Positive Health Online

It is a constant wonder to me how many meanings can be ascribed to the same pattern of words in a sentence, whether spoken or written. We hear the tone of voice, heeding it more than the actual words spoken. We read the words with the understanding formed by our background, rarely for what they are, and with an open mind. Each one of us carries a personal vocabulary, formed in childhood, developed during education, enlarged and enhanced by interests and beliefs. It is this vocabulary which processes and presents the spoken or written word to our understanding.

Twenty years ago, I would have interpreted the title as a pharmacological function. Now, with a change of occupation and emphasis, my interpretation is far wider and encompasses the diverse aspects of aromatherapy whilst acknowledging the multifarious other uses of essential oils in perfumery, flavouring, foods, cleaning materials and as solvents, to name but a few.

If we focus on the therapeutic use of essential oils and on aromatherapy, we can explore at various levels. Perhaps the most obvious is that of the pharmacological and physiological effect; the concept of the "magic bullet" and the allopathic approach of matching a remedy to a symptom. In this way we need to know the principal components of an oil, their effects on the body and how this is affected by the presence of the other constituents. Because essential oils are volatile, they carry a fragrance and it is this which lends its name to the therapy – AROMA therapy: a therapy with and of aromas. Here we use the most primordial of the senses – the sense of smell – our intimate connection with the environment.

Every breath taken is monitored for our safety and well-being and recorded with associated events. The olfactory bulb projects out of the brain and transmits directly into the limbic system, the seat of memory and emotion. With this in mind, we are aware that there will always be at least two components of any use of essential oils; the physical and the psychological. While it is comparatively simple to list the physiological effects of a substance, it is impossible to know the smell memory of another or their association of fragrance or aroma with events, good or bad. Indeed most people are totally unaware of these associations until they are presented with a similar smell and, when handled with delicacy, gives the wonder and fascination of emotional release.

In order to practice a therapy it is necessary to know the how and why, the mode of action and the limits of competence. To use a substance effectively and safely in a therapy, it is necessary to know as much as possible about it. What is it? Where does it come from? How is it made? How does it work?

Again and again in explanation we encounter ENERGY

As a wide generalisation most therapeutic interventions involve an exchange of energy and, in my view, this is most obvious in aromatherapy. In the first place, there is the energy present in the essential oils, in the medium used as carrier. There is the energy transferred during the massage, should this be the treatment chosen, and, above all, there is the energy exchanged between the therapist and the client or patient. Energy can be neither created nor destroyed, but only changed from one form into another. Starting from light energy emitted from the sun and wonderfully described by William Anderson in his poem on light

". . .leaves become the point of interchange
Of instantaneous chemical activity
As their molecules of chlorophyll
Absorb the bands of the sun's spectrum –
All except one, all except green –
And the photons slipping through the leaves,
Like angels through walls,
Excite in their passage
The magnesium in the chlorophyll to explode like fireworks,
To split hydrogen from oxygen, to fix carbon
And to alter the fuel of life into the sweet sugars
That feed the plant cells hungry for growth."

A succinct explanation of activity in the plant – photosynthesis – the transformation of light energy into chemical energy, providing food and oxygen and all the secondary products which include essential oils according to the plant species. A similar energy is carried in the lipids of the "fixed" or fatty oils used alone as carriers or formulated into creams and lotions.

The energy transferred by touch during massage comes from the physical energy of the therapist (provided by food from plants) combined with mental and emotional energy. Applied with knowledge and empathy, it can generate warmth, comfort and trust and invigorate or relax. In addition, there is the exploration and creation of rapport during the consultation and choice of oils – an integral part of an aromatherapy treatment. With focused attention, sensitivity and understanding the client is led through a selection of essential oils to make their individual choice. Feelings, long hidden may surface, triggered by a forgotten odour, mood can be lifted, grief recognised and assuaged, minor aches and pains relieved, tiredness eased. The uses and application of mixtures, blends and single essential oils are myriad and marvellous when the client is actively involved in his or her recovery of balance and well-being.

In my practice of aromatherapy, it is the variety of people and application which provides increasing interest and wonder. There are so many adaptations one can make. One client may be frail, elderly and suffering from several chronic complaints; another may be a super fit young man coming for a regular monthly "servicing", commenting that he needs to look after himself as well as he looks after his car. Young, and not so young mothers come, creating a special time for themselves, re-balancing the backs, shoulders and pelvises pulled by carrying toddlers on a hip, heavy shopping or pushing pedal cars and bikes. Hospitals, hospices and nursing homes can be visited and these visits bring a constant variety of challenges as treatments are adapted to the needs of that patient at that particular moment.

This work, though challenging, is most rewarding. To be told by nursing staff that a patient has appeared relaxed and content, or that another has enjoyed peaceful sleep, when usually they have been very restless and disturbed, is a great reward. To encourage a withdrawn patient to participate in his choice of oils and method of treatment; to go further and work as part of a team to convince him that he can stand, then take a step, is some measure of the power of aromatherapy to make connections. It seem that an interest is aroused which unlocks, which frees, which encourages and empowers, which provides the courage to let go. In "letting go" the body is allowed to function more freely, to regain balance and restore homeostasis. The mind is liberated to create a healing relationship and to minister to the body and spirit. The ultimate privilege is to assist in the "letting go" which allows the spirit to soar and brings acceptance of mortality and a deep serenity.

The following notes illustrate some of my uses of essential oils in aromatherapy and in wider clinical applications over the past four to five years, much of this time was spent in hospitals or specialist centres. Names of clients and patients have been changed and some are composite studies.

The initial objective of the aromatherapy service in the first hospital was to provide an additional patient amenity, to be used for relaxation and comfort. It was not to be applied as a "treatment" for specific conditions. However, as all essential oils are antimicrobial to varying degrees and are metabolised and excreted by different pathways, fortuitous beneficial effects were experienced in addition to the relief of muscular and psychological tension.

These benefits were mainly predictable and according to traditional usage of essential oils: relief of nasal congestion, the mucolytic effects of the oils of the Melaleuca family, Cajuput, Eucalyptus, Myrtle; the cooling effect of dilute peppermint solution on burning itchy skin and the soothing effect of Chamomile (Matricaria) on inflamed areas. The application of special massage techniques to reduce muscle spasm not only relieved painful neck and shoulder muscles but also helped to ease the abdominal spasms of diarrhoea and helped too in constipation.

Uninterrupted time devoted to a patient along with unconditional positive regard can create space for an individual to come to terms with and sometimes alter subconscious perceptions which could be inhibiting progress or recovery. Areas of change can be in perception of self worth, improved body image, improved sense of well-being.
The essence of a holistic approach and of aromatherapy is the focus on the patient as a unique individual rather than a person with symptoms of disease or syndrome........

"ask not what kind of disease the person has, but what kind of person has the disease"(Osler)

A therapeutic relationship is engendered with the unconditional positive regard of Rogerian counselling facilitating the choice of approach and method of treatment.

Where possible, depending upon the condition and preference of the person, the treatment is given in a dedicated therapy room. Not only does this provide a pleasurable change of scene from the clinical room on the ward but also brings a sense of "normality". If an appointment had been made for aromatherapy or massage in normal circumstances, it is usually accepted that a visit would be made to the therapist's rooms and that the ambience there would be of a place set apart. A place of tranquillity and peace, private, secure and confidential; a place of comfort and enhanced awareness of colour, fragrance, sound and touch.

Essential oils are chosen involving the patient to the fullest extent. Odours have powerful associations many of them subconscious, the response is unknown until the odour is experienced.

Aspects of Aroma

Robert was one of the first patients requesting aromatherapy. He was debilitated with much muscle wastage, chronic diarrhoea and kaposi sarcoma on his legs. He was being fed intravenously and food had been one of his greatest pleasures. For him, aromatherapy brought all the delight of the table to his bedside with smell and stimulated taste. We spent time preparing smelling strips of oils of culinary herbs and spices – a dash of lemongrass brought his favourite Thai restaurant right there into his hospital room. Massage with rosemary and lavender or marjoram or grapefruit in 1% dilution in macadamia oil eased his aching legs and helped to maintain tone in his shrinking muscles.

Refugee from Roses. The importance of individual choice.

Hugh found that a weekly aromatherapy session kept him in 'balance' emotionally through the combination of time, touch and smell. He welcomed the opportunity to unload to a 'detached' person – uninvolved with family, work or medical treatment, giving time totally focused upon him as a person. The massage helped him to relax and reassured him that there was nothing untoward appearing on his skin. The choice of oils fascinated him and he delighted in trying all kinds of combinations, associating them with travel and other experiences, being aware of his own varying emotional state and how it could change in response to smell and recalled events. He tried most of the essential oils available, singly and in combination, depending on how he was feeling. Neroli, rosewood and sandalwood were regular choices along with bergamot, frankincense, geranium and grapefruit. A frequent blend was frankincense with grapefruit and, almost as often, cardamom with grapefruit or bergamot.

I had the opportunity to visit Dr. Peter Wilde and to buy his very specially produced English Rose Oil. Nothing would satisfy Hugh until he had tried it. In retrospect, we both knew that he was not at all a "Rose" person. He had never wished to try rose oil before. We were carried away by the excitement of the visit and the wonderful fragrance. Hugh received a full body massage with two drops of the "Wilde Rose Oil" in 20 ml of grapeseed oil. He was well satisfied, beautifully relaxed and was left dozing. The fragrance was powerful and filled the room causing delighted comment from staff and visitors. Two days later, after having the linen changed and new pillows supplied, Hugh went home for the weekend a day early to escape from those "B——- roses!" He was allocated a different room on his return – the earlier one referred to for the next few weeks as "The Rose Room".

A similar mixture was used with great success for Alice, receiving palliative care. She had three young children and found it hard to relax and release her anxiety. Gentle massage with one drop of the "Wilde" rose in 10mls of almond oil with the addition of 1ml jojoba helped her to sleep and relieved her dry skin. A tiny vial of this precious oil, left with her, gave her the freedom to create a euphoric hour for herself by allowing just one drop to evaporate on a tissue.

Grandmother's Wardrobe. The association of smell and memory.

Peter had been a regular user of the aromatherapy service for several months. He was referred in the first instance after a sudden onset of neuropathy made walking difficult and the use of his hands painful and unreliable. After his first treatment, his comment was "That is the first thing that has happened to me here that hasn't hurt!". The treatments to reduce the sensitivity in his feet and hands and arms continued and little by little remission of the intense pain was gained.

Peter's sleep pattern had been disrupted by the unremitting pain in his hands and, even though this was easing, he had difficulty in sleeping, once disturbed. We experimented with various oils and many blends and eventually produced a blend of lavender, marjoram, neroli and rosewood. This mixture has evolved and developed, having a resonance entirely its own; the fragrances interweaving, amalgamating, harmonising, creating counterpoint melodies each with its own vibrations and synergies. It has become well used in our practice yet unique for each person in the proportion of the oils used and order of blending them.

A 5ml bottle of Peter's particular blend was prepared and used successfully from time to time. On being admitted to the ward for further investigations, Peter took the mixture with him and prepared several tissues each with two drops of the blend in order to establish "his place". He slept reasonably well despite the constant bustle of a busy ward. Later that week he had a most horrendous nightmare, waking up, fighting and struggling through the bed clothes. In his dream he had been a small boy again, no more than a toddler, terrifyingly locked in the darkness of what appeared to be his grandmother's wardrobe. Musty clothes were hanging over his face and he was fighting to breathe. If only he could clear his face and find the door. . . . . . . . . !

Eventually, a nurse came in, folded back the sheet which had been pulled over his head, sponged and comforted him.

In the enclosed space, once the sheet had enveloped him, the power of the lavender component in the blend prevailed. The camphoraceous herbiness of marjoram, the sensuous luxury of neroli, the enticing spiciness of rosewood, separately or together could not overcome the awakened memory. A memory which had lain, filed but not forgotten, to be triggered by the association of smell.

We know little enough about our own "smell memory" and cannot tell about another's. We only know as or after the association is made. In this case, after several months of use and then only in a particular circumstance. For subsequent use a similar blend was used but without lavender. However, that particular memory no longer holds fears and lavender is now one of Peter's favourite essential oils.

A Walk in the Wood. A favourite place made accessible.

Ernest was considered "difficult". He was confined to bed or to a wheel chair and it seemed that nothing could be done to please him. He found fault with everyone and everything and was not a happy man. Eventually, he was referred for aromatherapy. When approached he was straight and to the point. He did not want to be touched. He did not like those smelly things. They should be banned – he could smell the oils even from another patient's room and he did not want them in his.

The case of oils safely out of sight, a conversation was begun. Fitfully at first but gathering pace and involvement when shared interest was realised. After some time, Ernest was asked if there was somewhere else he would rather be. A place, real or imagined, where he felt comfortable and happy. He talked about a wood near his home and how he had enjoyed walking through it with his dog; how the dog scrabbled in the undergrowth, turning up the loose soil with the pervading smell of leaf mould and damp earth.

At the suggestion that we might try to recapture the haunting memory of that special place by its smell he was totally disbelieving. His were "real smells" those in the case were "fancy things" – not worth trying. We prepared smelling strips of "woody" "green" and "earthy" oils and his interest was aroused. An hour later, after much talking, sniffing, and hilarity at the mismatches, we arrived at "something like".

Ernest did not ever receive a massage nor anything which HE would describe as aromatherapy but enjoyed deciding what HIS room would smell like when HE chose.

Touch and massage procedures

Any massage technique used must be appropriate for the individual and his/her condition, using familiar procedures with experience and expertise. Effleurage to relax: pressure to alter perception or to relieve pain, alternating pressure to increase sensation in loss of feeling, stroking and holding to relieve pain and tingling in peripheral neuropathy, rolling finger pressures to relieve swelling.

The power of touch

Olaf was suffering from cranial toxoplasmosis and was unable to move unaided. The Registrar and Ward Sister considered that he might benefit from aromatherapy, at least it would provide a diversion and possibly some comfort. Two nurses helped to turn him over so that he could receive a back massage. On working up the spinal channel with gentle pressures he screamed – on alarmed enquiry he explained that he had not felt any discomfort but the brilliance of the colours he experienced caused him to cry out. All he wanted now were his paints! He had to capture the brilliance of this wonderful green of early tropical dawn before the memory faded. He was seen each week for several months during his hospital treatment and slowly regained the use of his legs.

He remained in remission for about 3 years and received aromatherapy every week. He continued to experience flashes of brilliant colours when any pressures were exerted around his spine, particularly around the sacral and cervical areas.

Olaf felt that the regular aromatherapy treatments not only made him feel good, they were enjoyable and a new way of communication. The choice of oils with their varied odours provided a total change in environment. The massage, the touch on his body kept him 'in touch' and encouraged him to work on stiff muscles and reluctant nerve pathways.

William had great difficulty in coming to terms with his status, pretending to himself it did not exist. After some years he developed peripheral neuropathy and dreaded the thought of losing his mobility, utterly determined not ever to accept a wheelchair. He had heard via the 'grapevine' that the aromatherapist "worked wonders with peripheral neuropathy" and although he had steadfastly refused aromatherapy when offered, he decided that it was time to use it to help to alleviate the sensations in his legs and feet. This decision was initiated by an interactive session with patients, nurses and occupational therapists given by a former patient in conjunction with the aromatherapist. The session was focused on self help and simple strategies which anyone could adapt for themselves. The availability and the benefits of aromatherapy and massage were openly discussed by patients and staff.

When eventually, William was admitted for terminal care, the pain in his feet was so intense that he screamed when anyone entered his room, causing any form of vibration. Teamwork involving the physiotherapists, occupational therapists, and aromatherapists was instituted alongside his medical and nursing care. Holding and light stroking of legs and feet was started to accustom the painful areas to gentle touch. After some time, this was left to the aromatherapist, the occupational therapist and physiotherapist concentrating on maintaining mobility. Various chemotypes of thyme were used in a 1% dilution in almond oil for their antioxidant effect and 2% oil of clove was applied to the toes as a local analgesic.

It was at this time that his family became involved in twice daily massage. They were taught simple stroking and holding movements and encouraged to use them at William's request.

I am indebted to these and many others who have admitted me into their personal space, shared their fears and their joys, good and bad times, "sick" and hilariously funny jokes. They have taught me patience, perseverance and humility and caused my spirit to sing. They have encouraged me and given the practical experience which refines knowledge into a foundation on which to build; to extend and to explore further. Our research and teaching depends on them.