Pampering Vs. Therapy: It's All Good
It's understandable - completely wrong, but understandable - that some laypeople in the United States still see spa treatments as "just pampering." The reasons are largely historical. These days, with a spa in every big hotel and a day spa on practically every corner, it's easy to forget the long, eventful history of spa culture in this country, but it plays a big part in current attitudes toward spa.

Natural cures and sanitariums were popular in the 19th and early 20th centuries, but some early natural healers made exaggerated claims. At the same time, modern medical technology was becoming more effective, and the mainstream medical community more powerful. In the 1930s, the American Medical Association shut the natural healing centers down.

"Another thing that led to the abandonment of spa in this country was that, to Americans, spa just took too long," says spa educator Anne Bramham. "Americans want things done fast. But in Europe, where people are a little more patient, they never ditched the traditional treatments. They kept them and integrated them with the new medicine."

Spa - once respected, then reviled as crackpot and banished - was re-introduced to America toward the end of the 20th century. The context was, of course, a health-care culture invested heavily in pharmaceutical remedies, high-tech prevention and heroic, crisis-oriented surgeries. Alongside antibiotics and open-heart surgery, spa didn't look much like health care - a basic preventive and curative regimen - but like frill, an expensive self-indulgence. Spa was something that movie stars and other wealthy people picked up while they flitted around the Continent.

That is, in fact, where modern American spa gets much of its inspiration, but the decadent image associated with anything European was, and is, just silly. It's a genuinely American attitude, though: If it feels good, it must be very expensive.

Spas in North America basically functioned as fat-farms for the well-to-do until about 20 years ago. That's when some leaders in the industry - Rancho La Puerta, The Oaks at Ojai, The Golden Door and Canyon Ranch - began moving toward a more European, healing-from-the-inside approach. Many of their customers had been to the great healing-and-pampering spas of Europe, and they were looking for something holistic and sophisticated closer to home.

As we all know, they started a revolution in the spa industry. Today, as the interdependency of mind and body, and the very real limitations of Western medicine in dealing with chronic disease become clearer, public perception is changing fast. The American public is developing a more realistic understanding of spa as a potentially serious alternative to medicine.

Even for some people who should know better, though, the association of spa with luxury still obscures its therapeutic seriousness. It's an interesting misperception, actually, because, in a way, it's right. The therapeutic value of spa cannot be separated from pleasure. In spa, luxury - an effortless experience that bathes all the senses in pleasant sensation - contributes to therapeutic effect. (Spa is guilty as charged!)

I'd like, however, to pretend for a moment that health and pleasure have nothing to do with each other. First I'll address the therapeutic and then the pampering aspects of spa.

Spa as Therapy
From ancient times, massage therapists have known what Tiffany Field's Touch Research Institute is now busily documenting for the scientific and medical communities: Touch calms, comforts and promotes healing. Touch is necessary for normal human development, and for well-being of body, mind and soul. This has become so widely accepted that physicians now write referrals for massage therapy, and an increasing number of insurance companies and HMOs cover bodywork even for clients who self-refer.

Massage is an important part of spa, of course, but spa encompasses much more: hydrotherapy, manual lymph drainage, energy medicine, aromatherapy, guided imagery, color therapy, dietetics, kinesiology, tribal healing practices, and on and on. Do these practices work? Yes, and there's a large and growing body of research documenting their effectiveness in terms that fit the official Western medical model. A search on any of them on the National Library of Medicine's PubMed site (www.ncbi.nlm.nih.gov/entrez) produces dozens of titles from respected journals all over the world. Recent studies range from a double-blind study of the calming effects of aromatherapy on patients with severe dementia to a clinical trial of spa-exercise therapy for people with ankylosing spondylitis.

Take hydrotherapy, probably the best-documented of the "alternative" therapies. (A search on PubMed produces 66 pages of titles.) Hydrotherapy is one of the oldest forms of treatment known, and its longevity is due to its efficacy. Human beings have soaked their arthritic joints and aching muscles in the Dead Sea since the beginning of recorded time, and they're still doing it today. Why? Because it makes them feel much better.

Even standard American medicine has a place for hydrotherapy. Epsom Salts® are sold in every drug store, along with an ever-increasing selection of more expensive, exotic mineral salts. Immersion is standard treatment for injury, and post-surgical patients often take their first walk in a pool. And water soothes mind as well as body: Shell-shocked soldiers in World War I were sent to spas to recuperate before being sent back to the front lines.

Still, few people in the United States understand how widely used and respected hydrotherapy is in Europe, where doctors of hydrotherapy prescribe courses of treatment administered by massage therapists and hydrotherapy technicians. The Kneipp Vademecum Pro Medico (1987), a handbook for physicians published by a German hydrotherapy association, meticulously specifies weeklong regimens for convalescents and for patients suffering from chronic illnesses ranging from arthritis to hyperthyroidism to varicose veins. Since allopathic European medicine has evolved alongside traditional cures and recognizes hydrotherapy for the vascular gymnastics it is, the Kneipp protocols are designed to be integrated with standard treatments.

Is hydrotherapy luxurious? In one sense, it is: It isn't fully available to everyone. In the best of all possible worlds, everyone would have access to the best possible care, an integrated blend of modern medical technology and the oldest cures of all - rest, quiet, pleasant surroundings, fresh air, exercise, hydrotherapy and skilled, compassionate touch. The fact that not everyone does have access to holistic, low-tech modalities doesn't mean that they aren't good; it just means that our health-care system is in desperate need of improvement.

Pampering: What's wrong with it?
Call it pampering, coddling, babying or grooming. Call it being indulged. Call it being lulled to a conscious state almost undistinguishable from sleep - the most healing of all physical and mental states. Call it being catered to and waited on and being made very, very comfortable.

Call it being comforted.

Call it whatever you want - we all need it.

We pamper ourselves and the people we love in all sorts of little ways - or we are neither happy nor healthy. A candlelight dinner and a bottle of wine; a scented bath and a cup of tea; a picnic on a beautiful afternoon; a neck-rub and sympathy to the soundtrack of a favorite CD; an hour spent curled up with a pet and an afghan. These are creature comforts, and we must have them, because we are physical beings with five acute senses living in an over-revved, touch-deprived world.

Spa is not different from everyday self-care; spa just takes pampering to the level of art. And spa pampers for a reason - to help the individual integrate all five senses, thereby achieving a physical, emotional and mental state of maximum comfort and ease. That's no small order: Designing and delivering great spa treatments requires expertise, empathy and meticulous care because we're nervous, observant, intelligent, highly stress-susceptible creatures.

All aspects of spa offer real benefits for the very large part of us that loves to groom and be groomed, touch and be touched. A manicure is possibly the least health-oriented of all spa treatments, and yet nail polish and emery boards are two of the basic tools of an effective, Nobel-Prize nominated program for badly traumatized Cambodian refugees. According to Andrew Solomon's The Noonday Demon, Phaly Nuon, living in an impoverished settlement of refugees from Khmer Rouge terror, established a steam room and a place where women under her care could sit and talk and help one another heal as they did one another's nails. Even beauty services can be profoundly therapeutic.

The ultimate aim of spa is soothing the psyche itself - the hardest part of ourselves for any of us to manage - and thereby calming and integrating body and mind. When the body relaxes, it heals. When the mind lets go, the body relaxes. Spa heals.