Sunday, June 17, 2012

Boiling down the problem

Science pretty much boils down to this: 

"The first principle is that you must not fool yourself - and you are the easiest person to fool." - Richard Feynman, Caltech commencement address, 1974.

The way individual brains work pretty much boils down to this:

"The boxes are the same color. Don't believe me? Put a finger across the middle of the page and see for yourself."- Unlawful Humor

The first is in place to counteract the second.

As far as manual therapy goes, as far as any kind of social grooming goes, I happen to think it likely all boils down to this: 
1. Primary somatosensory cortex discriminates affective significance in social touch (open access)
Abstract: "Another person’s caress is one of the most powerful of all emotional social signals. How much the primary somatosensory cortices (SIs) participate in processing the pleasantness of such social touch remains unclear. Although ample empirical evidence supports the role of the insula in affective processing of touch, here we argue that SI might be more involved in affective processing than previously thought by showing that the response in SI to a sensual caress is modified by the perceived sex of the caresser. In a functional MRI study, we manipulated the perceived affective quality of a caress independently of the sensory properties at the skin: heterosexual males believed they were sensually caressed by either a man or woman, although the caress was in fact invariantly delivered by a female blind to condition type. Independent analyses showed that SI encoded, and was modulated by, the visual sex of the caress, and that this effect is unlikely to originate from the insula. This suggests that current models may underestimate the role played by SI in the affective processing of social touch."
... and this: 
2. Attention Modulates Spinal Cord Responses to Pain (paywall)
"Reduced pain perception while being distracted from pain is an everyday example of how cognitive processes can interfere with pain perception [1,2,3,4,5]. Previous neuroimaging studies showed distraction-related modulations of pain-driven activations in various cortical and subcortical brain regions [6,7,8,9,10,11], but the precise neuronal mechanism underlying this phenomenon is unclear. Using high-resolution functional magnetic resonance imaging of the human cervical spinal cord in combination with thermal pain stimulation and a well-established working memory task [12], we demonstrate that this phenomenon relies on an inhibition of incoming pain signals in the spinal cord. Neuronal responses to painful stimulation in the dorsal horn of the corresponding spinal segment were significantly reduced under high working memory load compared to low working memory load. At the individual level, reductions of neuronal responses in the spinal cord predicted behavioral pain reductions. In a subsequent behavioral experiment, using the opioid antagonist naloxone in a double-blind crossover design with the same paradigm, we demonstrate a substantial contribution of endogenous opioids to this mechanism. Taken together, our results show that the reduced pain experience during mental distraction is related to a spinal process and involves opioid neurotransmission."
...and this:
3. The kinaesthetic senses (open access) 
"This review of kinaesthesia, the senses of limb position and limb movement, has been prompted by recent new observations on the role of motor commands in position sense. They make it necessary to reassess the present-day views of the underlying neural mechanisms. Peripheral receptors which contribute to kinaesthesia are muscle spindles and skin stretch receptors. Joint receptors do not appear to play a major role at most joints. The evidence supports the existence of two separate senses, the sense of limb position and the sense of limb movement. Receptors such as muscle spindle primary endings are able to contribute to both senses. While limb position and movement can be signalled by both skin and muscle receptors, new evidence has shown that if limb muscles are contracting, an additional cue is provided by centrally generated motor command signals. Observations using neuroimaging techniques indicate the involvement of both the cerebellum and parietal cortex in a multi-sensory comparison, involving operation of a forward model between the feedback during a movement and its expected profile, based on past experience. Involvement of motor command signals in kinaesthesia has implications for interpretations of certain clinical conditions."

I also think one has to set up solid treatment, contact, therapeutic boundaries, no matter who you are or what gender, or what the gender of the person you are treating, to cancel out well in advance any possible misunderstandings that could arise. Cory Blickenstaff refers to the shaping of the treatment encounter as setting up of Contextual Architecture, being a deliberate contextual architect. Vital, in order to dampen any fear (quell noise from the amygdala), obviate any mistrust. 

I'm a big fan of therapy being mostly about obviating:
"To obviate means to make something unnecessary." 

Think of all the things that one can render unnecessary: surgery (a lot of the time), pain, worry, stress, discomfort, impaired mobility, disability real or perceived, etc. With all that out of the way, one (as a therapist) can feel a bit like one can reset the start button on somebody's everyday life, or at least, enjoy the delusion. 

 Obviate is a transitive verb. What is a transitive verb? Here's the Wikipedia definition
A "transitive verb is a verb that requires both a subject and one or more objects. The term is used to contrast intransitive verbs, which do not have objects."

There are two kinds of transitive verbs, monotransitive (only one object), and ditransitive - at least two (maybe more?) objects. 

"In grammar, a ditransitive verb is a verb which takes a subject and two objects which refer to a recipient and a theme." 

Ooh.. the plot thickens... What is this "theme" business? 

In a number of theories of linguisticsthematic relations is a term used to express the role that a noun phrase plays with respect to the action or state described by a sentence's verb. For example, in the sentence "Susan ate an apple", Susan is the doer of the eating, so she is an agent; the apple is the item that is eaten, so it is a patient.

What?? The object of a transitive verb is a "patient"???? Is that where the term "patient" arose in the first place? Maybe! 
Patient (def): "the semantic role of an entity that isn't the agent but is directly involved in or affected by the happening denoted by the verb in the clause"

Hey, way to go English language. 
Way to rob a person in some kind of distress of his or her own locus of control. 

Now I'm starting to see the point of refraining from calling those we treat "patients" - it means they are "objects" acted on by "agents" - we come back to having to distinguish between operator and interactor models. What exactly do we think we're doing when we treat alive awake human beings with nervous systems fully awake and alive and responsive on every level from skin cell to sense of self? How are WE acting? Are we aware of, and obviating potential misunderstanding? Are we aware that the brain at the other end of our own stands directly between anything we do/think, and any potential way the individual belonging to that brain will eventually feel? Or are we blindly, blinkeredly, performing a robotic bunch of steps we believe will "fix" a problem in an "object", historically known and defined(!) as a "patient"? 

Old SomaSimple thread, "Shared Space"

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