Navigating "even keel" between uncertain death and uncertain death, toward certain death

Life, if we are realistic, is just a waiting room in which we amuse ourselves before we can go through a door with a sign on it, upon which is clearly written, DEATH. Lucky for us, the waiting room is huge, big enough to encompass entire oceans, full of brightness, infinite distractions, lots of other people, most of whom are merry, many useful and interesting ways to spend time together or alone.

"Even keel" is a metaphor. It stems from the many centuries, I like to imagine, when humans traveled by ship to visit each others' cultures, trade, conduct war, all those human things. Thinking about "even keel" takes up quite a bit of my personal hard drive. Not only have I learned how to be even keel in my own life (am not finding myself blown sideways by it or capsized as often anymore, that is..), when I am at work I focus on how to help brain parts in another person' nervous system get along better together, or at least I imagine that's what I'm doing. Like an engineer fixing systems in a building, or in a computer. Except, I don't really do anything, I just add bits of provocation and wait for feedback to tell me I'm on the right track. Most of it has to do with waiting for then seizing moments. But I'm geeky enough to want to know everything I can, anyway, about the systems I work with, even though human primate social grooming is really quite instinctive.

"Even keel" applies to nearly everything on any level in human life. I made a little picture (thank you photoshop) out of other little pictures to illustrate the old Greek story about the sea monster and the whirlpool that I first read about in James Willis' excellent essay by the same name. In his essay, the two-headed sea monster represents pseudo- and anti-science, which he does not want to steer too close to in his work as a doctor. The whirlpool represents scientific reductionism, tyranny by protocol. He doesn't want to become sucked into becoming a protocol zombie. Instead he wants to be able to steer his own boat, stay even keel between two extremes, retain his own locus of control within his treatment relationships.

I decided to steal his metaphor, practically intact, for my own work as a human primate social groomer. My sea monster has two heads too - one is anti-science and the other pseudo-science too, although, some days their names change to myofascial release and craniosacral therapy. The whirlpool is orthopaedic manual therapy, which (at least in Canada) is almost a Byzantine religion with its own high priests and devotion toward evidence-based regimented protocols, ostensibly to keep therapists safe from harm or blame, keep them "pure" and untainted, keep the money of society flowing toward our profession. But when I look at OMPT in Canada, I see huge flashes of tooth fairy science as described so succinctly by Harriet Hall. In Beyerstein's excellent essay on pseudoscience (50-page pdf) he stated that in his expert opinion, any "science" which doesn't take neuroscience into account is pretty much, by definition, pseudo. I have never sat in an ortho training workshop in Canada and once heard the slightest whiff of anything to do with neuroscience, not even physical nerves which slide past the beloved joints upon which ortho-lovers are so transfixed. In the workshops I attended they taught that you can actually feel movement in joints and improve movement in joints with fancy pressures at precise angles. From outside the living human body. Maybe this has changed in the last few decades, but judging by the kinds of ortho-esque "studies" I see done... somehow I doubt it.

Anyway, enough rambling on about that. "Even keel" is what each human, regardless of what one ends up doing in the Big Waiting Room called "life" prior to going through the door called DEATH, tries to achieve. We each have a life to navigate and moods to manage. How we each end up doing that and whatever success we manage to demonstrate in the process, has a lot to do with luck and circumstance in terms of genetic makeup plus upbringing, nature/nurture. I found a nice paper today, Psychosocial and Neural Correlates of Resilience, which is open access, at least for now. (Thank you to Integral Options blog.) In it I found:

"In experiments by Meaney and colleagues, the offspring of female rats displaying more nurturing behavior (high licking and grooming compared to low licking and grooming) had less methylation of the glucocorticoid receptor (GR) gene in the hippocampus, resulting in higher GR expression, lower anxiety-related behavior and better HPA axis regulation. In addition, research by Nestler and colleagues has delineated molecular mechanisms underlying resilience to a social defeat stress paradigm in rodents, including the induction of gene expression changes only seen in resilient mice."

Gee, I like to think I'm resilient, even keel, or at least have learned how to be, even though I ended up with a human mother who did not believe much in pleasant licking or grooming. Somehow, even though this happened to be my personal fate, in the big waiting room of life, I was drawn, explicitly and implicitly, to work which is all about (metaphoric) licking and (actual) physical social grooming! The complete and utter simplicity and rightness of it, the naturalness of it to me as a human primate, is the wind that fills my sails, rows my boat, has helped me attain/remain "even keel."

That is pretty much all that is at the core of what I find mysterious in my own life. It's not earth-shaking or dramatic or life-threatening, it's just a story, likely a boring one. But it's my own little one. And I don't mind putting it here, where very few will probably ever find it.

May your days be merry and bright

This has to be the most stressful time of the year for social and symbolically afflicted animals like us, when we are trying to change our way along. But I am pleased to be able to say that this year the stress is much less.

I went to a party last night, 16 people, a catered turkey dinner at the senior drop-in center where I go and volunteer, peel potatoes etc., the local good churchwoman (best friend of my mom) said grace, there was a party afterward in my mother's living room, most of the people there in their 80's, some corny games, some Christmas carols accompanied by one of the 80-somethings on a portable piano, a present exchange, three people (women) wearing identical red vests (- I was one - guess I'm blending in well around here, the kid of the bunch at not quite 60 yet). It all feels a weird combination of surreal (this is not my life, surely) combined with acceptance (really, it's not so bad, a bunch of older folk all living independently, manufacturing for themselves and apparently enjoying simple social pleasures, keeping each other going and cheered up in a safe, humble little prairie community). There were four men and a lot of widows. My own father checked out 9 years ago.

It's a nice gentle way to be passing time, hanging out with advanced seniors. Which is odd, because at younger ages I would have been bored out of my mind by this sort of repetitive socializing for the sake of socializing. I would have felt myself trying to burst out of invisible cages.

Instead I feel very welcome and nurtured by this group. Its members find lots of little ways to let me know that they like and appreciate my being there with them. I find myself open to accepting this without feeling uncomfortably vulnerable at the same time.

I have what I consider to be my "normal life," which to them is strange since none of them use computers, lived virtually, being online, studying, thinking, conversing by email/writing. The inner world of me.

I have this weird (to me) and yet oddly comfortable outer life now, my only peer group at the moment comprised of people my mother's age or close. Preferable IMO to living in an increasingly nasty urban jungle, full of darkness, lack of sun, fighting every day just to make myself stay there. I seem to have created a symbolic "child" world again, and my own mother is actually still physically present in it, part of it. I can feel long-lost parts of me lapping up this nurturing environment like thirsty camels lap up oasis water.

It slowly is dawning on me that it barely matters anyway, what I am or what I make or don't make of myself in the world. I never thought I'd see the day when personal existential angst would appear to comfortably recede or dissolve. Maybe it has to do increased light levels. Maybe with having managed to revisit "child" mode once again for a little while. Maybe a combination. Whatever. I remain acutely aware that one day I'll just slide right out of existence, but I feel detached about this in yet another new way for now, even as I anticipate attending many funerals in the coming years. Which won't involve fun probably. So for now it seems important to just relax, support these people and their gentle socializing for all the camaraderie and fun it seems to bring them, all I can, just for now. It's what is right under my nose at the moment. I can always go back to paid physical human primate social grooming, later.

How to sleep like a proper human primate

This morning a member of SomaSimple brought this article forward in a discussion we are having called Pain of Comfort:

Instinctive sleeping and resting postures: an anthropological and zoological approach to treatment of low back and joint pain by Michael Tetley, PT.

I'm bringing it here as a gift to all who wonder why there is so much insidious body pain in our nice, comfy, dry, temperature controlled, civilized lives. We are perhaps, as the article suggests, too far removed from our primate origin, unable to relax and sleep on a house floor, let alone a forest floor, or a wide tree branch surrounded by air and insects and potential danger.

I never had seen this article until now, and immediately fell in love with it, even though it contains a strong ortho-dominant perspective (as if there were nothing inside the body more important than joints) - otherwise it resonates with everything I think about self-efficacy. There are photos of natural sleeping positions that in my mind elongate and refresh neural tunnels everywhere. If the nerves alongside large joints are healthy, then so will the "joints" be. But this is a minor quibble overall.

The first sentence is;

If you are a medical professional and have been trained in a "civilised" country you probably know next to nothing about the primate Homo sapiens and how they survive in the wild.

Well, not quite true for me. I've been thinking about how to be a good human primate social groomer for quite a long time, Michael.

When people in pain ask me,"What should I do?" I start by teaching them how to get down on the floor and relax there. I tell them, the floor is flat and hard. When you lie down, you will immediately feel all your tightness easily. Once your brain can sense it, it can do something about it, lengthen out various tensions. When you get down on the floor, something's gotta give, and it's not gonna be the floor. The floor is the best biofeedback device there ever was, always cheap and always available. Make the floor your friend. And deep breathe with your abdomen to relax through anxiety and discomfort.

When they ask "What kind of mattress should I be on?" I say, in general, whatever gets you through the night, but the harder the better, so no waterbed.

"Monkey College"

In this video, a little primate cousin is being trained to help human cousins with disabilities. The monkey will go to live with a disabled individual, will do all of the handling of objects, even scratch itches and push eyeglasses back up noses, fill watter bottles, lift paralyzed arms up onto wheelchair arms, change CDs, magazines, switch lights on and off. It has agile hands (with a very big S1M1 same as we have, I imagine) and it has a trainable brain reinforced sufficiently through affection and positive reinforcement.

Apart from the admiration one feels for those who have designed and executed such a useful "primate social grooming" facility, and the endearing qualities these monkeys demonstrate, this whole idea puts a really interesting twist on the matter discussed in the previous post - kind of blurs the edge between species.

Where did the term "human primate social grooming" come from?

I coined this term, have used it for a few years now. I suppose I should explain what I mean by it.

It arose out of thinking about the whole problem we have with PT having evolved as a culturally specific form of health care, along with most of the others, without good biological foundation (i.e., embryology and evolution), therefore rudderless. Although I've tried to grow myself a rudder, the profession lacks such a thing collectively.

Anywhere humans have a culture, there exists "healthcare." Culturally specific forms of health care we are familiar with in the western world include:

1. manual/physical therapies: PT, chiro, osteopathy, massage (many kinds), and the multitude of techniques named after individual originators who came out of the woodwork, Rolfing, Bowen, all these..
2. medical, surgical and nursing care for life-threatening trauma and disease
3. care for emotional, mental and psychological difficulties, e.g. psychotherapy, psychiatry

Other cultures combine these three main forms in other ways. All are categories of interventions sought, instinctively, by people who are undergoing life-disrupting or life-derailing problems with their bodies or their ability to think or relate appropriately.

Humans are primates, and primate survival is enhanced by being a member of a "troop". All three of these categories represent "help" extended to an individual who seeks it from the social human "troop" in times of either overt or perceived need. One can quibble over what constitutes "true" need; however, usually the most prioritized need is the one that bothers a given individual most within a given time frame. This would include such things as the "need" to breathe, to drink if thirsty, etc. Of the array of "need" states that can be defined, many of which the individual can instinctively take care of, a few seem to be recalcitrant to self-help for some people; e.g., pain is one (defined as a need state by Patrick Wall) that looms quite large for many people who have an active and functional nervous system. Pain is a frustrating phenomenon to endure; it can cause stress, and stress can in turn worsen pain. Pain can reduce one's ability to cope in a mature manner, thus interfering with relationship. Relationships interfered with may threaten one's place in a troop, and threat like that can lead straight to anxiety - for a primate - and more stress.

When stressed, primates (including human) seek social grooming. There will always be those among us who feel best when able to access "social grooming" of some sort for pain or distress or illness, and there will always be a supply of groomers ready to help, because humans are primates. Other primates groom each other instinctively, and so would we, if we were not constrained by "culture" and laws in place to regulate boundaried contact (for good reason). Social needs blurred into biological needs have a way of making culture adapt to them. Enter quintessentially "human" primate social grooming.

Also, enter the collision between who and what humans (collectively) think ourselves to be, and who or what humans (individually) default to in times of stress or physical need - biology takes over. Enter the "professional" splintering of a nurture behavior once fueled by nature into a bunch of modern (correction - let's make that postmodern, counter-enlightened) fragmented, rigorously (or not) regulated, politically defensive turf-raiding, territory-defending groups that are operationally primate troops in and of themselves to a great extent. Some are science-based while others are thoroughly a- or even anti-scientific. They exist in relation to each other, like rail cars on a train track, their position in the train having emerged by their relation to science; they all move along (some eagerly and some reluctantly), clashing, colliding, all ultimately pulled along through time by the chugging engine of Science and Society, the caboose of anti-science bringing up the rear, linked by that primate biological troop mandate "to help" and "to serve" and restore quantity and quality of living to fellow human primates, doomed to never escape the train - unless sidelined permanently, decommissioned due to dwindled popularity or de-legalized by future social contracts. This train is not bound for glory. It is slow and lurches uncomfortably. Cars routinely collide into each other. Any individual can climb aboard anytime onto any car of choice. Individuals that belong to one car can move about the train and visit other cars, check them out.

The whole point of the interaction of human primate social grooming (the non-medical kind, the more strictly manual therapy kind), or the establishment of any therapeutic relationship, is to get the right placebo response (in the Patrick Wall sense) started. All forms of health care are therefore veiled forms of human primate social grooming, and manual therapies are more direct forms, attempts to physically elicit said placebo response.

Social grooming started out as the simple 'nurture of nature', you might say - an animal activity, i.e., mammal mothers attentively licking their pups/kittens/calves etc. Primates took it further into wider social arenas, intra-troop behavior, maintenance of relationship.

Primatologists think one of the factors that may have driven development of our big brain in the first place was that it may have come in handy for keeping track of who was who, and to keep the peace (see Dunbar's number). The initial bonding that goes on between humans (e.g. parent/child) may well need to be reaffirmed artificially once in awhile, such as when there is a period of personal drama or trauma,, chaos or growth, which may or may not include physical injury. What we know for sure is that physical injury is certain to knock one off one's tracks for awhile; how it is handled socially, therapeutically, can be/often is pivotal to good resolution. See here, and here, for old blog posts about the insula.

If that's all true, then good old, non-nociceptive/unresolved 'pain', physical and/or psychological, is a need state all right, one that may require consummatory movement on a spectrum that ranges from just practicing some creative motor output at one end of the scale, further along to active physical relating e.g., hugging/sex with a partner, way over to the far end of the social spectrum to boundaried input of a physical sort from a therapeutic 'stranger', all depending on the individual. In the latter case perhaps the bond inside the patient, their intra-psychic balance, the bond they have, perhaps with their perceived relationship to their own biological life itself, can only be restored through physical human contact, from way outside the immediate family.

I think this is probably so fundamental that everyone just ignores it completely.

There are likely to be social groomers out there who because of human belief systems, won't entertain the possibility that we evolved instinctively doing this merely because of how healthy it feels, both for the groomer and the groomee. (Manipulation is likely more of a latecomer on the social grooming scene. It has its own unique sensory charm for some, I suppose.) There are still more who insist on trying to turn (manual) human primate social grooming into something quantifiable, standardized, objectified, reproducible... something more "human" (by mechanized western cultural standards), but possibly something at the same time less "humane" (by human primate social grooming standards). Still others get the kinesthetic part, love the kinesthetic part, but refuse to try to understand such a phenomenon scientifically - they even reject it, preferring to adopt mystical explanations instead, presumably because these "feel" better. We probably all get held back by all these proclivities.

This was once a huge problem/obstacle/quandary for me.. I could barely see the outline of it and it felt awfully big, like a chasm in the fog. When I came up against it in my own thinking I just didn't quite know where to go with it, how to dissect it, deconstruct it, deal with it, digest it. I understood it but not well enough to dispel it. I felt capable of nothing but blatting it out halfbaked. It made me feel cognitively dissonant, weak in the knees. Maybe the whole faintly nauseated feeling cognitive dissonance confers is what drives PTs and other "groomers" off to once again cling to religious anti-evolutionary belief systems. The truth (and I think this is truth) kinda sucks, doesn't it? - adds no glamour at all to our profession, makes us humble, puts us in our place at the bottom of the health care hierarchy, confronts us with the probability that we mostly deal with the non-human underpinnings of physical human existence, the deeper ways that bodies and nervous systems are connected. To go there boldly means confronting the fact we are primates, I think. And that like monkeys, our various manual therapy professions, by virtue of being "hands-on", and more primally primate than others, perhaps.

Yet, when I pondered the matter from another side, as one who instinctively moved toward this type of work when I was still a child, driven perhaps by overactive mirror neurons, it feels real and honest and natural and honorable by comparison with lots of other human activity going on that is greed-based and disgusting and destructive. What I find more disgusting is when human primate social grooming is dragged down further by greed and scam and dopamemes.

Fast forward a few years and I'm still not quite sure how all this fits together, but I think this sociological/evolutionary/psychological overview deserves at least a mention in the overall consideration of manual therapy. Acupuncturist/medical physician, Anthony Campbell, wrote:

"Among primates, we are the only species that does not routinely perform physical grooming. The manual therapies provide one of the few occasions when it is socially acceptable for comparative strangers to touch another's body in a manner that approximates to primate grooming. It seems likely to me that part of the success of the manual therapies depends on this, and differences in success rates among therapists are probably related to differences in how they apply touch.

The mechanism of touch as therapy is no doubt complex but is likely to involve the limbic system (cingulate gyrus) and release of oxytocin."

(See his whole comment in "Rapid Responses" after this article, Characteristic and incidental (placebo) effects in complex interventions such as acupuncture.)