Saturday, August 11, 2007

Trailblazing; No Time Left for Making Nice

Yet another discussion cropped up on SomaSimple, necessary though not without misunderstandings. It had to do with a "health performance solution" system dreamed up by a chiro and sold for major bucks to athletic trainers (among others), a rehash of everything that's already known and recycled endlessly in what I like to think of as "Mesodermolandia", a mythical "rain forest primeval" that gave rise to the world of human primate social grooming. Here is where reliance on "what works" feeds and fosters a conceptual anything goes attitude. Here, safe from challenge to status quo, a predatory spirit of postmodern what-the-bleep-do-we-know-anyway retreat into confused troop mentality flourishes, and a dense fast-growing tangle of argument based on next to nothing at all, combined with the blistering humidity of interpersonal opinion, chokes any real effort to think scientifically or even logically; all ideas underpinning this little subculture remain unexamined yet vigorously exchanged for coin.

After a reasonably successful deconstruction, the thread postmortem included the usual comments re: we weren't "nice" to the bringers - we pressed them for detail on their treatment construct (something seen as a bit rude in this world, believe it or not..), our interchange was seen to be "sarcastic", we seemed "hostile". I wrote the following post in response to these criticisms of our seemingly poor demeanor.
I'd like to point out that therapeutic niceness and politeness is likely what got us the deepest into this boggy morass in the first place, the swamp of erroneous belief, unsupportable treatment construct, and mesodermal bias, out of which grow giant trees of nonsense, treatment systems with deep roots down into the economy, choking out rational thought and real scientific advance of our human primate social grooming professions.

We each wake up one day and realize we have a choice to make - continue playing nice and do nothing, the mental equivalent of living wild and swinging from vine to vine like our primate siblings, OR.... learn to exercise our minds and their capacity to think, sort, discriminate, categorize, make sense, link, develop and strategize a way out of the mental jungle we have found ourselves in. Occam's razor isn't nearly big enough to do the job required in this profession. We need Occam's chainsaw. And when wielding Occam's chainsaw, inevitably some sawdust will get in someone's eye from time to time, or a wood chip hit them on the head, or the roar of the machine itself may sound uncomfortable.

But it's necessary. We mean no one any personal harm. Wear a hard hat and stay out of the way when the big trees topple. We're going to do this, blaze a trail of deconstruction, because we have to find a way for this profession to get itself out to the main road. Don't worry, it's far from being a clearcut.

Personally I'm determined to cut down whatever I need to, and in my tiny backpack I'm salvaging and carrying the essentials of soft kind gentle manual therapy. I get ever more invigorated to the task when more mesodermal bias looms in front of me, blocking my way.

Thursday, August 09, 2007

The Brain's Kindness Detector? Right Anterior Insula

There is a long thread on SomaSimple to do with the insular cortex, a part of the brain that was researched heavily last winter. Well, the fun never stops, and now there's a book by Sandra and Matthew Blakeslee called The Body Has a Mind of its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better, not quite published yet. I will be reading the book not only as the owner-operator of an insula, but as a therapist who treats patients with persistent pain, who therefore deals with other peoples' insulae on a daily basis.

The September edition of Scientific American Mind features an excerpted chapter that has definitely sharpened my appetite for the book. The Blakeslees discuss the point that this region is found only in primates and by extension, us. Frogs, even other mammals like dogs etc, even though they can act sometimes as if they can feel everything the way we do, can't/don't. But first they explain the system. Here is a small part of it:

Just as a road atlas is full of maps that represent real-world locations, your brain is full of body maps that represent aspects of yourself, inside and out. In contrast, the main goal of exteroception, externally oriented perception, is to create maps and models of your body, the world around your body, and your body's relation to the world. Your brain creates and maintains maps of your skin surface, limb position, joint movement and musculoskeletal system so that you can move about and interact with objects and people. You have distinct fibres in your spinal cord that carry such information in both directions: up from your body to your sensory maps and back down from your motor maps to your muscles.

Interoception is a separate realm of somatic sensation that is oriented inward. It has two sources. The first is the internally mapped state of your body. Bring your attention to the sensation these maps are generating in you right at the moment. Think about your heart, lungs, stomach, intestines, rectum, larynx, throat. Try to feel their activity if you can. All your innards have receptors that send information up to your brain for mapping your "gut" feelings of hunger, thirst, air hunger and other visceral sensations.

The second source of your interoceptive maps consists of a different class of receptors found on your body's surface, including your teeth, gums and tongue. Unlike the touch receptors that deal in pressure and vibration and are tied mainly to deliberate touch and action, these other receptors carry information about the "homeostatic" condition of your body - temperature, pain, itch, muscle ache, sexual arousal, crude touch and sensual touch. Homeostasis refers to your body's ability to maintain internal balance. Your spinal cord contains an evolutionary older set of fibres that carries this information to and from your brain.

This may seem strange at first, because many of your body parts end up being mapped by both systems. If someone pinches your arm, the pressure and pain will be represented in your primary touch map. But the pain will be rerepresented in your insula. Why is pain from one pinch mapped in two places? Because your insular maps serve a different function from your primary touch and motor maps. They are the command center for homeostatic self-regulation. For example, to run your body's thermostat properly - to keep your body temperature constant - your brain needs to know not just about your core temperature, but also about air touching your skin. Pain in your muscles, lungs and joints is important for marshaling your body's resources during exertion, but so are sensations of strain and movement and resistance in your joints and skin. So the primary brain maps for homeostatic signals from your body surface - about itch, sharp pain, dull pain, burning pain, tickle, sensual touch, heat and cold - as well as the sensations arising from your body's interior, are mapped in your insula, not in your primary touch cortex. You use those feelings less to deal with the outside world than to seek balance within your body and put your internal sensations in context. And as Critchley's results imply, interoception does far more for you than just letting you know your are hungry or exhausted or sexually sated. It is also a crucial ingredient in some of the most important aspects of human beingness: sentiment, sentience and emotional awareness.

The take home point here, is, keep your handling of patients, above all, kind.

Let kindness and slowness and non-invasiveness and invitation to move be the first and the main kinesthetic food you feed your patients' insulae, and all will be well.

This is the part of the brain you really need to impress with what a wonderful manual therapist you are, by being kinesthetically non-noceboic. Because it picks up emotional content so easily, make darn sure you are operating from your own best/highest emotional ground - THIS is the part of your patient's brain that can read your intention, emotionally. Give it NO reason to be suspicious of you in any way whatsoever. Make sure you get to know your own insula intimately, and inspect and repair the fence you put up around it, daily. These are your personal boundaries. In no way should your patient ever come to know what its contents are. What's in your own insula is absolutely none of their business.

"A memory is a moment when the past meets the future in the present" - Joseph LeDoux