Brain Science Podcast #42: "On Being Certain"

In reference to Alberta woman with chiropractic stroke sues bigtime:

Ginger Campbell's latest podcast is about the book, "On Being Certain: Believing You Are Right Even When You're Not ", by neurologist Robert A. Burton, MD.

About half way through it, she says;

"Earlier on I asked the question, "What would be the possible benefits of "a feeling of knowing" that is actually false?" This brings us to a consideration of our brain's reward systems, and how they interact and influence our thoughts.

We know that there are extensive connections between the pleasure rewards systems, emotions, and the opioid peptides in the brain. We have talked about in the past the mesolimbic-dopamine system, which is a key component of the brain reward circuitry that originates in the upper brainstem. It, not surprisingly, seems to use dopamine as its key neurotransmitter. This mesolimbic dopamine system connects to the parts of the brain that are involved in emotion and cognition, including parts of the frontal lobes, and the nucleus accumbens which is thought to be involved in addiction. It's been shown that brain mediated rewards cause behaviours to persist, including addictions.

So you have to wonder, how is this related to the feeling of knowing? Dr. Burton gives an example in the book, of a person faced with a charging lion, who climbs up in a tree and survives. After the person escapes he has the feeling that he has learned something. And if you make these sorts of decisions repeatedly, you will probably have a positive feeling of "correctness" that becomes linked to that behaviour.

Dr. Burton argues that the feeling of knowing and feelings of familiarity are integral to learning."

Fine, so why am I bringing this forward? Because my human primate social grooming brain thinks humans are learning machines who:
1. can learn all sorts of crazy things
2. learn all sorts of physical actions
3. make up all sorts of bizarre and sometimes dangerous rituals

.... that often fall into the category of "stupid human tricks."

Among these, I would definitely put neck manipulation of the high velocity sort.

I can't prove it, but have always suspected that both doing it and having it done to one's own person likely belong in the category of "addictive behaviours" as well as "stupid human tricks", but this is the first time I've heard a (potentially associated) brain pathway actually spelled out.

No one in the greater HPSG sub-troop acts more "certain" of themselves, on the whole, than those practitioners who favor this approach. Except possibly the patients who've been on the receiving end of it, convinced that it "helps" them, even when they still "need" it monthly for 10 years, etc. (See Keith's observations/comments in "Alberta woman" link.) I'd put that in the category of "false knowledge"; the feeling of being certain outweighs the obviousness that it doesn't really help much of anything at all, except a reward pathway (temporarily) and furthermore only reinforces a behaviour peculiar to humans, reinforces a pathway that goes nowhere and does nothing permanent, does not give the brain a chance to learn a new behaviour toward self-sufficiency.


Further reading:

1. Harriet Hall's review of the same book.
2. Is certainty a dopameme?


August 8/08

I'm back into this post to drop a link to Ginger Campbell's Podcast #43, an interview with the author. It really rips along - give it a listen! Thumbs-up.

Manipulation and the Brain

This entry is a more edited version of a post I made on NOI in a discussion regarding manual therapies. I have included some references.

One of the participants asked, “If we discredit manipulation are we not at risk of undermining other manual type techniques for the same reason (myofascial, massage, mobilizations etc)???”

I answered with a prior version of this:

I don't think so. There is a layer of "brain" all around the outside of the body, a.k.a. skin, with fibres that go straight up to the insular cortex.1,2,3,4 We could consider manual therapies as altering the nervous system through THIS organ - I think all of the manual therapies you named do this anyway to a large extent, yet there is a conceptual void that needs filling; long ago manual therapies were named for the mesoderm (deep to the skin sensors) they were supposedly targeting (e.g. myofascial) or the sort of physical movement needed to perform them (e.g. massage, mobilization). These sorts of archaic designations deflect accurate therapeutic understanding from including the perspectives that patients' own unique nervous systems may have, keep our constructs off track, bias our self-image toward being PHYSICAL therapists instead of being physical THERAPISTS.

I doubt the actual therapy procedures, the physicality of them, are discreditable. These seem to be something humans evolved doing in order to help/comfort one another, cognitively consolidated action memeplexes that appear to stem from some deep ancestral well of primate social grooming. However, the constructs that attempt to explain and inform their use do nothing but describe such treatment as something we the treatment heroes "do" unto others. This perpetuates confusion, maintains invisibility/disregard of the highly variable nervous systems at the receiving end of the interactions as passive recipients, does nothing to consider or include the highly active role that nervous systems play in their own recovery by first accepting as non-threatening, then responding to, exteroceptive input.

Manual therapy ranging from skin touch only to active skin stretch to deeper pressure into underlying bones, muscles, neural tunnels, what have you, at varying speeds, should always be kept within our scope, but framed instead as varying kinds of exteroceptive input into a living perceiving system. Rather than being framed so strictly in biomechanical language, with its attendant and unavoidable misconceptions of cause and effect, the effects produced by manual therapies should be more carefully read as responses by the patient's living perceiving system. This necessitates seeing a patient's nervous system as more of a verb than a noun. This necessitates developing abilities to stay one step ahead of that nervous system, guiding it toward better behavior/output, not overtreating the mesodermal anatomy of it, or holding that foremost in our minds.

I'm all for retaining, but renaming, all forms of manual therapy interventions as a necessary part of their long overdue upgrade; new manual therapy names should include and reflect modern pain and nervous system concepts, and a sense of the interactivity of two nervous systems working together at every level to help one of them reduce pain and improve function/freedom. I would predict that as the perception of them shifted in us, the users of these therapies, the balance of usage of them would too; I think a trend more toward less intensive and slower forms would develop.

1. Unmyelinated tactile afferents signal touch and project to insular cortex; Nature Neuroscience (2003); H. Olausson, Y. Lamarre, H, Backlund, C. Morin, B.G. Wallin, G. Starck, S. Ekholm, I. Strigo, K. Worsley, Å.B. Vallbo, and M.C. Bushnell.
2. Pain Mechanisms: Labeled Lines Versus Convergence in Central Processing, Annu. Rev. Neurosci. 2003; A.D. (Bud) Craig.
3. Antero-posterior somatotopy of innocuous cooling activation focus in human dorsal posterior insular cortex, open access 2005; L.H. Hua, I.A. Strigo, L.C. Baxter, S.C. Johnson, A.D. (Bud) Craig.
4. The Integrative Action of the Autonomic Nervous System: Neurobiology of Homeostasis 2006; W. Jänig.

I see the understanding of how to treat live people as inversely proportional to the amount of force used and the speed of its delivery. I see the misunderstanding of how to treat live people as directly proportional to the amount of force used and the speed of its delivery. I guess nothing will ever be able to make me change my mind on this, ever.