if we think we might have carpal tunnel...When massage is the best therapy for carpal tunnel.. So right from the beginning , even massage therapists, are culturally conditioned...
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Your replies are appreciated Gordon. Your real-life examples are great testaments to the work we do and they help identify the possible "whys" of massage therapy's poor (medical) recognition of its true value -- too simple to be believed, not invasive (enough) to be effective, etc.?
I am learning a lot from your posts and want to thank you for the attachments.
Happy Thanksgiving everyone!
Gordon J. Wallis said:Just to add to my comment.. I think massage therapy is respected now.. But not for its true potential. I mean there are spas and clinics all over the place now.. And I believe more people are getting massage more then ever.. But it is not respected for its true medical potential.. Not by a long ways..I had another example just the other day.. A women, sixty years old came into the spa to celibate her birthday. When I asked her what she needed from this massage she told me just to relax. So it is respected for that.. Relaxation...Everybody agrees with that... and it is very very good for that.. Perhaps the best therapy out there for those wanting to unwind and relieve stress...But its not recognized for its full potential... And she is a perfect example of what I mean....On palpation she had a nocioceptive( pain, flinch response) movement when I touched her left hip... Then she told me that she just has to live with that pain. She has been dealing with it for years...She went to a medical & physical therapy clinic in the past for several weeks without relief.. They finally told her that she needed cortisone injections, and if that didn't work , they described to her a specific surgical procedure . She didn't like the sound of that and finally quit seeing them on her own.. Figuring she would just have to live with it... NOW NOBODY PALPATED HER HIP.. Nobody. I did of course... It was a trigger point in her Gluteus Medius.. The TrP2 in the attachment.. Thats it. That was her hip pain. ...She left my massage table with no pain in her hip. She also left a big tip. So is massage therapy recognized.. No it is not. Not for its full potential anyway.. Not even close. Only a very few medical professionals know the true value of soft tissue work.
Gordon J. Wallis said:Gosh almost everyday I'm helping people with rotator cuff problems, hip problems(sciatica), low back pain, carpal tunnel and so on that these people have had for days, weeks, and even years.. Even though they have gone to medical doctors and other types of health care people...One guy told me he spent thousands of dollars...And Ive helped them in one or two sessions...Just the other day I had a client with a rotator cuff injury she had for a month. Obviously the medical person she saw before me didnt know anything about trigger points.. I palpated trigger points in her Infraspinatus, Supraspinatus, and Levator Scapulae... Within a few minutes those were gone, and so was her rotator cuff injury...I know that once any underlying pathology is ruled out( for structural problems), its soft tissue work all the way... And when I meet people I often here comments like.. " Oh I believe in massage"... Its like we are in the same category as Big Foot, UFOs, and the Lock Ness Monster. lol And pay scale is interesting... Not too long ago this young man came in to see me because his back and neck hurt...it had been hurting him for two months... He went to another type of health care professional twice a week for a month, and had two more weeks left on his treatment plan.. All he had was a trigger point in his Rhomboids..that was gone in a minute, and so was his back pain...So withing ten minutes of meeting him, his problem was over...I charged him for 15 min.,, he came in on a follow up a few days later, and he was fine...I saw him drinking a beer in a bar a few days after that , and he told me that his back is fine and that the other health care provider is still calling him to come in and finish up the treatment plan...And that health care provider drives a very expensive car...I think I made $40.00 total for fixing his problem. One of the thing thats been a hard lesson to accept is.. Life is not fair. But things can and do change...And the other thing. And Ive said this many times...Our massage text books tell us to run to a medical doctor if we think we might have carpal tunnel...When massage is the best therapy for carpal tunnel.. So right from the beginning , even massage therapists, are culturally conditioned...
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