Spa Industry, Culture, and Evolution
Time, Temperature, Touch and Truth

By Jonathan Paul De Vierville

Originally published in Massage Bodywork magazine, August/September 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

An ever-aging nation and an increase in the amount of advertising are significant reasons for the interest in, growth of, and gross market expansion of today's spa industry -- a result of the early '90s when the field quickly materialized into business and financial activities that created demand and markets.

During this vibrant period, this "new" industry sought to create and distribute a fashionable and healthy public identity. In 1991, the International Spa Association (ISPA) was founded for spa providers, and several years later the ISPA Foundation was organized for the general purpose of spa research and public education. ISPA began to identify itself through the "spa experience," defined as: "Your time to relax, reflect, revitalize and rejoice."1 The ISPA Foundation engaged itself with research into the education and benefits of the spa experience and explored spa types, domains, lifestyles and culture.2

Supported by mass marketing campaigns, the new industry gained an economic and commercial presence within the North American public. At the same time, the spa industry continued to create, invent and clarify its identity.

Rapid Growth
Reported in 2000 and again in 2002, the national accounting firm of Pricewaterhouse analyzed and described the new spa sector growth and expansion as moving rapidly toward a $10 billion industry. Seeing the widening positive growth signs and possible financial profits, many new entrepreneurs, including mom-and- pop businesses, small firms and major corporations, joined and contributed to the rapid growth, expansion and development of the modern spa industry.

Shortly after the turn of the century, several new medical spa associations and conferences organized and a small, but new, medical spa industry began to emerge. Primarily motivated by a major public shift in healthcare attitudes and their related market forces, traditional medical institutions began looking in new directions and searching for new growth areas. This change had begun much earlier, as far back as the '60s and '70s, with interest in non-Western, non-traditional and native medicine. In recent years, these wide-ranging, non-traditional medical interests have developed rapidly and gained further acceptance, including well-financed and federally-recognized programs in complementary, alternative and integrative medicine.

Historically, what is important to know is this recent emergence and development is not being guided by, or driven from within, the spa industry. Rather, the new medical interests in spa are coming from medical and healthcare professionals and institutions seeking to redefine, rediscover and reinvent themselves within a wider and more comprehensive spa industry that is still defining and redefining itself. The consequences of this medicine and spa courtship, engagement and marriage are still being worked out in unknown family dynamics. Caution is warranted, especially given the sad state of affairs with our current public healthcare systems, health maintenance organizations and private medical practices. On the other hand, here and now is a great challenge and opportunity for the spa industry to facilitate helpful transitions and corrective transformations. Good spa medicine will require a fully-integrated, interdisciplinary and multidisciplinary explanation with authentic knowledge and comprehensive understanding above and beyond the current marketplace fads and forces.

Prior to the new millennia, the spa industry made a great effort to establish a commercial and economic identity. Today, with more and new interests, more and new individuals, more and new investments, and more and new institutions, spa businesses and corporate identities continue to grow and expand. But even in the real world of big business and high finance, "more" and "new" are not always better. This growth is forcing the spa industry to re-examine itself even more deeply than before. Better spas continue to realistically reimagine and reinvent not only their identity, but their integrity.

Health Through Water
So, what really is "spa"? The origin of the word gives us a clue. Etymologically, spa is traced from the Latin verb "spargere," to pour forth. Roman legions built their military camps at hot springs, where healing waters "poured forth." Also, the acronym S.P.A., referring to salus per aqua (health through water), was scrawled on the brick walls of many Roman thermal establishments.

The modern word spa found its way into the English language through the old Walloon word "espa," which referred to a fountain. From espa, the English derived "spaw." In 1326, at a little village located in the Ardennes range, the name spa was used to identify some hot mineral springs discovered to possess therapeutic and medicinal values. Shortly thereafter, pools were built in Spa, Belgium. Around 1550, William Slingsby discovered the sulfur springs of Tewhit near Harrogate, England, and compared these natural sulfur mineral fountains to those found in Belgium. Hence, the English spa.

Four hundred years later in the 1950s, Sidney Licht, M.D., a founding president of the American Society of Medical Hydrology and Climatology, defined a spa as a place where mineral-containing waters flow from the ground naturally, or to which they are pumped or conducted, and are therefore used for therapeutic purposes. Similarly, Walter S. McClellan, M.D., the first medical director of the Saratoga Spa in Saratoga Springs, N.Y., considered a spa a place or location where nature has provided natural healing agents such as mineral waters or peloids, at which provisions have been made in physical plant and equipment for the administration of treatments which utilize these agents, and where the program is carried out under medical control. The origins and true definition of spa recognize and include an important cultural dimension and a social institution that provide for a place and time for not only healthcare services and therapeutic treatments, but also cultural activities, shared events, societal leisure, relaxation and renewal. All of these features in combination eventually spawned the emergence of the contemporary spa industry with its related professions and culture.

Looking at spa from this larger social and cultural context necessitates us to gaze further back and deeper into the fundamental dimensions and dynamics of spa. What emerges is nature's "blood of life," the primal element, water. Wherever and whenever the word spa is used, it is necessary to experience, touch, be touched and take the waters in all their forms and forces. In short, spas are times, places and processes for drinking, washing, showering, bathing, soaking, floating and flowing within, upon, under and through the waters.

In modern-day spa culture, "taking the waters" has acquired a new meaning that includes a variety of locations and types of places in an urban setting or rural landscape: Day, stay, hotel, resort, club, community, ship, adventure, vitality, mineral springs and medical spas. Regardless of the spa type, the true purpose of spa is to provide, through some form of the waters, helpful health services and treatments that are relaxing, restful, regenerative and socially re-creative. To suggest or claim otherwise is missing the main meaning of spa. Spa is not a pampering escape or self-indulgent avoidance. It is a necessary way of life that consists of services, activities and treatments best done within the wholeness, harmony, balance and rhythms of nature's blood -- water. Unfortunately, the original intentions of spa are often lost in the immediate rush to retail and quota sales.

Integrated Processes
In a refreshing effort to reassemble and remember the primary purpose of spa, let's take a Janus look (backward and forward) into some basic ideas, concepts and definitions of spa and spa culture.

Fundamentally, a spa is an eco-socio-cultural learning community and civil institution that attempts to bring together and truthfully integrate all the dynamic dimensions of time and space, temperatures, touch and therapeutic treatments within a supporting context of goodness, beauty, harmony and wholeness of nature. In a few words: Spa is integrated and regulated processes of time, temperature and touch (clocks, thermometers and hands) utilizing nature's primal elements: Water, air, earth, fire and "ether." In fewer words, spa is a place with a purpose, through a plan for a person, with processes, over a period of time/space and energy of nature. (Notice, I am not including the word "technology." Tools, techniques and technologies are human constructs; nature, on the other hand, is created and constructed by the Earth, universe and cosmos. This small, but important, point will take on clarity as we proceed.)

A spa is a place with the purpose of facilitating whole human healthcare, wellness and social well-being through a specific plan for a person by using physical, physiological and psychological processes, including agents, principles, procedures, services and time/space and energy of nature.

1. Spa agents include nature's primary elements and resources:

- Water and flow

- Air and breath

- Earth and minerals

- Fire/heat and light

- Ether/energy and electricity

2. Spa principles include traditions, sciences, arts, knowledge and understanding within the basic fields and systems of spa services, activities, applications and treatments:

- Hydrotherapy, balneotherapy (bath therapy), crenotherapy (drinking water therapy)

- Kinesotherapy, massage, bodywork and movement therapy

- Phytotherapy (herbs and plant therapy) and herbal formulations

- Nutrition

- Mind/body meditation, prayer, regulative therapies and lifestyle patterns

3. Spa procedures include numerous methods, modalities, protocols and modus operandi required for the systematic administration and skillful application of the spa principles. A few examples:

- Contrast foot baths and herbal half baths

- Swedish massage and reflexology

- Herbal teas and juices

- Mineral waters, low fat and various balanced diets

- Meditation, yoga or walking the labyrinth

4. Spa services are wide in range and type and can span from simple skin care applications all the way to major restorative therapies for chronic illness. The range of spa services includes:

- Skin care and beauty

- Prevention and wellness

- Fitness and exercise

- Assessments and evaluations

- Clinical and therapeutic treatments

- Rehabilitation and restorative management

5. Spa time/space and energy in nature combine both path and pace of spa services as a series and course. In theory, the nature of time/space and energy, especially in relationship with the body's temperature shifts and rhythms, is important for health and should be observed continually. Today, unfortunately, we seldom consider spa treatment time and/or service timing in relation to subtle body temperatures, except if the client exhibits chills or fever.

Rhythmic Relationships
The wider significance of spa time/space and energy is more important than appointment book schedules. Spa time, space and energy, especially the timing and rhythmic relationships of the body's changing temperatures, are vital to health and its care. Time and temperature act, react and interact with one another differently at different times and at different degrees. This is the main reason why water is the central and vital element of spa. Water directly influences and regulates body temperatures in the form of energy: Heat, or the lack thereof. In short, spa is about the time and timing of water's degrees and temperatures. Spa is about the times, changes and rhythms of body heat and body cold; heat and cold are all about energy and/or entropy. Spa is primarily a matter of degrees of change in the body's temperatures in a timely manner.

Spa services, applications, treatments and therapies function best when systematically scheduled and synchronized in accordance with the naturally changing rhythms of body temperatures. Our bodies generate heat through a variety of metabolic mechanisms from the food we digest and liquids we drink. We dissipate approximately 85 percent of body heat through the skin. The skin serves as the principal area of entry and exit for heat and cold within the body; the skin provides the primary link between the body's temperatures and the brain's hypothalamus. The two linking pathways between the skin and the hypothalamus are through the peripheral nervous system and the circulation system's capillaries, the small lacework of blood vessels that reach from our fingertips to our toes.

Timely and correctly administered cold and/or hot wet stimuli applied to various skin surfaces will affect thermoregulatory responses within the hypothalamus which, in turn, are followed by internal reflex arc actions and corresponding restful reactions. Some examples of spa time, timing and timed treatments include an early morning short cold wash stimulus to produce increased body heat or an afternoon hot herbal wrap/hot herbal bath to induce sleep.

Over a 24-hour cycle, these timed spa services and treatments will have a healthy, harmonizing and balancing effect on whole body sleep patterns, circadian rhythms, rapid eye movements and dream time. Spa effects are best achieved when our natural rhythms and patterns of body time and body temperature are considered in relation to one another and integrated into the larger spa experience. Spa involves not only the role of the skin but also the rhythm of daily activities and nighttime sleep. Spa time and temperature touches the whole person in full time/space and energy. Spa is more than skin deep; spa is also deep dreaming sleep.

These temporal and thermal types of spa services, applications, treatments and therapies, of course, take more time than most of us have or are willing to give. With further research, study and experiences in the field of chronobiology, we can learn and understand the critical healthcare role and relationships between body time and body temperature. This is not an easy task, especially in our excited electronic environments and fast-paced technological terrain. On the other hand, it is encouraging to know that more people are beginning to stretch their spa time from hours into full days and weeks, monthly visits and even annual events. Here is when and where we can consider the ancient European tradition of Die Kur -- the three- to four-week series and course of spa culture that incorporates, along with the vital roles and dynamics of body time and body temperature, mind, heart and soul time within the environments of springs, wells, pools, ponds and gardens of Kur Parks.

We can go even further back into the history of spa culture and look at the ways ancient civilizations utilized the thermal effects of the waters. The Romans understood time and temperature and the systematic application of rhythms and rituals for warming, heating and cooling the body. The Roman thermae (spa complexes) included several distinct architectural features placed within a sequential space and built to maintain different temperature levels. The Roman thermal spa spaces typically included a:

- vestibule (entrance)

- apodyterium (changing rooms and lounge)

- palaestra (exercise yard)

- tepidarium (warming rooms)

- caladarium (main hot room)

- laconicum (sweating room)

- frigidarium (cold-water bathing hall for cooling off)

- natatio (large swimming pool)

- lavatrina (washrooms and toilets)

Beneath and behind the scenes were the praefurnia (furnaces) and other service areas for wood, food and laundry. In Rome, as in most major Roman cities, the thermae were built to function as an integral part of daily life and leisure much like our wellness centers and fitness clubs today. The main difference between the two is the Roman thermae systematically employed time, timing and the regulated temperatures of vapors, hot, warm and cold waters, while today most health and fitness facilities are mainly concerned with the heat and sweat generated from muscles and machines.

Spa Ecology
We have briefly reviewed some spa culture history and looked deeper into the identity of spa, especially as identity relates to the main meaning and primary purpose of spa.

Just as important as identity is integrity. With the recent growth and rapid expansion in the modern spa industry, the imperative issue of integrity is causing professionals, practitioners and patrons to ask penetrating questions that require deeper definitions of spas, regardless of their type. This new round of quality questioning is raising important issues of honesty, ethics and morality, to name a few.

Most modern American consumers look at everything through an economical, technological and industrial point of view. We interpret truth, goodness and beauty as a constant pursuit of life, liberty and happiness directly dependent on market share and access to business opportunities that result in material gain and profit. This narrow and limiting economic perspective had its place, especially during the rapid expansion and in the hurried writing of the late 20th century business plans and second millennium's money-making paradigms. This point of view is still heard in the continual media hype about yet another "ultimate unique signature spa experience." Much of the North American spa industry keeps on vending and putting up for sale random cafeteria-style treatment menus geared primarily to sell sizzle and escape. As a result, many spa services, treatments, therapies and environments have become muddled and taken on an existence similar to the fat-reducing half-and-half coffee additives: Half real and half fake.

But which half is real and which is fake? Despite the continued glorified promotions for diversions directed at consumers, there are new attempts and momentous efforts underway to re-examine and reflect deeper into a fuller meaning of spa culture and a needed imperative for a socially responsible, environmental and ecologically sustainable position.

The new concerns move beyond economics of business and utility of industry, and focus on a wider scope of the spa culture of ecology. Spa ecology moves beyond self-serving commercial ideologies and searches out self-integrating ideals, self-renewing principles and self-sustaining values of community. Spa ecology encourages honest and reliable services, healthful transformations and authentic solutions that demand true, good and beautiful spas with genuine, simple and real results. Fundamentally, spas and spa culture become ecological and environmental learning communities and Earth-service centers of nature.

The contemporary spa culture, both as a social healthcare movement and as a capital marketing trend, is now moving out of childhood and into a young adult phase. During this transition, the most important right of passage is initiation and transformation from the fantasies of childhood into adult identity and social integrity.

Recent world events have provided collective crises along with reflec-tive opportunities for this deeper re-orientation of the spa industry. These milestone ordeals include Sept. 11 and the subsequent Persian Gulf War II, the global spread of SARS along with the constant threat of AIDS and other spreading social illnesses and environmental concerns. Fallout from these world events included the cancellation and re-scheduling of the ISPA Europe and Asian conferences, and the failure of several spa shows and groups. Now the task for spa professionals and professional spas is a search and discovery of authentic identity and real integrity -- the real purpose and symbolic significance of spa in terms of culture and nature, humanity and Earth, soul and cosmos.

Jonathan Paul De Vierville, Ph.D., is the owner/director of Alamo Plaza Spa in San Antonio, Texas. He is the secretary of the ISPA Foundation and a member of the Medical Spa Advisory Committee. He facilitates "The Dream Spa Seminar and Liquid Sound Workshop" at Bad Sulza, Germany. He also directs The Spa Course Kur Tour with The International Training Institute and Studies in Interdisciplinary Spa Programs, Activities and Services at Karlsbad, Czech Republic. He recently received a fellowship to the New Cosmology seminar at Schumacher College, England. De Vierville can be contacted at 210/822-7238 or

2. Spa types became listed and classified as day spas, hotel/resort spas, destination spas, mineral water spas, club spas, community spas, cruise ship spas and medical or medi-spas.

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