February 24, 2025 • 59 mins
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Corey Rivera and Cal Cates address the alarming suicide rates among massage therapists by exploring underlying risk factors, including perfectionism, isolation, and occupational stress. By recognizing these nuances, the conversation encourages community engagement and accountability to promote better mental health outcomes.
• Discussing general risk factors for suicide
• Understanding perfectionism and its types
• Examining isolation within the massage therapy profession
• Highlighting the economic instability faced by massage therapists
• Analyzing the impact of ACEs on mental health
• Exploring job demand and control dynamics
• Reflecting on the effects of COVID-19 on the workforce
• Emphasizing the need for community and support in the profession
Healwell Blog; Worst. Game. Ever.
CDC Article: Suicide Rates by Industry and Occupation
Healwell Class: Empowering Individuals to Navigate Crisis
Integrated Motivational Volitional Model of Suicidal Behavior
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Corey Rivera (00:06):
Welcome to the Rub a HealWell podcast about
massage therapy.
I'm your host, Kori Rivera,licensed massage therapist and
information magpie, and todaywe're going to continue our
conversation about the suiciderate for massage therapists by
talking about risk factors.
Before we get started, youshould know that I got COVID a
(00:32):
couple weeks before recordingthis episode and that means for
some of this recording I soundedlike well, like I had COVID.
This episode is my re-recordingof some of the information,
with HealWell's ExecutiveDirector Cal Cates' comments
dropped in.
Sorry about the unevenness ofthis episode.
You can join us on Tuesday,February 25th, at 7pm Eastern
(00:54):
for an online processing sessionabout this information.
The event is free, but you willneed to register at the link in
the show notes.
Also, we now have a phonenumber where you can leave a
message for the podcast, whichis also in the show notes.
If you didn't listen to thelast episode, I highly recommend
going back and checking it out.
The question that I sort ofskated directly by in that
(01:17):
episode was probably the firstquestion on your mind, which is
why why are massage therapistrates so high?
And the reason we glossed overit is because we felt it was
more important to give peopleinformation about what they
might be dealing with in thepresent than it was about musing
about why it might be so.
Today, Cal Cates and I are goingto talk about the first part of
(01:39):
the integrated volitional model.
We talked about parts two andthree in the last episode, and
now we're going to talk aboutthe first one, which has to do
with background and risk factors, which are reasons or past
experiences that can increasethe risk of suicidal behavior or
things that make you vulnerableto entering the cycle of defeat
, entrapment, suicidal ideationand suicidal action.
(02:00):
There is no scoring system forrisk factors.
It is not one plus one equalstwo.
It's not straightforward andit's not that if you have all of
these traits, you're going toenter the cycle.
So we can talk about riskfactors that increase risk and
we can talk about factors thatdecrease risk in groups of
people, but that risk doesn'tdirectly apply to a single
(02:21):
person.
In this episode we're going totalk about things that increase
risk for everybody in generaland things that increase risk
that have to do with jobs andoccupations, and then we're
going to sort of ponder someideas that might have to do with
massage therapists specifically.
The ideas that have to do withrisk in general are quite well
supported.
There's a lot of studies thathave been done.
They have a lot of attention.
(02:42):
There's a lot of money that hasbeen put into these ideas to
try and understand them.
As for the things that have todo with massage therapists,
we're guessing because we don'tput money or effort into
studying ourselves.
We just don't, and you're goingto hear me say that a lot and
maybe for forever on thispodcast, until we start doing it
, because it's a thing thatdrives me absolutely batty.
(03:04):
The Massage Therapy Foundationhas very specific grants that it
awards people with every year,and those grants are very, very
specifically written and theyexclude us from funding studies
to study ourselves.
As far as I understand, thiswas just an oversight.
Building something like theMassage Therapy Foundation and
launching an academic journal isa gigantic, enormous task that
(03:27):
I am honestly constantly amazedwas successful.
So for now, just know that theconversations Kyle and I are
going to have about massagetherapy are things from our
experience.
They're from what we see andwhat we hear from people, which
is certainly a valid form ofgathering data, but it's not as
comprehensive as we wish it was.
Okay.
General risk factors.
I'm going to start right offthe bat with guns.
(03:49):
Owning a gun ups your risk forattempting suicide.
It doesn't matter if you willuse the gun in the suicidal act.
Just owning one increases yourrisk, particularly if you're
male.
Men are more likely tosuccessfully complete an act of
suicide and women are morelikely to attempt it, but men
tend to complete the act moreoften, and partly that has to do
(04:13):
with the use of firearms.
As for race or ethnicity,Native Americans and Alaskan
Natives are at the most risk.
White people are actuallysecond on the list and it turns
out that Black women have thelowest rates, and no one is
completely sure why.
For family history, suicide isnot genetic, but having a family
(04:37):
member make an attempt or haveideation or an experience with
it can increase your risk.
The best predictor of a futureattempt is a past attempt or
past self-harm.
That's something that we knowabsolutely for sure.
We know that isolation is alsoa big factor.
We know that mental healthproblems can contribute,
although only about 70% ofpeople who attempt have a
diagnosed mental illness, whichmeans about a third of people do
(04:59):
not, and most people with ahistory of mental illness will
never make any attempt at all.
So those are basic demographicrisk factors, there are also
personality risk factors.
There's a personality traitcalled perfectionism that I have
(05:19):
some experience with.
Perfectionism itself is a scale.
It's not a binary.
It's not that you are aperfectionist or you are not.
Generally, most people aresomewhere along the continuum
and it's circumstantial, whichmeans that something happens
that makes it flare up.
In one of the books I read, itsays it acts up when provoked,
which I thought was a very gooddescription.
There are three types ofperfectionism.
(05:40):
The first is self-orientedperfectionism, which is what we
expect of ourselves.
The second is sociallyprescribed perfectionism, which
is what we think others expectof us.
And the last is other-orientedperfectionism, which is what we
expect of other people.
The one that really gets you isthe second one, socially
(06:01):
prescribed what we think othersexpect of us, and this is really
important, because it's notactually what others expect of
us, it's what we think theyexpect of us.
There's a scale that's used tomeasure this.
With questions like I find itdifficult to meet others'
expectations of me, and peopleexpect more from me than I am
capable of giving.
(06:22):
We tell ourselves stories allthe time to make sense of the
things around us, and all of ourstories are always incomplete
and you don't actually know whatanybody else is thinking unless
you act them directly.
And even then they would haveto know what they're thinking
and tell you directly in orderfor you to get a whole picture.
So it's really just thisprocess of ongoing guessing.
(06:44):
So this idea that you arethinking about what other people
are thinking, which makes youthink about yourself, is known
as metacognition, or havingthoughts about your thoughts,
and it's hard because it feelslike you're not in control.
The thoughts are real, but thereality of those thoughts might
not be.
Here's Kel Cates.
Cal Cates (07:04):
I mean, you alluded to this very problematic thing
that I think we tend to glossover in daily life, which is
that we don't typically haveunfettered access to our own
thoughts and that when we askother people to tell us what
they're thinking or what they'refeeling, they're in the same
(07:24):
boat, and so they they perhapsnot even with intentional plans
to obfuscate the truth.
You're not.
You're getting what they haveaccess to, which, as you said,
is always incomplete.
And yeah, so I, we can't.
I feel like you can't stressthat enough, that we are living
(07:47):
in a world of stories thathaven't been fact-checked, and
this is how we make thedecisions in our lives and how
we shape our view of what ourworld looks like, and it's very
hard to notice that we're doingthat and to fix it, even if we
do notice it, like, how do youactually see what's true?
I think that's a very hardthing.
Corey Rivera (08:10):
And in the final part of this re-recording I want
to tell you that there's aninteresting correlation in
specific states Montana, wyoming, colorado, utah, nevada and New
Mexico have about a 30% higherrate than the national average,
and nobody knows completely whyNevada and New Mexico have about
a 30% higher rate than thenational average and nobody
knows completely why.
(08:30):
The first theory I read wasabout living at high altitudes,
which I don't know.
That I really believe the otherreasons were that these states
are very rural and they don'thave a lot of mental health
resources.
They have high rates of gunownership, which we talked about
earlier, and high rates ofpopulation shift, which means
that people sort of come and goin the communities and they
don't necessarily stick aroundto build community ties.
So they have weakened socialbonds.
(08:52):
That means their isolationismincreases, their social
connection decreases and thatmaybe results in higher rates.
Here's Cal Gates again.
Cal Cates (09:14):
I have to support the idea that it's not about
altitude, as there are lots ofthriving here's Cal Gates again.
And isolation people go oh well, I have lots of friends or I'm
married or I have kids and theidea that if there are people
around, that you're not isolated.
And you know, I know thatmassage therapists will get into
how isolating this sort of jobis.
(09:36):
But it's a people job, right?
And I think that we have thisstory that if there are people
around or I am quote unquote ina community, I'm not
experiencing isolation.
And I know we're going tounpack that.
But that feels very importantto me that it's not actually
about being in a crowd or not ina crowd, or being a member of a
(09:57):
family or not.
It's.
It's again about yourperspective, about your level of
connection about your level ofconnection.
Corey Rivera (10:07):
Yeah, we will get into more of that a little bit
later, but for now I want totalk about this idea of comfort
with the idea of death, and thisis something that came up in
the last podcast episode, but wedidn't really talk about it
very much, partly because Ihadn't really thought too much
about it in relation to massagetherapists.
(10:27):
It seemed more like a generalidea and then the more I thought
about it, the more.
The more I thought about it,the more pertinent it seemed to
become as far as being a massagetherapist.
So here's my theory, and thenI'll ask Calcates to jump in
here.
So massage therapists have ahuge role to play in death and
(10:50):
dying, whether or not you workin a hospice situation, but
probably especially if you workin a hospice situation.
But the risk isn't aboutunderstanding or being
introspective about death, isn'tabout understanding or being
introspective about deathAlthough if you're going to work
in these situations, you shoulddefinitely get some education
and HealWell has some reallygreat stuff that you could check
(11:10):
out to help you with that butthe risk is inherent in the job
itself, because you're dealingintimately with people's lives
and people get sick and peopledie and family members get sick,
lives and people get sick, andpeople die and family members
get sick, and there's a lot of,just there's a lot of exposure
and really direct exposure, Ithink, probably for any
(11:32):
healthcare professional, but forus, we're next to it, but we're
also in it with people and inorder to do that job and to be
there for people, you have toget more comfortable with the
idea in order to take care ofthat person that you're working
with.
So I think of it as like therisk of getting burned when
you're working in a kitchen,it's just always a risk because
(11:55):
you're in a kitchen and thingsare hot and there's no way to
get away from it, and that'sjust.
That's just nature of the jobitself, calcates.
You have a very, verythoughtful expression.
Cal Cates (12:08):
I feel like yes, and because in my experience, even
massage therapists who comethrough our end-of-life classes
or our classes that are aboutmortality and such, are coming
for other people.
They're not there to look atsort of their own mortality.
And also I think that there ispossibly and this is maybe part
(12:31):
of what exacerbates theisolation that massage
therapists experience is thatwhat you've just said is
absolutely true.
What we are doing is workingwith human bodies, which, you
know, in Buddhism, the fiveremembrances are I am of a
nature to grow old, I am of anature to die, I'm of nature to
become sick, like this is whatbodies do.
And every time we see a person,maybe they're in the quote,
(12:54):
prime of their life, right, andthere aren't obvious signs of
infirmity or sort of mortality.
And yet I think there's athere's that metacognition, that
that thoughts about thoughts,that while you're working with
this person, you're pushing awaythis death piece, this sort of
infirmity piece.
And so it's there, but likewellness, big air bunnies, and
(13:21):
like the health industry, etcetera, is deeply invested in
not acknowledging that I wasjust thinking of, like what the
commercial looks like.
Corey Rivera (13:33):
That's like you're going to die.
Would you like to buy some soap?
Cal Cates (13:38):
Death stinks, but you don't have to.
Corey Rivera (13:42):
So, yeah, high comfort with the idea of death
equals more risk.
Just because you're less afraidof dying again, it does not
mean none of this means that youare necessarily more at risk.
It means it's a general sort ofsense.
The next one that came rightafter that that I also kind of
glossed over in the last episode, was sensitivity to physical
(14:04):
pain and I was like that's notreally us, that's like, that's
like firefighters and that'slike, again, with the kitchens.
My husband worked in the kitchenfor a long time.
So I have a lot of a lot ofkitchen stories but like a lot
of standing, a lot of like a lotof twisting and kitchens, a lot
of lifting of heavy things.
I was like it's more like that,that's not really us and more
(14:28):
like that, that's not really us.
And then and then I had aconversation with someone and
they were like oh yeah, I thinkI just dislocated my pinky and
it'll be fine and I'm going togo work on the three people that
I still got today.
And I was like, oh, maybe we do.
I used to work with someone whohad ganglion cysts in their
wrists from being a gymnast andthey just just bothered her all
the time and she just came towork every day and worked on six
people all the time and, youknow, took some ibuprofen and
(14:49):
got on with her job.
So injury and physical pain anddiscomfort is 100% part of
being a massage therapist.
Cal Cates (14:58):
Well, and I wonder.
I mean, pain is so complicatedand obviously we all have our
biases and stories and judgmentsabout it.
But I wonder also about thethat when you are, I'll say, in
denial and that's maybe not agraceful way to say it, but in
denial about your physicalexperience, it's another piece
(15:21):
of isolation, right, it'sanother piece of disconnection
that you're like just pressingon despite all evidence to the
contrary, and it makes sensethat that would be a risk factor
and that it's not.
I don't know.
There's I think there's sort ofsome bragging that happens even
.
Corey Rivera (15:39):
Oh, definitely.
Cal Cates (15:40):
Right About how you can work through anything and
like you know pain don't hurt.
Corey Rivera (15:44):
Look how tough I am.
Right About how you can workthrough anything and, like you
know, pain don't hurt.
Look how tough I am.
Cal Cates (15:47):
Right and culturally.
I feel like there's a lot ofsupport for the idea that you
just suck it up and well yeah,being a good little productive
member, look at you.
Right, no, no wellness, it'snot for me, it's for you.
Corey Rivera (16:09):
Yes, I'm a purveyor of wellness, not a
consumer, not an actualpractitioner.
That's not not for me, right,yeah, yes, the last thing I want
to talk about, that is sort ofa generalized risk factor, are
what are called ACEs, whichstands for adverse childhood
experiences.
Aces are events that happen topeople usually when they're
(16:30):
under 18 years old.
There's 10 items in this listand they include things like
abuse of any kind, exposure toviolence, parental divorce,
having household members inprison, and, of this list, the
more ACEs you have generally theworse your health outcomes are,
kind of all the way around.
So ACEs have gotten to be ametric that is used in most, I
(16:54):
think, health measurement studysituations is to compare how
many ACEs people have to whatthe health outcomes ended up
being.
So multiple ACEs in this casemeans a greater risk of a
suicide attempt, and it'sexponential.
So seven or more ACEs increasethe chance of a suicide attempt
for adolescents by 51 times and,as an adult, by 30 times.
(17:18):
So it's big Things.
To remember about ACEs is thatthe ACE count only counts bad
experiences.
It does not take into accountgood experiences or resiliency
building experiences that mightcounteract the ACE experiences
that happened.
So it's an incomplete pictureby any sense of the word.
(17:38):
It's an incomplete picture,however you want to take it, but
it is pretty reliable, sort ofas a predictor and a scale that
we now use in this time in ourlives, slash history where, um,
I feel like it is trulyincumbent upon us to see each
(18:00):
other fully aces feel havealways felt really important.
Cal Cates (18:03):
But I feel like, if we, if we each just passed each
other a card that had our aceson it when we met, you squared
around your neck like a lanyard,like can you?
I mean, can you imagine peoplebe like, oh right, like every
meetup would start with a hug,um, and then we'd all be like,
oh okay, yeah, okay, yeah, no,how about if I don't harm you?
(18:25):
Like, how about if we just tryto, you know, stem the tide here
, and that we just have solittle awareness of how each of
us has been shaped and thevulnerabilities that we sort of
come to adult life with, or evenadolescence?
And so, as you said, the acesis not a complete picture,
(18:48):
because, of course, for many ofus there are plenty of aces.
But then also there was thatbasketball coach who sort of
took you under their wing, orthere was that, you know, all
these other experiences thatmaybe mitigate or ameliorate the
long term impact, but stillthat when you look at the list,
there are a few of us that don'thave some ACEs right, at least
(19:09):
one, yeah, yeah.
So an adverse childhood eventsis such a sanitized sort of way
to say what's on that list, butit makes complete sense that it
might add to a sense ofhopelessness or a sense of a
need to escape as you continueto live this human existence.
Corey Rivera (19:31):
So this is the general sorts of everyday
population level risk factors,and now I want to talk about
risks that are specific tooccupation.
So there have been since aboutthe 70s and 80s, and then sort
of increasing from there,studies about how jobs and work
(19:53):
environments affect people andspecifically how it affects
their health, how it affectstheir happiness and because we
are a capitalist society how itaffects their productivity,
because if you're making anargument to a company or a boss,
they like the word productivityto be included and they get
much more interested when yousay productivity is lower, and
(20:15):
then they perk up.
So the CDC report that we gotthose statistics from has, it's
just a list of like six to eightthings that might contribute,
and so I took the list of six toeight things and then went to
look for all of them, becausethis is what I do in my job now.
So there were a couple ofthings that were really really
(20:36):
straightforward that contributedto suicide risk in an
occupational manner.
The first one was lower inabsolute relative economic
status, which means you're justpoor and you might not be able
to get out of it ever.
So that one was prettystraightforward, made a lot of
sense.
The second one was lowereducational attainment, and I
(20:58):
couldn't find a really goodexplanation as to why lower
educational attainment was onthis list, and part of me feels
that higher educationalattainment also sort of goes
with the idea of not havinglower economic status.
Cal Cates (21:12):
It doesn't seem like a unique factor.
Corey Rivera (21:17):
It's sort of like representative of other life
situations.
Most people are pretty wellaware now that getting a degree
doesn't necessarily mean thatmuch and what you got your
degree in doesn't necessarilymean that much.
So just having the degree beinga thing that lowers your risk
is like I don't know, I don'tknow, that's the piece of paper
that did it.
The third thing was lowerskilled jobs.
(21:38):
I don't really like the termlower skilled personally,
because I think all jobs requireskills.
They just might not be astechnical or require an eight
year degree as other skills.
That doesn't mean you wereunskilled.
But when I was discussing someof this with Dr Ambler-Kennedy,
(21:59):
who ran a project called COPEduring the COVID lockdowns that
was assessing moral distress inhealthcare workers, including
massage therapists, shementioned that a lot of the
things that showed up at the topof this list for suicidal rates
are occupations that do nothave transferable skills.
So like bartending is on thislist, and if you're a bartender,
(22:23):
you're a bartender.
And if all the bars are closed,what do you do?
You don't really have a placeto go.
And then I had a discussionwith a nurse and she talked
about how a lot of her friendsjust switched nursing jobs.
So they maybe were working in ahospital with patients and then
during COVID they were like,nope, can't do it, peace out,
I'm going to go do paperwork.
(22:43):
So their job skills aretransferable or at least they
have places to go.
And as far as massagetherapists go, we're massage
therapists Like that's.
We don't really have apaperwork job to slide into.
Cal Cates (22:58):
Well, I'm thinking oh well, we could be bartenders
because there's a lot ofsimilarity there, but not if
there's no bars open, so nevermind, that's true, that's true.
Corey Rivera (23:09):
So skills that don't shift well to a new job
opportunity.
So that sort of feeds into theentrapment idea that we
discussed in the last episode.
The next one was economicinstability or variability.
I think this one applies to usa lot.
Massage therapists do not getpaid time off.
For most of us we don't getpaid if we don't have clients
(23:31):
booked.
We don't get paid for time thatisn't spent hands-on most of
the time.
Demand sort of waxes and wanes,everybody, all massage
therapists know that Valentine'sDay, if you like couples
massage, it is the time for you,and if you hate couples massage
, that's too bad for about threeweeks Because you're going to
have to set up both those tablesand have that wife glare at you
(23:53):
while you work on her husband,and that's just what's going to
happen for a while.
And then in summer, right,people just sort of go off and
do summery things and maybe yourschedule's not so full, so the
variability is relatively high.
And then even with booking yourschedule, aside from that,
clients cancel at last minute.
(24:14):
We struggle with our no-showfees, so you don't get anything.
If you're working for yourself,maybe your business this is one
of my favorites is when theperson that you work for is like
well, do you want to enforcethe no-show fee?
Can I make you the bad personwhere you enforce the no-show
fee?
Cal Cates (24:38):
where you enforce the no-show fee.
Well, I was thinking that youknow, when I had a really busy
private practice that certainlythere's the boundary issue right
of enforcing the no-show fee.
But another thing that pointsback to sort of the overwork et
cetera is that when clientswould cancel last minute, I
would often just be relievedbecause I had time to either
catch up on my notes or mylaundry or right.
It's like I don't feel rightmaking you pay for time that I'm
getting back, right, and soit's sort of a wash.
(25:01):
But it's also not a wash Right,because no one is paying me for
that hour when I support mybusiness, right.
Corey Rivera (25:07):
So your relief is apparently enough for you not to
enforce the no show fee andthen also to assuage your guilt
that you're not, that you'relike kind of okay, yes, just got
some quote free time, unquote,correct and maybe you can go
home, you know, 40 minutesearlier because you were able to
do the other thing.
But when you look at it from abusiness standpoint, you just
made zero dollars.
Cal Cates (25:28):
So zero dollars less than zero dollars.
Right, Because you worked forfree, really.
Corey Rivera (25:34):
Really yeah, yeah, Yep.
So we are definitely.
We definitely fit the economicinstability and variability
category.
And then the next two conceptsI want to talk about kind of
together, but I want to explainthem separately.
So these are the things thatkind of came out of the 70s and
80s.
And if you start readingliterature about occupational
stress and like mood disorders,it comes up in every article.
(25:56):
These things every, everysingle article cites both of
these concepts.
So the first concept is calledjob demand or low job control,
and this is a structural issue.
So job demand theory describestypes of work in two dimensions.
So, if you like, picture like abox plot sort of thing one of
(26:19):
those dimensions is thedifficulty of the job.
So do you have a hard job or doyou have an easy job?
And the other dimension is howmuch control you have over the
execution of the job.
So do you have a lot of controland you get to make choices, or
do you have very little controland you have to follow somebody
else's rules?
Whether or not those rules makesense, it doesn't, you know.
(26:41):
And we've all had all kinds ofjobs that have all of these
traits.
So if you put it in a box plot.
It creates four kinds of jobs.
Right, there's a high demand,high control job, which is
something like a surgeon, whereyour job is really hard but you
have a lot of control.
You're the person in charge,you get to make those decisions.
And then the other end, there'sa low demand, low control job,
(27:02):
which might be like a fast foodworker Although I could also
make an argument for that beinghigh demand.
But in this scenario low demand, low control you're doing the
same thing all the time.
It's extremely regulated andrigid and there's a lot of rules
and a lot of routines that youhave to follow.
But you're not openingsomebody's aorta either.
(27:25):
So those are the two sort ofspectrums.
So the danger zone comes in whenyour job is high demand, when
you have a lot of responsibilityand you have low control over
how you execute thatresponsibility, and this sounds
a lot like the worst kind offranchise work that could ever
exist.
So you're taking care of aperson and you're taking care of
(27:46):
their body and their mind andyou're comforting them and
you're interacting at a reallypersonal level no-transcript and
(28:17):
self-reporting.
So they have questionnairesthat they give out to people to
self-report and then they trackwhether or not, they have heart
attacks later.
The results are not great forpeople who are in high-demand,
low-control jobs.
So this is the experience ofhaving lots of responsibility
and being micromanaged.
This is about structure, like Isaid before, so this is about
(28:40):
power structures at work.
This is about the division oflabor at your work.
This is about democracy howmuch say in what you do.
So one study showed that lowjob control increases suicide
rate by four times, which isquite a bit.
It's very stressful, and if youare in a situation where you
cannot change jobs and you don'thave a prospect which we're
(29:02):
going to talk about in a secondand you're stuck there, that's a
lot of stress to put on a human.
Cal Cates (29:08):
I wonder also.
I was talking in one of ourclasses, just actually we were
talking with our palliative careprogram students yesterday.
The conversation was about this, this ongoing tension of sort
of the customer being right, andI feel like certainly we think
about structural factors interms of low control.
And you know, if you work in anenvironment where someone else
(29:30):
is setting your schedule, butthat even in your treatment room
, depending on your treatmentsetting, you are often being
asked by the people who are yourclients, customers, whatever
word you use, you're being askedto do things that are against
what you know is sort of safe orhealthy or supportive, and that
you sort of don't have theability to say actually like,
(29:55):
let's, you know, work a littlebit differently, or I hear what
you're saying and let's do this.
That you really just are, youknow.
To go back to our robot episode, you're being expected to do
what the customer wants, even ifthat goes against whatever
boundaries you have internallyor whatever you know about
safety and technique, et cetera.
So another aspect of lowcontrol yes, yeah.
Corey Rivera (30:18):
So it's not just your manager but it is also your
clients, so it's from bothdirections.
So the second idea that comesup in almost every piece of
literature that I read is calledeffort, reward and balance, and
this is both structural andpersonal.
So effort, reward and balanceis the idea that you work super
hard and nobody cares, um, andeven if they do care, and maybe
(30:40):
they love you a lot and they'llgive you an amazon gift card
once in a while and they'll havea ceremony at work where they
give you a trophy that youreally could use the 30 they
sent on spent on the trophy, butyou know, thanks anyway.
So it is constant effortrewarded with little or nothing.
And high effort alone and lowreward alone are not nearly as
(31:05):
stressful as having both of themtogether, so they like compound
each other.
So if you work really hard andpeople kind of recognize it,
then it's OK.
And if you aren't rewarded alot but you don't actually have
to do a lot, then like that'snot great but it's also okay.
But high effort, low reward badnews bears.
So this causes problems withyour self-efficacy and your
(31:29):
self-esteem and your sense ofbelonging, because you're being
taken advantage of and you knowit, and nobody cares, and
obviously I mean massagetherapist, right.
So we're like it must be me, um, must be something about me,
and we are constantly, I think,put in a position of
(31:53):
subservience to most of thepeople that we work with, to our
clients and our managers, soyou don't have a lot that you
feel like you can say about it.
The other important piece aboutthis and I think I laughed out
loud when I first read it soreward in this context is
considered money, esteem andcareer opportunities, and that
(32:15):
includes job security andpromotions.
And we got none of them, not aone.
Cal Cates (32:21):
Well, and I feel like the esteem thing is
particularly complicated because, you know, even when we talk
about the rewards, the rewardsCorey are internal rewards.
The rewards Corey are internal.
I am a loving, compassionateperson.
So the idea that I would evenfeel exploited, even if I don't
say it out loud, as you said,means that I'm doing something
(32:42):
wrong, because as a massagetherapist, I am proud of my open
hearted, giving nature, and ifI'm feeling like there's an
imbalance there, that's on me,and so it is that double whammy
of you know, I better keep quietabout it which of course takes
us back to isolation, which ofcourse takes us to disconnection
, and it is a really it's noteven a single dog chasing its
(33:05):
tail right.
It's like a whole, like puppymill Pack.
Yeah.
Corey Rivera (33:09):
A puppy mill?
Oh no.
So this imbalance happens whenthere are a few job alternatives
.
So we talked about lack ofmobility and lack of your skills
transferring when yourcontracts are poorly defined.
This is an interesting conceptthat I would like to pursue.
So there's an idea called anincomplete contract.
(33:30):
That is not, it's not a lawidea, it's like a philosophical
idea.
So it means that nobody toldyou or something started to get
assumed about your obligationsand benefits of your job.
So in an incomplete contract,it's like we did a handshake and
(33:53):
an elbow rub and like you knowwhat the job is like, it'll be
fine, that's fine, and then thejob just grows.
Or you don't know how, like howyou're being evaluated.
You don't know who's evaluatingyou or why.
You just don't have enoughsolid information to make
(34:17):
decisions or even makesuggestions about your job.
So high effort, low rewardoften happens at the beginning
of a work life because you thinkthat if you put up with it for
long enough, then you will getan opportunity later.
This is internships.
Internships are massively,massively in this high effort,
(34:43):
low reward thing.
So I'm not going to pay you.
Or for massage therapists, it'sexposure, right, I'm going to
pay you an exposure.
Just you'll get your name outthere and you'll work for 10
hours at our job fair.
Sure, that's going to work out.
So we're much more willing tokind of compromise at the
beginning.
And also I think there's no oneto tell you not to do it and I
sort of quietly assumed thatthis is just how it always
(35:06):
happens.
Right, you always have to payyour dues, like that.
Cal Cates (35:10):
Well, and I would argue that, even the sort of
incomplete contract withyourself that I have worked at a
couple of places, at a massagetherapist, but as a massage
therapist, but I've largelyworked for myself and I remember
when I first began my practicethat I set my hours right and
then I was like, oh, I will seeanyone anytime they can.
(35:30):
You don't say, no, right, you'rebuilding your practice and it's
like, oh, but you're buildingyour practice on poor boundaries
and you don't know that untillater.
But we, I think we go intoprivate practice with pretty
incomplete contracts withourselves, which also sets us up
for these other risk factors.
Corey Rivera (35:46):
Yeah, and I'd say with self-employment too, you're
like this is what the job isgoing to be, and then you're
like, oh, it's and this, oh andthis, oh and also this other
thing that I didn't think about.
Now I have to fight with theguy who delivers my sheets, like
what is going on?
Yep, high effort maybe, okay,reward, but, as we discussed,
that is money, esteem and careeropportunities, so not
(36:09):
necessarily.
The other thing that rolls intoeffort, reward and balance,
which made me laugh in exactlythe same manner as perfectionism
did, is the over committedtrait, which I have no
experience in at all, just likeperfectionism.
Uh.
So over committed is when youhave a poor perception of two
things.
One is underestimating the workdemands and overestimating your
(36:30):
resources to deal with thosedemands, so it's not just taking
on too many things, it's takingthem on and having no way to
manage any of it, and that justcompounds the effort reward
problem.
This rolls into ideas aboutfairness A lot of fairness ideas
here in the workplace andthere's a lot of policy ideas
(36:52):
that could be attached to sortof fixing an effort-reward
imbalance that you feel at work.
Those things are increasingyour wages, job security and
training people in social skillsand development and leadership
(37:15):
behavior so that if they do havethat overcommitted sort of
trait, you give them tools tomanage that better.
So I want to sort of talk abouthow this fits in with the job
demand.
So effort, reward and balanceis the idea that you are doing a
(37:37):
lot of work and no one isnoticing.
And job demand and control isthat you do a really hard job
and you either have control overhow you do it or you do not.
And I think the two thingsintertwine a lot into how you
currently feel about your joband how much stress your job is
(37:57):
causing you.
So my job demand I would say Ihave a lot to do and I do it
independently.
I have high control over my joband I've been in jobs with low
control and like that is justawful, that is.
That is everyday torturous, Idon't want to do this anymore
(38:18):
feeling.
But the effort, reward andbalance if we're talking
capitalism, then no, I'm notgetting rewarded properly.
But if we're talking actualsatisfaction, then yes, I think
I am.
And if we're talkingovercommitting, then like that's
just life for me, that's justhow I roll.
So I we're talking overcommitting, then like that's
just life for me, that's justhow I roll, so I'm I'm
relatively comfortable with that.
Cal Cates (38:39):
And I think this relativity piece is so
interesting because you know,when we go back to like the
conversation about perfectionismand how the the idea that I am
trying to live up not to whatother people actually expect of
me, but to what I think theyexpect of me.
I feel like right, this is sucha huge I am satisfied a because
(39:03):
I get to work with amazingpeople and I get to do work that
I feel like is important.
And could I be paid more?
Yes, and I want, like you said,I want this job.
So I live my life in a way thatI don't want to be.
It doesn't feel like, oh, Iwish I could do this thing, that
if I made more money, I coulddo it's like I love not hating
(39:26):
every moment that I'm at workand I've had those jobs also.
I have worked in cubicles and Ihave worked for bosses who don't
understand my job and you knowI have been treated like a robot
.
So it is relative in that youwill give up some things for
other things.
I mean people say, oh well,yeah, you know I'm stressed or
(39:48):
like when somebody cancels, Idon't want to charge them for a
no show, but I'm in my house,right, I didn't have to drive to
an office today.
I don't have to, you know.
So I'm willing to deal becauseof these other bonuses.
And, yeah, it makes it hard to.
It makes it easy to rationalizebeing in an abusive
relationship with yourself orwith your work right.
Corey Rivera (40:12):
Yeah, it's so complicated, yeah.
So then then, like, part ofthat question too, becomes what
is it about this dynamic?
Or could it be about thisdynamic that would stress out
massage therapists?
So obviously people love theirjobs, um, you wouldn't, god.
I hope you're not doing thisjob if you hate it.
(40:32):
Um, because you're not going toget anything else like money
and promotion.
Esteem not, but I think that Ithink that the job demand and
not being able to have controlover your choices in your job is
probably pretty hefty for us,and I think that doing a job
(40:54):
that does not have a promotionalopportunity is really rough,
because I think for massagetherapy, sort of your only
promotional direction to go isto manage other people, and a
lot of people don't want to dothat at all or are going to be
bad at it, like.
And then in that case, like, isit a promotion?
Like, not, not really Foranybody.
Cal Cates (41:16):
For anybody Right yeah?
Corey Rivera (41:18):
So not to like change the subject and change
the subject just slightly righthere.
This is why we need some sortof tier system in what we do.
It is not just because somepeople want to be better than
other people, it's it's.
It's not that.
It is that if there's a ladderto climb and there's a thing
like if there's steps to go withand recognition to be had that
(41:42):
you have done hard work andsomebody has noticed and you
earned a thing, and now yourclients notice because you have
the thing that is respected,that demonstrates that you did
the hard work.
Cal Cates (41:52):
Like psychologically, that is important and we don't
have it don't have it Well, andI think it makes the contract
complete.
To go back to your earlierpoint, in that you know, you, if
it is clear to consumers and tothe practitioner what they can
expect from you, ourovercommitment and our you know
(42:13):
discomfort with not meeting theneeds is potentially lessened.
That you know, if you go tothis type of massage therapist,
you can expect this and as thistype of massage therapist,
therapist, you're expected toknow and do these things,
whereas if you're in this othertier, here are the, the set of
understood expectations at thatlevel.
Corey Rivera (42:33):
Yeah, so they're.
Yes, I never actually thoughtabout it that way with the
contracts, but your jobdescription becomes much better
defined and I think there's alot of struggle with massage
therapists and like just frommarketing on up.
So how do you market yourself?
How do you talk to your clients?
Uh, oops, I don't think thatclients for me, um, like all of
(42:58):
that could be just taken awayand cleared up or at least, um,
maybe neatened.
Maybe we could fold the clothesand put them in the basket, and
maybe not necessarily in thedrawer, but like in the basket.
Cal Cates (43:11):
Yes.
Corey Rivera (43:12):
That's job demand and effort reward and balance.
So the other um really bigthing in occupationally and this
goes for all occupations isthat isolation piece that we've
been talking about.
So isolation includes poorsupervisory and colleague
support, so it is the people youwork with and the people you
work for, and social integration.
(43:35):
So any type of socialintegration increases, like the
protectiveness that you can haveagainst suicidal risk.
So whether that those socialinteractions happen at work or
they happen at home or theyhappen at the roller rink, like
any of them count to protect you.
(43:56):
So there's a conversation thatI read in an amazing study of
2000 people in Korea who are inservice jobs.
The study was fantastic, but ittalked about how it is not just
fostering relationships at yourwork.
It is your work allowing you tofoster relationships outside of
your work, by helping you withyour work, life balance, by
(44:18):
giving you time off, byencouraging you to go to your
kid's basketball game, by, youknow, flexibility.
All of those things help withthe isolation problem.
And for massage therapists whoabuddy, do we have an isolation
problem?
You've heard me talk about iton this podcast.
Again, I will continue talkingabout it until we figure out
(44:40):
what to do about it.
But massage therapists go from aclass of maybe two people or
maybe 20 people in school.
They leave that class.
They go into possibly, privatepractice A lot of us maybe they
go into a franchise situation.
But either way, you work withclients alone in a room and that
(45:00):
is your job and we don't dothings together and we don't
really know how to do thingstogether and we're taught
scarcity, so we're sort oftaught to dislike each other or
to be in competition all of thetime and that's messed up.
Like it's just.
It's just messed up.
We gotta stop doing this, guys.
I know it's hard to connect.
I, it's just messed up.
We got to stop doing this, guys.
I know it's hard to connect, Iknow it's hard to have time.
(45:23):
I think a lot of massagetherapists really think that
having a social interactionmeans trading massages.
But that's doing more work Like, and nobody.
Like we all want to get amassage but nobody really wants
to do more work.
Like it's not.
And then trades get weird right, because I owe you and then you
owe me and then like it's allmessy and then that relationship
is weird, like we just need tospend time with each other in a
(45:46):
supportive manner.
You don't actually have totouch each other.
I know it's weird to say to themassage therapist, but you
don't.
(46:17):
So the next part is risks that Ithink are specific to massage
therapists, and I want to beclear that it's not just us, but
these are things that I seewins is the one that capitalism
provides for us, which is thatthis new technique will make you
rich and successful, andfollowing that, if you did not
become rich and successful, itmust be your fault.
I liken this to the celeryjuice thing, which is that
(46:39):
celery juice will make you thin,but only if you have this
specific juicing machine and youdo it at this exact time of day
, for this temperature, and itneeds to be four hours before
eating.
And if you didn't do that, well, it's not the celery juice,
obviously.
Like it must be you that sucks,and like this is.
This is how our marketing rollsright.
So this one special techniquewill make you lose 12 pounds of
(47:02):
belly fat.
Um, it's, it's everywhere andit is ingrained in our
continuing education.
Uh, and I presented thisargument to ruth werner and she
was like ah and I was like what,what?
and she said from the educatorside, it is extremely hard to
sell classes that do not usethis promise.
(47:23):
So we're just eating our owntail.
So massage therapists want tomake more money and buy that
class, and people who teachclasses want to teach classes,
but in order to sell them alsokind of have to teach that class
, and then we don't nobodylearns anything.
Have to teach that class, andthen we don't nobody learns
(47:44):
anything.
And massage therapists don'thave the time or the money to
take classes that they can't seea direct benefit for, because
we're so strapped for cash andif you don't work you don't get
paid.
Cal Cates (47:53):
Well, and let's not forget that massage therapy
instructors are massagetherapists trying to make more
money, right.
And creating a class andspending time in the classroom
is expensive.
But yeah, I mean again, we'vegot the dog chasing its tail,
the hustle hustling the hustlers, and there's a lot of hustle
going on that.
Corey Rivera (48:12):
maybe it's a lot of hustle, yeah yeah, which goes
back to that scarcity thingthat just keeps us apart.
So that's education, marketing,marketing and bootstrapping,
and then sort of added on top ofthat like the worst icing ever,
um terrible icing made of likebroccoli, broccoli icing it's
(48:37):
broccoli fondant.
Yeah, so I call it the funhousemirror of social media.
So this is that we all pretendon social media.
Everybody pretends that theyare successful.
Their Instagram shows all ofthe pretty pictures that have
been edited and filtered.
We all pretend that we arehappy and nobody wants to speak
up first.
And it is.
(48:57):
This is in the literature, bythe way, guys like it is not
just social media, it is inacademic literature.
So the wonderful Clary Jordanfound an article the other day
that I cannot get a copy of tosave my life, so I just have the
abstract, but it's calledWorking Conditions and
Complementary and IntegrativeHealth Care Professions, and
(49:19):
this study is bonkers.
And complementary andintegrative healthcare
professions and this study isbonkers.
So it's like all of theseintegrated healthcare
professions like they have goodhours and people are satisfied
at their job.
But the health professionsincluded are massage therapists,
chiropractors, naturopaths,midwives, and I think there's
like three other jobs that havenothing to do with each other.
(49:42):
We have nothing to do with it.
They're not similar at all,except that you decided they
were all integrative.
So one of the things is theywere like.
All of these people said thattheir work-life balance and
flexibility schedule is prettygreat and I was like I don't
think midwives have aparticularly flexible schedule.
(50:03):
I think the babies come.
When the babies come, it'scertainly a surprise.
Cal Cates (50:05):
Variable, but not flexible.
Corey Rivera (50:07):
But not like yes, that's flexible, indeed.
So no one wants to be the firstperson to admit they're unhappy
.
Everybody pretends they'rehappy and that means again, with
the isolation, you sit in acorner and you're like, if I'm
unhappy it's my fault and theremust be something I'm not doing
that everybody else is doing andI guess I'll just stay in my
(50:29):
corner alone and it's just nottrue.
It's not true.
There wouldn't be so muchhustle from that education
standpoint on both sides ifeverybody was just doing great.
And then that also brings usback to the idea of what's great
, right?
Massage therapists don't make alot of money.
(50:49):
We just don't.
We like our clients, we likethe job that we're doing.
If you can afford to do thisjob, that's great, you can be
happy.
But a lot of people can't andmaybe could be great at it.
I don't know.
The emperor's got no clothesguys.
Cal Cates (51:08):
Yeah, and I feel like the other piece that we're
missing in our not looking atourselves and how this is
possible is that, in myexperience, a number of the
massage therapists who are happyand feeling appropriately
compensated are people who havea spouse or a partner who has a
much more, is much moregainfully employed and so, as
(51:30):
the person who is not primarilyresponsible for the household
budget, that makes it a loteasier to be cool with, like
people canceling last minute orjust not making ends meet on
your own, and I am deeplycurious about how many people in
the massage profession are in asituation like that where, in
(51:50):
fact, if they were the onlyperson, making money for that
household, they would be at orbelow the poverty line.
Corey Rivera (51:59):
That would be a great question for our survey
for the massage therapyprofession.
Yes, indeed.
Cal Cates (52:06):
Let's collect that data.
Corey Rivera (52:08):
Whoever's listening.
You want to help us collectthat data?
Please let me know.
Love to hear from you.
Let's do it.
The last thing I want to talkabout is I'm not going to say
it's pure speculation, becauseit's not pure speculation, but
it is a story that I'm tellingmyself.
The suicide rate data is fromthe year 2021 and it is
(52:29):
impossible to talk about 2021without talking about the COVID
shutdowns and what they meantfor our profession.
There's a lot of thoughts.
I have a lot of thoughts aboutwhat kind of things this could
mean.
So if you have thoughts aboutit too, please text the show.
There's a phone number now inthe show notes that you can call
(52:50):
and leave a message that I willget.
I would love to hear frompeople about your experience and
what you felt and what thiscould mean for us.
So, and what this could meanfor us.
So, during the pandemic shutdown, I feel like our amount of
moral distress just skyrocketed,and it skyrocketed in a
different way than people whohad to go to work at a hospital
(53:12):
every day and deal with nothaving enough PPE and not like.
It was a different experienceand, I think, still just as
scarring.
So I live in Michigan and inMichigan they just gave
everybody money.
Essentially, they were like ifyou can't work because of COVID,
here is money and I got itwithin two weeks and they kept
(53:34):
giving it to me every two weeksso I could stop working and was
safe.
But they are massage therapistswho live in places who did not
do that um and did not care anddid not protect people really at
all, and those places tend tobe places that refuse to have
mask mandates and, in fact,became hostile to people who did
(53:56):
wear masks wear masks.
So if you were a massagetherapist in a situation like
that, not only could you notprotect yourself because you
couldn't stop working, youcouldn't protect yourself or
your clients because wearing amask became political and
controversial.
So even like the small amountof protection you might've had
(54:19):
got taken away and that'sentrapment, like that's so much
entrapment, what are yousupposed to do?
So there was this wholeconversation that started
happening online with massagetherapists about massage
therapists insisting that theywere essential workers.
And, aside from the fact that,no, you're not, because there's
not enough PPE to go around andthat personal protective
(54:40):
equipment has to go to hospitalsfor people who are just
swimming in COVID right now,I've started to think a lot
about what people meant whenthey said essential workers,
because if you'd asked massagetherapists three years before
that if they were essentialworkers, they probably would
have told you no, or nobodywould have used that language.
That was kind of new languagefor us during the lockdowns.
(55:03):
So when somebody tells you thatthey are an essential worker
and very clearly believes it,what they are saying could be a
multitude of things.
It could be that they aresaying it is essential for me to
keep working because I will behomeless.
They could be saying it isessential for me to keep working
(55:23):
because, like psychologically,this is so stressful that I
cannot handle it.
It could be I am an essentialworker because my clients are in
pain and I understand thatthey're in pain and they're
telling me that they're in painand there's nothing that I can
do about it, and that isextremely.
That's a lot of moral distressto deal with.
(55:44):
So this part of theconversation is kind of like it
would be, I think, a nicetheoretical thing, except that
we're going to have anotherpandemic, like it's going to
happen.
It's just going to happen andthat makes this idea and this
problem extremely pertinent,because what happens next time
(56:06):
that we do it?
As far as HealWell goes,calcates wrote a blog post that
you can read that I will link inthe show notes about the worst
game of hot potato ever, whichwas that nobody did anything to
help the massage therapists.
The states didn't have guidance.
The associations told people tolook to their states for
guidance and that was it.
(56:27):
That was all people had.
So they were finding solutionsin each other and we all know
how well the internet worksfinding solutions on our own for
people with a ton of incompleteinformation, solutions on our
own for people with a ton ofincomplete information, and we
were all just guessing at thetime anyway.
So I worry about the statistic.
I worry about whether thestatistic is still happening the
(56:49):
suicide rate statistic thathappened in 2021.
And I worry about whether it'sgoing to happen again and what
we're going to do about it.
Cal Cates (56:58):
Well, and I think that we would be irresponsible
to not discuss the impact of theCOVID lockdown and the
potential of the window wherethe survey data was potentially
collected, and also all of thethings we've discussed that put
massage therapists at risk aretrue, whether or not there is a
(57:19):
pandemic.
Are true, whether or not thereis a pandemic.
So there's plenty of work to do, even if you lean toward being
unwilling or unable to believethat this was related to any
sort of isolation exacerbated bythe pandemic.
Corey Rivera (57:32):
So send me a text, leave me a message.
I promise we'll listen, Ipromise we'll read.
We want to know what yourexperience was like.
Any last words?
Cal Gates.
Cal Cates (57:50):
You're not alone out there, and thank you for
listening.
And let's change some of this.
Let's make this kind of jobthat feels connected and alive
and sustainable.
Corey Rivera (58:03):
Thank you for listening.
Welcome to the Rub a HealWell podcast about
massage therapy.
I'm your host, Kori Rivera,licensed massage therapist and
information magpie, and todaywe're going to continue our
conversation about the suiciderate for massage therapists by
talking about risk factors.
Before we get started, youshould know that I got COVID a
(00:32):
couple weeks before recordingthis episode and that means for
some of this recording I soundedlike well, like I had COVID.
This episode is my re-recordingof some of the information,
with HealWell's ExecutiveDirector Cal Cates' comments
dropped in.
Sorry about the unevenness ofthis episode.
You can join us on Tuesday,February 25th, at 7pm Eastern
(00:54):
for an online processing sessionabout this information.
The event is free, but you willneed to register at the link in
the show notes.
Also, we now have a phonenumber where you can leave a
message for the podcast, whichis also in the show notes.
If you didn't listen to thelast episode, I highly recommend
going back and checking it out.
The question that I sort ofskated directly by in that
(01:17):
episode was probably the firstquestion on your mind, which is
why why are massage therapistrates so high?
And the reason we glossed overit is because we felt it was
more important to give peopleinformation about what they
might be dealing with in thepresent than it was about musing
about why it might be so.
Today, Cal Cates and I are goingto talk about the first part of
(01:39):
the integrated volitional model.
We talked about parts two andthree in the last episode, and
now we're going to talk aboutthe first one, which has to do
with background and risk factors, which are reasons or past
experiences that can increasethe risk of suicidal behavior or
things that make you vulnerableto entering the cycle of defeat
, entrapment, suicidal ideationand suicidal action.
(02:00):
There is no scoring system forrisk factors.
It is not one plus one equalstwo.
It's not straightforward andit's not that if you have all of
these traits, you're going toenter the cycle.
So we can talk about riskfactors that increase risk and
we can talk about factors thatdecrease risk in groups of
people, but that risk doesn'tdirectly apply to a single
(02:21):
person.
In this episode we're going totalk about things that increase
risk for everybody in generaland things that increase risk
that have to do with jobs andoccupations, and then we're
going to sort of ponder someideas that might have to do with
massage therapists specifically.
The ideas that have to do withrisk in general are quite well
supported.
There's a lot of studies thathave been done.
They have a lot of attention.
(02:42):
There's a lot of money that hasbeen put into these ideas to
try and understand them.
As for the things that have todo with massage therapists,
we're guessing because we don'tput money or effort into
studying ourselves.
We just don't, and you're goingto hear me say that a lot and
maybe for forever on thispodcast, until we start doing it
, because it's a thing thatdrives me absolutely batty.
(03:04):
The Massage Therapy Foundationhas very specific grants that it
awards people with every year,and those grants are very, very
specifically written and theyexclude us from funding studies
to study ourselves.
As far as I understand, thiswas just an oversight.
Building something like theMassage Therapy Foundation and
launching an academic journal isa gigantic, enormous task that
(03:27):
I am honestly constantly amazedwas successful.
So for now, just know that theconversations Kyle and I are
going to have about massagetherapy are things from our
experience.
They're from what we see andwhat we hear from people, which
is certainly a valid form ofgathering data, but it's not as
comprehensive as we wish it was.
Okay.
General risk factors.
I'm going to start right offthe bat with guns.
(03:49):
Owning a gun ups your risk forattempting suicide.
It doesn't matter if you willuse the gun in the suicidal act.
Just owning one increases yourrisk, particularly if you're
male.
Men are more likely tosuccessfully complete an act of
suicide and women are morelikely to attempt it, but men
tend to complete the act moreoften, and partly that has to do
(04:13):
with the use of firearms.
As for race or ethnicity,Native Americans and Alaskan
Natives are at the most risk.
White people are actuallysecond on the list and it turns
out that Black women have thelowest rates, and no one is
completely sure why.
For family history, suicide isnot genetic, but having a family
(04:37):
member make an attempt or haveideation or an experience with
it can increase your risk.
The best predictor of a futureattempt is a past attempt or
past self-harm.
That's something that we knowabsolutely for sure.
We know that isolation is alsoa big factor.
We know that mental healthproblems can contribute,
although only about 70% ofpeople who attempt have a
diagnosed mental illness, whichmeans about a third of people do
(04:59):
not, and most people with ahistory of mental illness will
never make any attempt at all.
So those are basic demographicrisk factors, there are also
personality risk factors.
There's a personality traitcalled perfectionism that I have
(05:19):
some experience with.
Perfectionism itself is a scale.
It's not a binary.
It's not that you are aperfectionist or you are not.
Generally, most people aresomewhere along the continuum
and it's circumstantial, whichmeans that something happens
that makes it flare up.
In one of the books I read, itsays it acts up when provoked,
which I thought was a very gooddescription.
There are three types ofperfectionism.
(05:40):
The first is self-orientedperfectionism, which is what we
expect of ourselves.
The second is sociallyprescribed perfectionism, which
is what we think others expectof us.
And the last is other-orientedperfectionism, which is what we
expect of other people.
The one that really gets you isthe second one, socially
(06:01):
prescribed what we think othersexpect of us, and this is really
important, because it's notactually what others expect of
us, it's what we think theyexpect of us.
There's a scale that's used tomeasure this.
With questions like I find itdifficult to meet others'
expectations of me, and peopleexpect more from me than I am
capable of giving.
(06:22):
We tell ourselves stories allthe time to make sense of the
things around us, and all of ourstories are always incomplete
and you don't actually know whatanybody else is thinking unless
you act them directly.
And even then they would haveto know what they're thinking
and tell you directly in orderfor you to get a whole picture.
So it's really just thisprocess of ongoing guessing.
(06:44):
So this idea that you arethinking about what other people
are thinking, which makes youthink about yourself, is known
as metacognition, or havingthoughts about your thoughts,
and it's hard because it feelslike you're not in control.
The thoughts are real, but thereality of those thoughts might
not be.
Here's Kel Cates.
Cal Cates (07:04):
I mean, you alluded to this very problematic thing
that I think we tend to glossover in daily life, which is
that we don't typically haveunfettered access to our own
thoughts and that when we askother people to tell us what
they're thinking or what they'refeeling, they're in the same
(07:24):
boat, and so they they perhapsnot even with intentional plans
to obfuscate the truth.
You're not.
You're getting what they haveaccess to, which, as you said,
is always incomplete.
And yeah, so I, we can't.
I feel like you can't stressthat enough, that we are living
(07:47):
in a world of stories thathaven't been fact-checked, and
this is how we make thedecisions in our lives and how
we shape our view of what ourworld looks like, and it's very
hard to notice that we're doingthat and to fix it, even if we
do notice it, like, how do youactually see what's true?
I think that's a very hardthing.
Corey Rivera (08:10):
And in the final part of this re-recording I want
to tell you that there's aninteresting correlation in
specific states Montana, wyoming, colorado, utah, nevada and New
Mexico have about a 30% higherrate than the national average,
and nobody knows completely whyNevada and New Mexico have about
a 30% higher rate than thenational average and nobody
knows completely why.
(08:30):
The first theory I read wasabout living at high altitudes,
which I don't know.
That I really believe the otherreasons were that these states
are very rural and they don'thave a lot of mental health
resources.
They have high rates of gunownership, which we talked about
earlier, and high rates ofpopulation shift, which means
that people sort of come and goin the communities and they
don't necessarily stick aroundto build community ties.
So they have weakened socialbonds.
(08:52):
That means their isolationismincreases, their social
connection decreases and thatmaybe results in higher rates.
Here's Cal Gates again.
Cal Cates (09:14):
I have to support the idea that it's not about
altitude, as there are lots ofthriving here's Cal Gates again.
And isolation people go oh well, I have lots of friends or I'm
married or I have kids and theidea that if there are people
around, that you're not isolated.
And you know, I know thatmassage therapists will get into
how isolating this sort of jobis.
(09:36):
But it's a people job, right?
And I think that we have thisstory that if there are people
around or I am quote unquote ina community, I'm not
experiencing isolation.
And I know we're going tounpack that.
But that feels very importantto me that it's not actually
about being in a crowd or not ina crowd, or being a member of a
(09:57):
family or not.
It's.
It's again about yourperspective, about your level of
connection about your level ofconnection.
Corey Rivera (10:07):
Yeah, we will get into more of that a little bit
later, but for now I want totalk about this idea of comfort
with the idea of death, and thisis something that came up in
the last podcast episode, but wedidn't really talk about it
very much, partly because Ihadn't really thought too much
about it in relation to massagetherapists.
(10:27):
It seemed more like a generalidea and then the more I thought
about it, the more.
The more I thought about it,the more pertinent it seemed to
become as far as being a massagetherapist.
So here's my theory, and thenI'll ask Calcates to jump in
here.
So massage therapists have ahuge role to play in death and
(10:50):
dying, whether or not you workin a hospice situation, but
probably especially if you workin a hospice situation.
But the risk isn't aboutunderstanding or being
introspective about death, isn'tabout understanding or being
introspective about deathAlthough if you're going to work
in these situations, you shoulddefinitely get some education
and HealWell has some reallygreat stuff that you could check
(11:10):
out to help you with that butthe risk is inherent in the job
itself, because you're dealingintimately with people's lives
and people get sick and peopledie and family members get sick,
lives and people get sick, andpeople die and family members
get sick, and there's a lot of,just there's a lot of exposure
and really direct exposure, Ithink, probably for any
(11:32):
healthcare professional, but forus, we're next to it, but we're
also in it with people and inorder to do that job and to be
there for people, you have toget more comfortable with the
idea in order to take care ofthat person that you're working
with.
So I think of it as like therisk of getting burned when
you're working in a kitchen,it's just always a risk because
(11:55):
you're in a kitchen and thingsare hot and there's no way to
get away from it, and that'sjust.
That's just nature of the jobitself, calcates.
You have a very, verythoughtful expression.
Cal Cates (12:08):
I feel like yes, and because in my experience, even
massage therapists who comethrough our end-of-life classes
or our classes that are aboutmortality and such, are coming
for other people.
They're not there to look atsort of their own mortality.
And also I think that there ispossibly and this is maybe part
(12:31):
of what exacerbates theisolation that massage
therapists experience is thatwhat you've just said is
absolutely true.
What we are doing is workingwith human bodies, which, you
know, in Buddhism, the fiveremembrances are I am of a
nature to grow old, I am of anature to die, I'm of nature to
become sick, like this is whatbodies do.
And every time we see a person,maybe they're in the quote,
(12:54):
prime of their life, right, andthere aren't obvious signs of
infirmity or sort of mortality.
And yet I think there's athere's that metacognition, that
that thoughts about thoughts,that while you're working with
this person, you're pushing awaythis death piece, this sort of
infirmity piece.
And so it's there, but likewellness, big air bunnies, and
(13:21):
like the health industry, etcetera, is deeply invested in
not acknowledging that I wasjust thinking of, like what the
commercial looks like.
Corey Rivera (13:33):
That's like you're going to die.
Would you like to buy some soap?
Cal Cates (13:38):
Death stinks, but you don't have to.
Corey Rivera (13:42):
So, yeah, high comfort with the idea of death
equals more risk.
Just because you're less afraidof dying again, it does not
mean none of this means that youare necessarily more at risk.
It means it's a general sort ofsense.
The next one that came rightafter that that I also kind of
glossed over in the last episode, was sensitivity to physical
(14:04):
pain and I was like that's notreally us, that's like, that's
like firefighters and that'slike, again, with the kitchens.
My husband worked in the kitchenfor a long time.
So I have a lot of a lot ofkitchen stories but like a lot
of standing, a lot of like a lotof twisting and kitchens, a lot
of lifting of heavy things.
I was like it's more like that,that's not really us and more
(14:28):
like that, that's not really us.
And then and then I had aconversation with someone and
they were like oh yeah, I thinkI just dislocated my pinky and
it'll be fine and I'm going togo work on the three people that
I still got today.
And I was like, oh, maybe we do.
I used to work with someone whohad ganglion cysts in their
wrists from being a gymnast andthey just just bothered her all
the time and she just came towork every day and worked on six
people all the time and, youknow, took some ibuprofen and
(14:49):
got on with her job.
So injury and physical pain anddiscomfort is 100% part of
being a massage therapist.
Cal Cates (14:58):
Well, and I wonder.
I mean, pain is so complicatedand obviously we all have our
biases and stories and judgmentsabout it.
But I wonder also about thethat when you are, I'll say, in
denial and that's maybe not agraceful way to say it, but in
denial about your physicalexperience, it's another piece
(15:21):
of isolation, right, it'sanother piece of disconnection
that you're like just pressingon despite all evidence to the
contrary, and it makes sensethat that would be a risk factor
and that it's not.
I don't know.
There's I think there's sort ofsome bragging that happens even
.
Corey Rivera (15:39):
Oh, definitely.
Cal Cates (15:40):
Right About how you can work through anything and
like you know pain don't hurt.
Corey Rivera (15:44):
Look how tough I am.
Right About how you can workthrough anything and, like you
know, pain don't hurt.
Look how tough I am.
Cal Cates (15:47):
Right and culturally.
I feel like there's a lot ofsupport for the idea that you
just suck it up and well yeah,being a good little productive
member, look at you.
Right, no, no wellness, it'snot for me, it's for you.
Corey Rivera (16:09):
Yes, I'm a purveyor of wellness, not a
consumer, not an actualpractitioner.
That's not not for me, right,yeah, yes, the last thing I want
to talk about, that is sort ofa generalized risk factor, are
what are called ACEs, whichstands for adverse childhood
experiences.
Aces are events that happen topeople usually when they're
(16:30):
under 18 years old.
There's 10 items in this listand they include things like
abuse of any kind, exposure toviolence, parental divorce,
having household members inprison, and, of this list, the
more ACEs you have generally theworse your health outcomes are,
kind of all the way around.
So ACEs have gotten to be ametric that is used in most, I
(16:54):
think, health measurement studysituations is to compare how
many ACEs people have to whatthe health outcomes ended up
being.
So multiple ACEs in this casemeans a greater risk of a
suicide attempt, and it'sexponential.
So seven or more ACEs increasethe chance of a suicide attempt
for adolescents by 51 times and,as an adult, by 30 times.
(17:18):
So it's big Things.
To remember about ACEs is thatthe ACE count only counts bad
experiences.
It does not take into accountgood experiences or resiliency
building experiences that mightcounteract the ACE experiences
that happened.
So it's an incomplete pictureby any sense of the word.
(17:38):
It's an incomplete picture,however you want to take it, but
it is pretty reliable, sort ofas a predictor and a scale that
we now use in this time in ourlives, slash history where, um,
I feel like it is trulyincumbent upon us to see each
(18:00):
other fully aces feel havealways felt really important.
Cal Cates (18:03):
But I feel like, if we, if we each just passed each
other a card that had our aceson it when we met, you squared
around your neck like a lanyard,like can you?
I mean, can you imagine peoplebe like, oh right, like every
meetup would start with a hug,um, and then we'd all be like,
oh okay, yeah, okay, yeah, no,how about if I don't harm you?
(18:25):
Like, how about if we just tryto, you know, stem the tide here
, and that we just have solittle awareness of how each of
us has been shaped and thevulnerabilities that we sort of
come to adult life with, or evenadolescence?
And so, as you said, the acesis not a complete picture,
(18:48):
because, of course, for many ofus there are plenty of aces.
But then also there was thatbasketball coach who sort of
took you under their wing, orthere was that, you know, all
these other experiences thatmaybe mitigate or ameliorate the
long term impact, but stillthat when you look at the list,
there are a few of us that don'thave some ACEs right, at least
(19:09):
one, yeah, yeah.
So an adverse childhood eventsis such a sanitized sort of way
to say what's on that list, butit makes complete sense that it
might add to a sense ofhopelessness or a sense of a
need to escape as you continueto live this human existence.
Corey Rivera (19:31):
So this is the general sorts of everyday
population level risk factors,and now I want to talk about
risks that are specific tooccupation.
So there have been since aboutthe 70s and 80s, and then sort
of increasing from there,studies about how jobs and work
(19:53):
environments affect people andspecifically how it affects
their health, how it affectstheir happiness and because we
are a capitalist society how itaffects their productivity,
because if you're making anargument to a company or a boss,
they like the word productivityto be included and they get
much more interested when yousay productivity is lower, and
(20:15):
then they perk up.
So the CDC report that we gotthose statistics from has, it's
just a list of like six to eightthings that might contribute,
and so I took the list of six toeight things and then went to
look for all of them, becausethis is what I do in my job now.
So there were a couple ofthings that were really really
(20:36):
straightforward that contributedto suicide risk in an
occupational manner.
The first one was lower inabsolute relative economic
status, which means you're justpoor and you might not be able
to get out of it ever.
So that one was prettystraightforward, made a lot of
sense.
The second one was lowereducational attainment, and I
(20:58):
couldn't find a really goodexplanation as to why lower
educational attainment was onthis list, and part of me feels
that higher educationalattainment also sort of goes
with the idea of not havinglower economic status.
Cal Cates (21:12):
It doesn't seem like a unique factor.
Corey Rivera (21:17):
It's sort of like representative of other life
situations.
Most people are pretty wellaware now that getting a degree
doesn't necessarily mean thatmuch and what you got your
degree in doesn't necessarilymean that much.
So just having the degree beinga thing that lowers your risk
is like I don't know, I don'tknow, that's the piece of paper
that did it.
The third thing was lowerskilled jobs.
(21:38):
I don't really like the termlower skilled personally,
because I think all jobs requireskills.
They just might not be astechnical or require an eight
year degree as other skills.
That doesn't mean you wereunskilled.
But when I was discussing someof this with Dr Ambler-Kennedy,
(21:59):
who ran a project called COPEduring the COVID lockdowns that
was assessing moral distress inhealthcare workers, including
massage therapists, shementioned that a lot of the
things that showed up at the topof this list for suicidal rates
are occupations that do nothave transferable skills.
So like bartending is on thislist, and if you're a bartender,
(22:23):
you're a bartender.
And if all the bars are closed,what do you do?
You don't really have a placeto go.
And then I had a discussionwith a nurse and she talked
about how a lot of her friendsjust switched nursing jobs.
So they maybe were working in ahospital with patients and then
during COVID they were like,nope, can't do it, peace out,
I'm going to go do paperwork.
(22:43):
So their job skills aretransferable or at least they
have places to go.
And as far as massagetherapists go, we're massage
therapists Like that's.
We don't really have apaperwork job to slide into.
Cal Cates (22:58):
Well, I'm thinking oh well, we could be bartenders
because there's a lot ofsimilarity there, but not if
there's no bars open, so nevermind, that's true, that's true.
Corey Rivera (23:09):
So skills that don't shift well to a new job
opportunity.
So that sort of feeds into theentrapment idea that we
discussed in the last episode.
The next one was economicinstability or variability.
I think this one applies to usa lot.
Massage therapists do not getpaid time off.
For most of us we don't getpaid if we don't have clients
(23:31):
booked.
We don't get paid for time thatisn't spent hands-on most of
the time.
Demand sort of waxes and wanes,everybody, all massage
therapists know that Valentine'sDay, if you like couples
massage, it is the time for you,and if you hate couples massage
, that's too bad for about threeweeks Because you're going to
have to set up both those tablesand have that wife glare at you
(23:53):
while you work on her husband,and that's just what's going to
happen for a while.
And then in summer, right,people just sort of go off and
do summery things and maybe yourschedule's not so full, so the
variability is relatively high.
And then even with booking yourschedule, aside from that,
clients cancel at last minute.
(24:14):
We struggle with our no-showfees, so you don't get anything.
If you're working for yourself,maybe your business this is one
of my favorites is when theperson that you work for is like
well, do you want to enforcethe no-show fee?
Can I make you the bad personwhere you enforce the no-show
fee?
Cal Cates (24:38):
where you enforce the no-show fee.
Well, I was thinking that youknow, when I had a really busy
private practice that certainlythere's the boundary issue right
of enforcing the no-show fee.
But another thing that pointsback to sort of the overwork et
cetera is that when clientswould cancel last minute, I
would often just be relievedbecause I had time to either
catch up on my notes or mylaundry or right.
It's like I don't feel rightmaking you pay for time that I'm
getting back, right, and soit's sort of a wash.
(25:01):
But it's also not a wash Right,because no one is paying me for
that hour when I support mybusiness, right.
Corey Rivera (25:07):
So your relief is apparently enough for you not to
enforce the no show fee andthen also to assuage your guilt
that you're not, that you'relike kind of okay, yes, just got
some quote free time, unquote,correct and maybe you can go
home, you know, 40 minutesearlier because you were able to
do the other thing.
But when you look at it from abusiness standpoint, you just
made zero dollars.
Cal Cates (25:28):
So zero dollars less than zero dollars.
Right, Because you worked forfree, really.
Corey Rivera (25:34):
Really yeah, yeah, Yep.
So we are definitely.
We definitely fit the economicinstability and variability
category.
And then the next two conceptsI want to talk about kind of
together, but I want to explainthem separately.
So these are the things thatkind of came out of the 70s and
80s.
And if you start readingliterature about occupational
stress and like mood disorders,it comes up in every article.
(25:56):
These things every, everysingle article cites both of
these concepts.
So the first concept is calledjob demand or low job control,
and this is a structural issue.
So job demand theory describestypes of work in two dimensions.
So, if you like, picture like abox plot sort of thing one of
(26:19):
those dimensions is thedifficulty of the job.
So do you have a hard job or doyou have an easy job?
And the other dimension is howmuch control you have over the
execution of the job.
So do you have a lot of controland you get to make choices, or
do you have very little controland you have to follow somebody
else's rules?
Whether or not those rules makesense, it doesn't, you know.
(26:41):
And we've all had all kinds ofjobs that have all of these
traits.
So if you put it in a box plot.
It creates four kinds of jobs.
Right, there's a high demand,high control job, which is
something like a surgeon, whereyour job is really hard but you
have a lot of control.
You're the person in charge,you get to make those decisions.
And then the other end, there'sa low demand, low control job,
(27:02):
which might be like a fast foodworker Although I could also
make an argument for that beinghigh demand.
But in this scenario low demand, low control you're doing the
same thing all the time.
It's extremely regulated andrigid and there's a lot of rules
and a lot of routines that youhave to follow.
But you're not openingsomebody's aorta either.
(27:25):
So those are the two sort ofspectrums.
So the danger zone comes in whenyour job is high demand, when
you have a lot of responsibilityand you have low control over
how you execute thatresponsibility, and this sounds
a lot like the worst kind offranchise work that could ever
exist.
So you're taking care of aperson and you're taking care of
(27:46):
their body and their mind andyou're comforting them and
you're interacting at a reallypersonal level no-transcript and
(28:17):
self-reporting.
So they have questionnairesthat they give out to people to
self-report and then they trackwhether or not, they have heart
attacks later.
The results are not great forpeople who are in high-demand,
low-control jobs.
So this is the experience ofhaving lots of responsibility
and being micromanaged.
This is about structure, like Isaid before, so this is about
(28:40):
power structures at work.
This is about the division oflabor at your work.
This is about democracy howmuch say in what you do.
So one study showed that lowjob control increases suicide
rate by four times, which isquite a bit.
It's very stressful, and if youare in a situation where you
cannot change jobs and you don'thave a prospect which we're
(29:02):
going to talk about in a secondand you're stuck there, that's a
lot of stress to put on a human.
Cal Cates (29:08):
I wonder also.
I was talking in one of ourclasses, just actually we were
talking with our palliative careprogram students yesterday.
The conversation was about this, this ongoing tension of sort
of the customer being right, andI feel like certainly we think
about structural factors interms of low control.
And you know, if you work in anenvironment where someone else
(29:30):
is setting your schedule, butthat even in your treatment room
, depending on your treatmentsetting, you are often being
asked by the people who are yourclients, customers, whatever
word you use, you're being askedto do things that are against
what you know is sort of safe orhealthy or supportive, and that
you sort of don't have theability to say actually like,
(29:55):
let's, you know, work a littlebit differently, or I hear what
you're saying and let's do this.
That you really just are, youknow.
To go back to our robot episode, you're being expected to do
what the customer wants, even ifthat goes against whatever
boundaries you have internallyor whatever you know about
safety and technique, et cetera.
So another aspect of lowcontrol yes, yeah.
Corey Rivera (30:18):
So it's not just your manager but it is also your
clients, so it's from bothdirections.
So the second idea that comesup in almost every piece of
literature that I read is calledeffort, reward and balance, and
this is both structural andpersonal.
So effort, reward and balanceis the idea that you work super
hard and nobody cares, um, andeven if they do care, and maybe
(30:40):
they love you a lot and they'llgive you an amazon gift card
once in a while and they'll havea ceremony at work where they
give you a trophy that youreally could use the 30 they
sent on spent on the trophy, butyou know, thanks anyway.
So it is constant effortrewarded with little or nothing.
And high effort alone and lowreward alone are not nearly as
(31:05):
stressful as having both of themtogether, so they like compound
each other.
So if you work really hard andpeople kind of recognize it,
then it's OK.
And if you aren't rewarded alot but you don't actually have
to do a lot, then like that'snot great but it's also okay.
But high effort, low reward badnews bears.
So this causes problems withyour self-efficacy and your
(31:29):
self-esteem and your sense ofbelonging, because you're being
taken advantage of and you knowit, and nobody cares, and
obviously I mean massagetherapist, right.
So we're like it must be me, um, must be something about me,
and we are constantly, I think,put in a position of
(31:53):
subservience to most of thepeople that we work with, to our
clients and our managers, soyou don't have a lot that you
feel like you can say about it.
The other important piece aboutthis and I think I laughed out
loud when I first read it soreward in this context is
considered money, esteem andcareer opportunities, and that
(32:15):
includes job security andpromotions.
And we got none of them, not aone.
Cal Cates (32:21):
Well, and I feel like the esteem thing is
particularly complicated because, you know, even when we talk
about the rewards, the rewardsCorey are internal rewards.
The rewards Corey are internal.
I am a loving, compassionateperson.
So the idea that I would evenfeel exploited, even if I don't
say it out loud, as you said,means that I'm doing something
(32:42):
wrong, because as a massagetherapist, I am proud of my open
hearted, giving nature, and ifI'm feeling like there's an
imbalance there, that's on me,and so it is that double whammy
of you know, I better keep quietabout it which of course takes
us back to isolation, which ofcourse takes us to disconnection
, and it is a really it's noteven a single dog chasing its
(33:05):
tail right.
It's like a whole, like puppymill Pack.
Yeah.
Corey Rivera (33:09):
A puppy mill?
Oh no.
So this imbalance happens whenthere are a few job alternatives
.
So we talked about lack ofmobility and lack of your skills
transferring when yourcontracts are poorly defined.
This is an interesting conceptthat I would like to pursue.
So there's an idea called anincomplete contract.
(33:30):
That is not, it's not a lawidea, it's like a philosophical
idea.
So it means that nobody toldyou or something started to get
assumed about your obligationsand benefits of your job.
So in an incomplete contract,it's like we did a handshake and
(33:53):
an elbow rub and like you knowwhat the job is like, it'll be
fine, that's fine, and then thejob just grows.
Or you don't know how, like howyou're being evaluated.
You don't know who's evaluatingyou or why.
You just don't have enoughsolid information to make
(34:17):
decisions or even makesuggestions about your job.
So high effort, low rewardoften happens at the beginning
of a work life because you thinkthat if you put up with it for
long enough, then you will getan opportunity later.
This is internships.
Internships are massively,massively in this high effort,
(34:43):
low reward thing.
So I'm not going to pay you.
Or for massage therapists, it'sexposure, right, I'm going to
pay you an exposure.
Just you'll get your name outthere and you'll work for 10
hours at our job fair.
Sure, that's going to work out.
So we're much more willing tokind of compromise at the
beginning.
And also I think there's no oneto tell you not to do it and I
sort of quietly assumed thatthis is just how it always
(35:06):
happens.
Right, you always have to payyour dues, like that.
Cal Cates (35:10):
Well, and I would argue that, even the sort of
incomplete contract withyourself that I have worked at a
couple of places, at a massagetherapist, but as a massage
therapist, but I've largelyworked for myself and I remember
when I first began my practicethat I set my hours right and
then I was like, oh, I will seeanyone anytime they can.
(35:30):
You don't say, no, right, you'rebuilding your practice and it's
like, oh, but you're buildingyour practice on poor boundaries
and you don't know that untillater.
But we, I think we go intoprivate practice with pretty
incomplete contracts withourselves, which also sets us up
for these other risk factors.
Corey Rivera (35:46):
Yeah, and I'd say with self-employment too, you're
like this is what the job isgoing to be, and then you're
like, oh, it's and this, oh andthis, oh and also this other
thing that I didn't think about.
Now I have to fight with theguy who delivers my sheets, like
what is going on?
Yep, high effort maybe, okay,reward, but, as we discussed,
that is money, esteem and careeropportunities, so not
(36:09):
necessarily.
The other thing that rolls intoeffort, reward and balance,
which made me laugh in exactlythe same manner as perfectionism
did, is the over committedtrait, which I have no
experience in at all, just likeperfectionism.
Uh.
So over committed is when youhave a poor perception of two
things.
One is underestimating the workdemands and overestimating your
(36:30):
resources to deal with thosedemands, so it's not just taking
on too many things, it's takingthem on and having no way to
manage any of it, and that justcompounds the effort reward
problem.
This rolls into ideas aboutfairness A lot of fairness ideas
here in the workplace andthere's a lot of policy ideas
(36:52):
that could be attached to sortof fixing an effort-reward
imbalance that you feel at work.
Those things are increasingyour wages, job security and
training people in social skillsand development and leadership
(37:15):
behavior so that if they do havethat overcommitted sort of
trait, you give them tools tomanage that better.
So I want to sort of talk abouthow this fits in with the job
demand.
So effort, reward and balanceis the idea that you are doing a
(37:37):
lot of work and no one isnoticing.
And job demand and control isthat you do a really hard job
and you either have control overhow you do it or you do not.
And I think the two thingsintertwine a lot into how you
currently feel about your joband how much stress your job is
(37:57):
causing you.
So my job demand I would say Ihave a lot to do and I do it
independently.
I have high control over my joband I've been in jobs with low
control and like that is justawful, that is.
That is everyday torturous, Idon't want to do this anymore
(38:18):
feeling.
But the effort, reward andbalance if we're talking
capitalism, then no, I'm notgetting rewarded properly.
But if we're talking actualsatisfaction, then yes, I think
I am.
And if we're talkingovercommitting, then like that's
just life for me, that's justhow I roll.
So I we're talking overcommitting, then like that's
just life for me, that's justhow I roll, so I'm I'm
relatively comfortable with that.
Cal Cates (38:39):
And I think this relativity piece is so
interesting because you know,when we go back to like the
conversation about perfectionismand how the the idea that I am
trying to live up not to whatother people actually expect of
me, but to what I think theyexpect of me.
I feel like right, this is sucha huge I am satisfied a because
(39:03):
I get to work with amazingpeople and I get to do work that
I feel like is important.
And could I be paid more?
Yes, and I want, like you said,I want this job.
So I live my life in a way thatI don't want to be.
It doesn't feel like, oh, Iwish I could do this thing, that
if I made more money, I coulddo it's like I love not hating
(39:26):
every moment that I'm at workand I've had those jobs also.
I have worked in cubicles and Ihave worked for bosses who don't
understand my job and you knowI have been treated like a robot
.
So it is relative in that youwill give up some things for
other things.
I mean people say, oh well,yeah, you know I'm stressed or
(39:48):
like when somebody cancels, Idon't want to charge them for a
no show, but I'm in my house,right, I didn't have to drive to
an office today.
I don't have to, you know.
So I'm willing to deal becauseof these other bonuses.
And, yeah, it makes it hard to.
It makes it easy to rationalizebeing in an abusive
relationship with yourself orwith your work right.
Corey Rivera (40:12):
Yeah, it's so complicated, yeah.
So then then, like, part ofthat question too, becomes what
is it about this dynamic?
Or could it be about thisdynamic that would stress out
massage therapists?
So obviously people love theirjobs, um, you wouldn't, god.
I hope you're not doing thisjob if you hate it.
(40:32):
Um, because you're not going toget anything else like money
and promotion.
Esteem not, but I think that Ithink that the job demand and
not being able to have controlover your choices in your job is
probably pretty hefty for us,and I think that doing a job
(40:54):
that does not have a promotionalopportunity is really rough,
because I think for massagetherapy, sort of your only
promotional direction to go isto manage other people, and a
lot of people don't want to dothat at all or are going to be
bad at it, like.
And then in that case, like, isit a promotion?
Like, not, not really Foranybody.
Cal Cates (41:16):
For anybody Right yeah?
Corey Rivera (41:18):
So not to like change the subject and change
the subject just slightly righthere.
This is why we need some sortof tier system in what we do.
It is not just because somepeople want to be better than
other people, it's it's.
It's not that.
It is that if there's a ladderto climb and there's a thing
like if there's steps to go withand recognition to be had that
(41:42):
you have done hard work andsomebody has noticed and you
earned a thing, and now yourclients notice because you have
the thing that is respected,that demonstrates that you did
the hard work.
Cal Cates (41:52):
Like psychologically, that is important and we don't
have it don't have it Well, andI think it makes the contract
complete.
To go back to your earlierpoint, in that you know, you, if
it is clear to consumers and tothe practitioner what they can
expect from you, ourovercommitment and our you know
(42:13):
discomfort with not meeting theneeds is potentially lessened.
That you know, if you go tothis type of massage therapist,
you can expect this and as thistype of massage therapist,
therapist, you're expected toknow and do these things,
whereas if you're in this othertier, here are the, the set of
understood expectations at thatlevel.
Corey Rivera (42:33):
Yeah, so they're.
Yes, I never actually thoughtabout it that way with the
contracts, but your jobdescription becomes much better
defined and I think there's alot of struggle with massage
therapists and like just frommarketing on up.
So how do you market yourself?
How do you talk to your clients?
Uh, oops, I don't think thatclients for me, um, like all of
(42:58):
that could be just taken awayand cleared up or at least, um,
maybe neatened.
Maybe we could fold the clothesand put them in the basket, and
maybe not necessarily in thedrawer, but like in the basket.
Cal Cates (43:11):
Yes.
Corey Rivera (43:12):
That's job demand and effort reward and balance.
So the other um really bigthing in occupationally and this
goes for all occupations isthat isolation piece that we've
been talking about.
So isolation includes poorsupervisory and colleague
support, so it is the people youwork with and the people you
work for, and social integration.
(43:35):
So any type of socialintegration increases, like the
protectiveness that you can haveagainst suicidal risk.
So whether that those socialinteractions happen at work or
they happen at home or theyhappen at the roller rink, like
any of them count to protect you.
(43:56):
So there's a conversation thatI read in an amazing study of
2000 people in Korea who are inservice jobs.
The study was fantastic, but ittalked about how it is not just
fostering relationships at yourwork.
It is your work allowing you tofoster relationships outside of
your work, by helping you withyour work, life balance, by
(44:18):
giving you time off, byencouraging you to go to your
kid's basketball game, by, youknow, flexibility.
All of those things help withthe isolation problem.
And for massage therapists whoabuddy, do we have an isolation
problem?
You've heard me talk about iton this podcast.
Again, I will continue talkingabout it until we figure out
(44:40):
what to do about it.
But massage therapists go from aclass of maybe two people or
maybe 20 people in school.
They leave that class.
They go into possibly, privatepractice A lot of us maybe they
go into a franchise situation.
But either way, you work withclients alone in a room and that
(45:00):
is your job and we don't dothings together and we don't
really know how to do thingstogether and we're taught
scarcity, so we're sort oftaught to dislike each other or
to be in competition all of thetime and that's messed up.
Like it's just.
It's just messed up.
We gotta stop doing this, guys.
I know it's hard to connect.
I, it's just messed up.
We got to stop doing this, guys.
I know it's hard to connect, Iknow it's hard to have time.
(45:23):
I think a lot of massagetherapists really think that
having a social interactionmeans trading massages.
But that's doing more work Like, and nobody.
Like we all want to get amassage but nobody really wants
to do more work.
Like it's not.
And then trades get weird right, because I owe you and then you
owe me and then like it's allmessy and then that relationship
is weird, like we just need tospend time with each other in a
(45:46):
supportive manner.
You don't actually have totouch each other.
I know it's weird to say to themassage therapist, but you
don't.
(46:17):
So the next part is risks that Ithink are specific to massage
therapists, and I want to beclear that it's not just us, but
these are things that I seewins is the one that capitalism
provides for us, which is thatthis new technique will make you
rich and successful, andfollowing that, if you did not
become rich and successful, itmust be your fault.
I liken this to the celeryjuice thing, which is that
(46:39):
celery juice will make you thin,but only if you have this
specific juicing machine and youdo it at this exact time of day
, for this temperature, and itneeds to be four hours before
eating.
And if you didn't do that, well, it's not the celery juice,
obviously.
Like it must be you that sucks,and like this is.
This is how our marketing rollsright.
So this one special techniquewill make you lose 12 pounds of
(47:02):
belly fat.
Um, it's, it's everywhere andit is ingrained in our
continuing education.
Uh, and I presented thisargument to ruth werner and she
was like ah and I was like what,what?
and she said from the educatorside, it is extremely hard to
sell classes that do not usethis promise.
(47:23):
So we're just eating our owntail.
So massage therapists want tomake more money and buy that
class, and people who teachclasses want to teach classes,
but in order to sell them alsokind of have to teach that class
, and then we don't nobodylearns anything.
Have to teach that class, andthen we don't nobody learns
(47:44):
anything.
And massage therapists don'thave the time or the money to
take classes that they can't seea direct benefit for, because
we're so strapped for cash andif you don't work you don't get
paid.
Cal Cates (47:53):
Well, and let's not forget that massage therapy
instructors are massagetherapists trying to make more
money, right.
And creating a class andspending time in the classroom
is expensive.
But yeah, I mean again, we'vegot the dog chasing its tail,
the hustle hustling the hustlers, and there's a lot of hustle
going on that.
Corey Rivera (48:12):
maybe it's a lot of hustle, yeah yeah, which goes
back to that scarcity thingthat just keeps us apart.
So that's education, marketing,marketing and bootstrapping,
and then sort of added on top ofthat like the worst icing ever,
um terrible icing made of likebroccoli, broccoli icing it's
(48:37):
broccoli fondant.
Yeah, so I call it the funhousemirror of social media.
So this is that we all pretendon social media.
Everybody pretends that theyare successful.
Their Instagram shows all ofthe pretty pictures that have
been edited and filtered.
We all pretend that we arehappy and nobody wants to speak
up first.
And it is.
(48:57):
This is in the literature, bythe way, guys like it is not
just social media, it is inacademic literature.
So the wonderful Clary Jordanfound an article the other day
that I cannot get a copy of tosave my life, so I just have the
abstract, but it's calledWorking Conditions and
Complementary and IntegrativeHealth Care Professions, and
(49:19):
this study is bonkers.
And complementary andintegrative healthcare
professions and this study isbonkers.
So it's like all of theseintegrated healthcare
professions like they have goodhours and people are satisfied
at their job.
But the health professionsincluded are massage therapists,
chiropractors, naturopaths,midwives, and I think there's
like three other jobs that havenothing to do with each other.
(49:42):
We have nothing to do with it.
They're not similar at all,except that you decided they
were all integrative.
So one of the things is theywere like.
All of these people said thattheir work-life balance and
flexibility schedule is prettygreat and I was like I don't
think midwives have aparticularly flexible schedule.
(50:03):
I think the babies come.
When the babies come, it'scertainly a surprise.
Cal Cates (50:05):
Variable, but not flexible.
Corey Rivera (50:07):
But not like yes, that's flexible, indeed.
So no one wants to be the firstperson to admit they're unhappy
.
Everybody pretends they'rehappy and that means again, with
the isolation, you sit in acorner and you're like, if I'm
unhappy it's my fault and theremust be something I'm not doing
that everybody else is doing andI guess I'll just stay in my
(50:29):
corner alone and it's just nottrue.
It's not true.
There wouldn't be so muchhustle from that education
standpoint on both sides ifeverybody was just doing great.
And then that also brings usback to the idea of what's great
, right?
Massage therapists don't make alot of money.
(50:49):
We just don't.
We like our clients, we likethe job that we're doing.
If you can afford to do thisjob, that's great, you can be
happy.
But a lot of people can't andmaybe could be great at it.
I don't know.
The emperor's got no clothesguys.
Cal Cates (51:08):
Yeah, and I feel like the other piece that we're
missing in our not looking atourselves and how this is
possible is that, in myexperience, a number of the
massage therapists who are happyand feeling appropriately
compensated are people who havea spouse or a partner who has a
much more, is much moregainfully employed and so, as
(51:30):
the person who is not primarilyresponsible for the household
budget, that makes it a loteasier to be cool with, like
people canceling last minute orjust not making ends meet on
your own, and I am deeplycurious about how many people in
the massage profession are in asituation like that where, in
(51:50):
fact, if they were the onlyperson, making money for that
household, they would be at orbelow the poverty line.
Corey Rivera (51:59):
That would be a great question for our survey
for the massage therapyprofession.
Yes, indeed.
Cal Cates (52:06):
Let's collect that data.
Corey Rivera (52:08):
Whoever's listening.
You want to help us collectthat data?
Please let me know.
Love to hear from you.
Let's do it.
The last thing I want to talkabout is I'm not going to say
it's pure speculation, becauseit's not pure speculation, but
it is a story that I'm tellingmyself.
The suicide rate data is fromthe year 2021 and it is
(52:29):
impossible to talk about 2021without talking about the COVID
shutdowns and what they meantfor our profession.
There's a lot of thoughts.
I have a lot of thoughts aboutwhat kind of things this could
mean.
So if you have thoughts aboutit too, please text the show.
There's a phone number now inthe show notes that you can call
(52:50):
and leave a message that I willget.
I would love to hear frompeople about your experience and
what you felt and what thiscould mean for us.
So, and what this could meanfor us.
So, during the pandemic shutdown, I feel like our amount of
moral distress just skyrocketed,and it skyrocketed in a
different way than people whohad to go to work at a hospital
(53:12):
every day and deal with nothaving enough PPE and not like.
It was a different experienceand, I think, still just as
scarring.
So I live in Michigan and inMichigan they just gave
everybody money.
Essentially, they were like ifyou can't work because of COVID,
here is money and I got itwithin two weeks and they kept
(53:34):
giving it to me every two weeksso I could stop working and was
safe.
But they are massage therapistswho live in places who did not
do that um and did not care anddid not protect people really at
all, and those places tend tobe places that refuse to have
mask mandates and, in fact,became hostile to people who did
(53:56):
wear masks wear masks.
So if you were a massagetherapist in a situation like
that, not only could you notprotect yourself because you
couldn't stop working, youcouldn't protect yourself or
your clients because wearing amask became political and
controversial.
So even like the small amountof protection you might've had
(54:19):
got taken away and that'sentrapment, like that's so much
entrapment, what are yousupposed to do?
So there was this wholeconversation that started
happening online with massagetherapists about massage
therapists insisting that theywere essential workers.
And, aside from the fact that,no, you're not, because there's
not enough PPE to go around andthat personal protective
(54:40):
equipment has to go to hospitalsfor people who are just
swimming in COVID right now,I've started to think a lot
about what people meant whenthey said essential workers,
because if you'd asked massagetherapists three years before
that if they were essentialworkers, they probably would
have told you no, or nobodywould have used that language.
That was kind of new languagefor us during the lockdowns.
(55:03):
So when somebody tells you thatthey are an essential worker
and very clearly believes it,what they are saying could be a
multitude of things.
It could be that they aresaying it is essential for me to
keep working because I will behomeless.
They could be saying it isessential for me to keep working
(55:23):
because, like psychologically,this is so stressful that I
cannot handle it.
It could be I am an essentialworker because my clients are in
pain and I understand thatthey're in pain and they're
telling me that they're in painand there's nothing that I can
do about it, and that isextremely.
That's a lot of moral distressto deal with.
(55:44):
So this part of theconversation is kind of like it
would be, I think, a nicetheoretical thing, except that
we're going to have anotherpandemic, like it's going to
happen.
It's just going to happen andthat makes this idea and this
problem extremely pertinent,because what happens next time
(56:06):
that we do it?
As far as HealWell goes,calcates wrote a blog post that
you can read that I will link inthe show notes about the worst
game of hot potato ever, whichwas that nobody did anything to
help the massage therapists.
The states didn't have guidance.
The associations told people tolook to their states for
guidance and that was it.
(56:27):
That was all people had.
So they were finding solutionsin each other and we all know
how well the internet worksfinding solutions on our own for
people with a ton of incompleteinformation, solutions on our
own for people with a ton ofincomplete information, and we
were all just guessing at thetime anyway.
So I worry about the statistic.
I worry about whether thestatistic is still happening the
(56:49):
suicide rate statistic thathappened in 2021.
And I worry about whether it'sgoing to happen again and what
we're going to do about it.
Cal Cates (56:58):
Well, and I think that we would be irresponsible
to not discuss the impact of theCOVID lockdown and the
potential of the window wherethe survey data was potentially
collected, and also all of thethings we've discussed that put
massage therapists at risk aretrue, whether or not there is a
(57:19):
pandemic.
Are true, whether or not thereis a pandemic.
So there's plenty of work to do, even if you lean toward being
unwilling or unable to believethat this was related to any
sort of isolation exacerbated bythe pandemic.
Corey Rivera (57:32):
So send me a text, leave me a message.
I promise we'll listen, Ipromise we'll read.
We want to know what yourexperience was like.
Any last words?
Cal Gates.
Cal Cates (57:50):
You're not alone out there, and thank you for
listening.
And let's change some of this.
Let's make this kind of jobthat feels connected and alive
and sustainable.
Corey Rivera (58:03):
Thank you for listening.
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