Thursday, June 12, 2014

Why language matters: "Avoiding Stupidity is Easier than Seeking Brilliance"

Sometimes it feels like the pile just grows higher and deeper with every year that passes.

What pile in particular?

The pile of cognitive bias and poor use of language - that pile.

Recently a blogpost appeared promoting a tissue-blaming and tissue-based manual therapy method that combines a kind of handling with a very botched explanatory model, historically so pounded into/conflated with the handling itself, that it would seem no one ever gave a fig about explaining it better. I replied a bunch of times, which has become a slideshow  now.. the conversation itself is still ongoing. A SomaSimple thread exists about it, too. 

Tissue-based targeting and tissue-based reasoning have GOT to be separated out, some day, from what we really do, which is try to help people with pain problems. (Before I die, I hope..)
Why? Who cares?

It matters because tissue-based referencing is noceboic to patients, that's why. Adriaan Louw says so.

It matters because patients don't care about tissue, they want to be able to move easier, or at least, not be afraid of moving even if their pain isn't the kind that responds to manual treatment. Bronnie Thompson says so. 

From this blogpost:

"In expert tennis, about 80 per cent of the points are won; in amateur tennis, about 80 per cent of the points are lost. In other words, professional tennis is a Winner’s Game – the final outcome is determined by the activities of the winner – and amateur tennis is a Loser’s Game – the final outcome is determined by the activities of the loser. The two games are, in their fundamental characteristic, not at all the same. They are opposites..." 
Think about it.

Eighty percent of professional games are won because the professional knows how to avoid mistakes.

Eighty percent of amateur games are lost, because one amateur makes more mistakes than the other does.
To win, all you have to do is make fewer mistakes!

In manual therapy terms, that might translate into not looking for, finding, or most of all not talking about postural defects, or bio-mechanical faults, to the patient, instead looking at only gross movement amounts and comfort levels instead.
Why not? Because "tissue faults" are misleading, and don't have anything to do with causing pain. Chances are higher that if they exist at all, they are a result of pain, not a cause, apart from any someone might have been born with.

The lesson to take away: Avoiding stupidity is easier than seeking brilliance.

One way to look at the mess manual therapy is in and always has been in would be to ignore the mess it's in and always has been in, with it's postural/structural/biomechanical/bio-medical/all the purely imagination-based cause-effect posthoc reasoning inherent in it. 

Yes, one could simply learn to ignore it. But I can't. Why not? Because I AM a manual therapist, and I want it to be better. 

That's why. 
For all the reasons I care about helping people who hurt. 
For all the reasons I hate when I get into pain myself (so fortunate that it's a very rare experience for me). 
For all the reasons that it matters in general for people in my profession to grow up intellectually and learn how to use their own brain instead of relying on manual therapy "culture" to do all their thinking for them or to have worked through all its own fallacious reasoning already. It hasn't, and it will never be able to, unless each of us does our own heavy lifting first.

And I don't care how many certifications someone has, or letters appear behind his or her name, or "big names" they can brag about treating. That sort of thing simply doesn't impress me any more.

Yesterday I was listening to the radio as I worked on a new image for my treatment manual. I learned that at McGill University, and for historic reasons unique to Canada, the law program prepares its students for the world by teaching civil law and common law simultaneously. It's done that way because it was noted that in the past, if one set of law was taught before the other in a linear manner, students would prefer whichever version they were taught first, that form would take over their brains, and from then on they would consider that form more important than the other form. So, the instructors decided to teach them simultaneously because both are equally important in Canada.

I thought about manual therapy, how it's taught operator-style to therapists, how that skews them into being egoists, thinking they have control over a process which in its essence is a dance between two nervous systems, equally, and over tissue targets that they can't even touch except via a blubber layer that slides all over the place and swiftly informs the brain about whatever is going on with its organism. So delusional.

What if manual therapy were taught from the start that it's about the dance, instead? 

I try hard to do that. I'm sure I fail, but I do try.

I learned a new word today - conspicuity. This idea backs up the law school at McGill's idea that you have to be careful how information is presented or students will end up skewed toward a particular cognitive bias. 

Conspicuity refers to an object's ability to catch a person's attention. When something is conspicuous it is easily visible. There are two factors which determine conspicuity: sensory conspicuity and cognitive conspicuity. Sensory conspicuity factors are the physical properties an object has. If an item has bright colors, flashing lights, high contrast with environment, or other attention-grabbing physical properties it can attract a person’s attention much easier. For example, people tend to notice objects that are bright colors or crazy patterns before they notice other objects. Cognitive conspicuity factors pertain to objects that are familiar to someone. People tend to notice objects faster if they have some meaning to their lives. For example, when a person hears his/her name, their attention is drawn to the person who said it. The cocktail party effect describes the cognitive conspicuity factor as well. When an object isn’t conspicuous, it is easier to be intentionally blind to it. People tend to notice items if they capture their attention in some way. If the object isn’t visually prominent or relevant, there is a higher chance that a person will miss it.

Gee, do you think that cognitive conspicuity could refer to learning tissue-based treatment models, instead of nervous system-based treatment models, as well?  I think so..

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