I blogged a bit about my new space, Almost there. It's the time of year when I feel the most blah, and I feel blah, even though I do seem to have enough steam build-up-ability to get through the days. The weather's pretty good, above zero and dry streets, blue skies, so that helps, a lot..
Today it occurred to me I'd need business cheques, so I stopped in and got a new business account started. It also occurred to me I was going to need a phone for that groovy new phone number I'm supposed to be getting tomorrow, so I stopped in and bought one at the local Sask-Tel store. I got new business cards and new stationary and three signs, one for each outside door and one for my own door, ordered.
On the whole, a busy day and a fair bit accomplished.
Yet I feel so blah. On the inside.
I suppose it doesn't matter two slices of bread around the outside of a sandwich how I feel, inside. The miracle is, I can function OK. I can get up early on a Monday, go to the "gym", work out, come home, go out and do errands, on foot, remember things that need to be done, do them, come home and sit and puzzle over why it all feels so.. blah to me. I just do not feel any thrill inside about any of this. I think part of me is still disgruntled at myself for having caved 4-5 years ago with SAD, and for dragging it back to a place it thought it had escaped and would never have to go back to except to visit.
Whatever. I'll get through this. I usually do. None of it really matters, what matters is that I create a new frame around what it is I do, treat pain in other people, and get on with it, and not ruminate on any small bits of it overmuch. Because, really, none of it, in and of itself, matters much at all. In the treatment moments, when someone will come in, and I treat them, and they get that "aha" look over their face, that will make all of this worth it.
I could have just continued treating other patients for other people and letting those faces show me their "aha" looks. But you know what? I really do not like working for and around other people much at all anymore. I don't have much to say to them, I'm kinda-sorta not very interested in whatever it is they think they have to say to me, and I'm not especially interested in any deep bonding with any of them. The only thing I live for anymore is that "aha" look on my patients' faces. And I can arrange my life to have less intrusive interruption, more quiet space for "aha"'s to appear. So, that's why. That's my motivation. No-frill, no-thrill (for me) motivation.
In other news, I've been going to the "gym" every day. I've lost 25 inches, about 15 pounds. So that's nice. It would be nice if "feeling great" would kick in one of these days.
Monday, November 28, 2011
Sunday, November 27, 2011
Why Things Hurt: Lorimer Moseley TEDxTalk
Lorimer Moseley did a TEDx talk recently about 'why things hurt' - here it is - just 15 minutes long. Lorimer is great speaker - his snakebite story is legendary by now.
Friday, November 25, 2011
Almost there
Today I popped in to my new 'location', a room I've rented in a neighbourhood spa. I'm a completely independent operator, just renting a room there, not affiliated with the spa in any way; just paying rent.
It's been a slow process - the phone isn't quite hooked up yet. Sask-Tel has to be the slowest phone company the world has ever seen. I have had the room rented from Nov 1st, but getting a phone hooked up seems to take a full 3 weeks. The line won't be in until the 29th, in the afternoon. But once it is, I'll be able to move in.
The office store here in town outfitted me with a desk, a desk chair, some waiting room chairs, a file cabinet (three drawer lateral). I have to keep patient files for 10 years in this province. Ten. Years. TEN!.. so I got a long file cabinet, which will hold many. But it's a good thing I have also outdoor storerooms off my balcony at home to use if needed.
Still to come: a treatment table. It won't arrive until in January sometime. It is an official osteopathic table, coming all the way from Belgium via Quebec, a company called "Gymna". I saw the bed in Whistler, in the trade fair at Congress in July, and fell in love. It has a head rest that bends completely down, completely out of the way, arm and shoulder pieces that can be moved away to allow full, comfortable, prone-lie arm-hang, nice high density foam cushiness, a heating option, some sort of thing you can stick in to rest your elbows on, and best of all, a foot rail that goes all the way round the bed, with which you can raise the bed up or down from any location. No more having to interrupt a treatment in order to find the stupid foot plate, which is always somewhere outside foot range and on the other side of the bed, which means you have to let go of your patient, interrupting the incredible insight into his or her physiology you've just wandered into, go back into regular brain mode, get up and go looking for it. Treatment interruptus. I'm really looking forward to this baby, I can tell you. Meanwhile, though, I'll be borrowing a regular no-frills massage table. Which, although not easily adjustable, will be just fine for a few weeks. It will be a terracotta colour.
Another thing I'm waiting on is a panel, a room divider, which will be moveable, covered in tasteful low-maintenance fabric, and will separate the 'office' part of the room from the 'treatment' part: such luxury.
Anyway, today I went in for the first time since the furniture was delivered last night. Ken, the office guy, had very kindly assembled the desk, and the chairs, for me! Such a kindness.
The room has been repainted; it used to be some sort of turquoise, which I can't stand on walls, but now is a warm tan colour, much more livable. The desk is a rich reddish cherry colour, with drawers that lock; the floor is a heavy durable brownish lino or vinyl tile with reddish and tan patches. Yes, this will all work, I think. We will work on getting a window installed, to get in a bit of natural light; until that happens I'll have to use a lamp. We'll see how that goes. If a window doesn't appear, and a few years slip by, I'll have to move to somewhere with a window. There is a glass block window into the hallway which lets a bit of natural light in from the outside door not far away, but it won't be nearly enough.
I have the keys now, so it all feels a lot more real now.
It's been a slow process - the phone isn't quite hooked up yet. Sask-Tel has to be the slowest phone company the world has ever seen. I have had the room rented from Nov 1st, but getting a phone hooked up seems to take a full 3 weeks. The line won't be in until the 29th, in the afternoon. But once it is, I'll be able to move in.
The office store here in town outfitted me with a desk, a desk chair, some waiting room chairs, a file cabinet (three drawer lateral). I have to keep patient files for 10 years in this province. Ten. Years. TEN!.. so I got a long file cabinet, which will hold many. But it's a good thing I have also outdoor storerooms off my balcony at home to use if needed.
Still to come: a treatment table. It won't arrive until in January sometime. It is an official osteopathic table, coming all the way from Belgium via Quebec, a company called "Gymna". I saw the bed in Whistler, in the trade fair at Congress in July, and fell in love. It has a head rest that bends completely down, completely out of the way, arm and shoulder pieces that can be moved away to allow full, comfortable, prone-lie arm-hang, nice high density foam cushiness, a heating option, some sort of thing you can stick in to rest your elbows on, and best of all, a foot rail that goes all the way round the bed, with which you can raise the bed up or down from any location. No more having to interrupt a treatment in order to find the stupid foot plate, which is always somewhere outside foot range and on the other side of the bed, which means you have to let go of your patient, interrupting the incredible insight into his or her physiology you've just wandered into, go back into regular brain mode, get up and go looking for it. Treatment interruptus. I'm really looking forward to this baby, I can tell you. Meanwhile, though, I'll be borrowing a regular no-frills massage table. Which, although not easily adjustable, will be just fine for a few weeks. It will be a terracotta colour.
Another thing I'm waiting on is a panel, a room divider, which will be moveable, covered in tasteful low-maintenance fabric, and will separate the 'office' part of the room from the 'treatment' part: such luxury.
Anyway, today I went in for the first time since the furniture was delivered last night. Ken, the office guy, had very kindly assembled the desk, and the chairs, for me! Such a kindness.
The room has been repainted; it used to be some sort of turquoise, which I can't stand on walls, but now is a warm tan colour, much more livable. The desk is a rich reddish cherry colour, with drawers that lock; the floor is a heavy durable brownish lino or vinyl tile with reddish and tan patches. Yes, this will all work, I think. We will work on getting a window installed, to get in a bit of natural light; until that happens I'll have to use a lamp. We'll see how that goes. If a window doesn't appear, and a few years slip by, I'll have to move to somewhere with a window. There is a glass block window into the hallway which lets a bit of natural light in from the outside door not far away, but it won't be nearly enough.
I have the keys now, so it all feels a lot more real now.
Saturday, November 19, 2011
Friday, November 18, 2011
Not for sissies
It struck me today that being a human awareness inside a humanantigravitysuit or any sort of awareness inside any biological kind of antigravity suit is not for sissies. Which is why, I suppose, that defensive mechanisms evolved in the first place.
The nervous system is not monolithic.
I say this every day to patients, as I try to help them understand what the inside of themselves, the inside of their own operating system, is like.
I tell them a story about how it's like a farmhouse that might have started out as a simple cottage in the days before electricity, but that over the decades new bits were added, a second story, a garage here, a new wing there. Before long the original cottage was completely buried by additions. Had it been an actual farmhouse, the sensible thing would be tear it down and start completely over with new wiring and plumbing. However, as a nervous system, it didn't turn out that way: nature never got rid of anything neurological, it just added more layers over top.
So, now we have the original, probably the enteric system, autonomic system, and a bit of somatomotor, covered over by faster, bigger, more complex inhibition systems.
Skin is weird, because it comes from ectoderm, as do all the nerves. Neural crest cells make up all the nerves that go to and from skin, as well as - get this - they make teeth. Teeth. I read earlier today that teeth evolved from skin. Or at least, from neural crest cells in skin. Or, at least, outside the mouth, which makes good sense, if the whole point of life and its evolution is to transform energy from one form/state to another to reduce energy gradients. I mean, to transform other organisms into sources of energy, it's necessary to rip them into tiny bits to be digested.. teeth come in handy, whether inside or outside the "mouth"..
Exaptation accounts for a lot of the preservation one sees in nervous system function.
Seth Grant in Australia has built an entire career on studying synaptic proteins, some of which have been conserved from original yeast-like single-cell ancestors.
Take-home point: Nature does not toss out anything that has proven useful, especially when it has to do with the operating system, i.e., the nervous system.
So, we ended up keeping everything that was there from the beginning, and added on. Now we have brains five times bigger than they need to be to run a creature/humanantigravitysuit our size. They suck away 20% of all our metabolic energy. Even though they comprise only 2% of our physicality. A measly 2%. Sucks up 20% of the energy. Think about it. It's no wonder we get distracted.
So, I was thinking, to actually turn it around enough to pay inward attention to our bodies, themselves, the physical creatures we inhabit, with attention and awareness, is so different from normal life, so ... non-social, kind of, so... outside a culture that pays the body almost no mind except to dress it up, or have it relate socially. To go in there just to find out how it's feeling, just out of interest, is not really supported by this culture. This generic North American culture. This culture is anything but introspective. Anything but intero-spective.
So, I'm thinking it takes courage.
It takes courage to go in and check interoceptive systems.
No wonder, then, that cultural systems that appear to have successfully navigated these strange waters are adopted holus-bolus, for the most part - things like yoga, meditation, acupuncture - with no translation. They are interoceptive practices, and mostly non-verbal therefore, anyway, except for the packaging, which is usually spiritual veneer of one sort or another.
What happens when a nervous system is probed, even by the awareness it gave rise to? Well, it might be important to remember that in any given individual parts of the nervous system may not get along with each other perfectly. If you are an "I" illusion inhabiting a particular brain, and you decide one day that you want to probe your own interoception, and your culture has never supported such a notion or behaviour, you find yourself swimming against a tide. You either graft a system onto yourself or you go it alone. You may find yourself outfitting yourself in yoga pants and learning a lot of polysyllabic words in a foreign language, or learning mantras and about mandalas, or learning strange non-existent non-anatomical body systems. To go it alone is preferable in my opinion, but may still require some outside support from a patient observer/coach from time to time. Most people won't bother doing any of this stuff until such time as they are unfortunate enough to sustain a pain episode, at which time it will suddenly be the only way out of the cage.
No matter what, anxiety will be a feature. If you are exploring by yourself, you will learn that deep breathing will take care of a lot of the anxiety, and will smooth out the process. You have to make yourself keep going back, though, until the behaviour becomes pleasurable enough to motivate you by itself. You could think of it as getting to know your inner zoo, all the creatures your antigravitysuit evolved through on its way to becoming human. You have to be careful not to spook any of them. Or yourself.
If you use one of the cultural adaptations, you have to adapt yourself to them. Which is fine, I suppose, until/unless cognitive dissonance interferes. Which it may well do, sooner or later, Which is why I personally choose/recommend the go-it-alone method.
If pain has driven you into the corner of your own existence and has forced you to become interoceptive just to get through the day, I feel for you - I really do. Deep breathing will still help, plus it will be of use to find yourself a caring human primate social groomer who vows not to create more suffering for you to have to endure, but will stand by you as you find your way out of the gloomy forest of being lost inside your own physicality with a suddenly heavy humanantigravitysuit that doesn't work right, and a nervous system that no longer feels like "you", but instead feels like a bunch of alien creatures biting at you.
The nervous system is not monolithic.
I say this every day to patients, as I try to help them understand what the inside of themselves, the inside of their own operating system, is like.
I tell them a story about how it's like a farmhouse that might have started out as a simple cottage in the days before electricity, but that over the decades new bits were added, a second story, a garage here, a new wing there. Before long the original cottage was completely buried by additions. Had it been an actual farmhouse, the sensible thing would be tear it down and start completely over with new wiring and plumbing. However, as a nervous system, it didn't turn out that way: nature never got rid of anything neurological, it just added more layers over top.
So, now we have the original, probably the enteric system, autonomic system, and a bit of somatomotor, covered over by faster, bigger, more complex inhibition systems.
Skin is weird, because it comes from ectoderm, as do all the nerves. Neural crest cells make up all the nerves that go to and from skin, as well as - get this - they make teeth. Teeth. I read earlier today that teeth evolved from skin. Or at least, from neural crest cells in skin. Or, at least, outside the mouth, which makes good sense, if the whole point of life and its evolution is to transform energy from one form/state to another to reduce energy gradients. I mean, to transform other organisms into sources of energy, it's necessary to rip them into tiny bits to be digested.. teeth come in handy, whether inside or outside the "mouth"..
Exaptation accounts for a lot of the preservation one sees in nervous system function.
Seth Grant in Australia has built an entire career on studying synaptic proteins, some of which have been conserved from original yeast-like single-cell ancestors.
Take-home point: Nature does not toss out anything that has proven useful, especially when it has to do with the operating system, i.e., the nervous system.
So, we ended up keeping everything that was there from the beginning, and added on. Now we have brains five times bigger than they need to be to run a creature/humanantigravitysuit our size. They suck away 20% of all our metabolic energy. Even though they comprise only 2% of our physicality. A measly 2%. Sucks up 20% of the energy. Think about it. It's no wonder we get distracted.
So, I was thinking, to actually turn it around enough to pay inward attention to our bodies, themselves, the physical creatures we inhabit, with attention and awareness, is so different from normal life, so ... non-social, kind of, so... outside a culture that pays the body almost no mind except to dress it up, or have it relate socially. To go in there just to find out how it's feeling, just out of interest, is not really supported by this culture. This generic North American culture. This culture is anything but introspective. Anything but intero-spective.
So, I'm thinking it takes courage.
It takes courage to go in and check interoceptive systems.
No wonder, then, that cultural systems that appear to have successfully navigated these strange waters are adopted holus-bolus, for the most part - things like yoga, meditation, acupuncture - with no translation. They are interoceptive practices, and mostly non-verbal therefore, anyway, except for the packaging, which is usually spiritual veneer of one sort or another.
What happens when a nervous system is probed, even by the awareness it gave rise to? Well, it might be important to remember that in any given individual parts of the nervous system may not get along with each other perfectly. If you are an "I" illusion inhabiting a particular brain, and you decide one day that you want to probe your own interoception, and your culture has never supported such a notion or behaviour, you find yourself swimming against a tide. You either graft a system onto yourself or you go it alone. You may find yourself outfitting yourself in yoga pants and learning a lot of polysyllabic words in a foreign language, or learning mantras and about mandalas, or learning strange non-existent non-anatomical body systems. To go it alone is preferable in my opinion, but may still require some outside support from a patient observer/coach from time to time. Most people won't bother doing any of this stuff until such time as they are unfortunate enough to sustain a pain episode, at which time it will suddenly be the only way out of the cage.
No matter what, anxiety will be a feature. If you are exploring by yourself, you will learn that deep breathing will take care of a lot of the anxiety, and will smooth out the process. You have to make yourself keep going back, though, until the behaviour becomes pleasurable enough to motivate you by itself. You could think of it as getting to know your inner zoo, all the creatures your antigravitysuit evolved through on its way to becoming human. You have to be careful not to spook any of them. Or yourself.
If you use one of the cultural adaptations, you have to adapt yourself to them. Which is fine, I suppose, until/unless cognitive dissonance interferes. Which it may well do, sooner or later, Which is why I personally choose/recommend the go-it-alone method.
If pain has driven you into the corner of your own existence and has forced you to become interoceptive just to get through the day, I feel for you - I really do. Deep breathing will still help, plus it will be of use to find yourself a caring human primate social groomer who vows not to create more suffering for you to have to endure, but will stand by you as you find your way out of the gloomy forest of being lost inside your own physicality with a suddenly heavy humanantigravitysuit that doesn't work right, and a nervous system that no longer feels like "you", but instead feels like a bunch of alien creatures biting at you.
Tuesday, November 15, 2011
Our fellow vertebrate creatures
Saw this earlier tonight: Fin massage relieves stress in surgeonfish
Another piece supporting the idea that social grooming provides stress relief, in vertebrates, from fish to humans. (Still not sure about reptiles.)
Further to a manual therapy theme, George Takei, who played Sulu on Star Trek, and who posts plenty of whimsey on Facebook, posted this picture. I do not know the original source.
It has manual therapy logo possibility. Rabbits are vertebrates. Humans are vertebrates. Vertebrates evolved social grooming. Manual therapy is human primate social grooming. I like the possibilities.
Another piece supporting the idea that social grooming provides stress relief, in vertebrates, from fish to humans. (Still not sure about reptiles.)
Further to a manual therapy theme, George Takei, who played Sulu on Star Trek, and who posts plenty of whimsey on Facebook, posted this picture. I do not know the original source.
It has manual therapy logo possibility. Rabbits are vertebrates. Humans are vertebrates. Vertebrates evolved social grooming. Manual therapy is human primate social grooming. I like the possibilities.
Saturday, November 05, 2011
Just because these links are so good
Check out Hyperbole and a Half (Allie Brosh's) blogpost on depression.
Looking on the bright side, eventually everything changes, even old incredibly self-flattering and self-reinforcing institutions. Maybe it's true that there is a season for everything, that everything eventually crumbles, and that in and of itself, hey, that's not so bad.
More about empathy:
Looking on the bright side, eventually everything changes, even old incredibly self-flattering and self-reinforcing institutions. Maybe it's true that there is a season for everything, that everything eventually crumbles, and that in and of itself, hey, that's not so bad.
More about empathy:
"They followed 891 diabetic patients for 3 years and conclusively showed that physicians’ empathy itself resulted in a 40-50% improvement in the measured results."Wow.
Sunday, October 30, 2011
Empathy comes in different flavours
Empathy and Evolution, a blogpost spotted today. It discusses various flavours of empathy, its expression during development and outward into the social sphere.
The sorting into various flavours interested me most.
Excerpt:
My bold. What if one has off the chart extreme empathy in one flavour, and not much in another? I feel other peoples' pain all the time. I've had to build strong boundaries in myself, around my insular cortex, in order to do what I have to do in life, which is to treat it in other people.
When I say, "have to", I don't mean that someone held a gun to my head and forced me into this line of work; rather, I mean, I was driven into it for completely self-contained reasons, chief among them to learn as much as I could about pain in order to be ready for when and if I ever needed to combat it in myself. (A situation in which I eventually found myself, and successfully won, so it all paid off.)
This coming week, I'll fly to Winnipeg to attend a workshop by Michael Sullivan, on progressive goal attainment. This involves careful attention to the "cognitive empathy" side of the scale, learning the thoughts and beliefs of another, helping them separate those from their feelings and emotions. It's for sure outside manual therapy kinds of "helping", but I think I'm ready to learn more about it and weave it in. Some might wonder what took me so long. To that, all I'd be able to answer would be, "better late than never" and, "I'm a late bloomer".
The sorting into various flavours interested me most.
Excerpt:
Psychologists distinguish two main components of empathy: cognitive empathy (knowing another person’s thoughts and beliefs) and affective empathy (knowing another person’s feelings and emotions).
The degree of empathy we have for others can be found on a spectrum. At lower ends, empathy only requires that we are aware of other people’s thoughts and feelings. But at higher ends of the spectrum, empathy may include actually experiencing one’s situation as if it was our own.
Some experts on empathy, such as emotion researcher Paul Ekman, say that these higher levels of empathy lead to a third kind of empathy: compassionate empathy, where we are so attuned to the thoughts and feelings of others that we are driven to alleviate their pain and suffering through kindness and charity.
My bold. What if one has off the chart extreme empathy in one flavour, and not much in another? I feel other peoples' pain all the time. I've had to build strong boundaries in myself, around my insular cortex, in order to do what I have to do in life, which is to treat it in other people.
When I say, "have to", I don't mean that someone held a gun to my head and forced me into this line of work; rather, I mean, I was driven into it for completely self-contained reasons, chief among them to learn as much as I could about pain in order to be ready for when and if I ever needed to combat it in myself. (A situation in which I eventually found myself, and successfully won, so it all paid off.)
This coming week, I'll fly to Winnipeg to attend a workshop by Michael Sullivan, on progressive goal attainment. This involves careful attention to the "cognitive empathy" side of the scale, learning the thoughts and beliefs of another, helping them separate those from their feelings and emotions. It's for sure outside manual therapy kinds of "helping", but I think I'm ready to learn more about it and weave it in. Some might wonder what took me so long. To that, all I'd be able to answer would be, "better late than never" and, "I'm a late bloomer".
Monday, October 10, 2011
Thanksgiving
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| Crude graph made in photoshop. Happy-ness has more chance to develop/exist if red and blue lines are deliberately kept separated. |
STRESS
Stress is not a fixed thing. It's a relationship one's nervous system has with existence.
Some stress is necessary or the brain will just sit there and do nothing - it won't learn. It won't remain flexible and adaptive.
Too much stress will make it adapt badly. It will impair the brain sooner or later.
Stress is described as an upside-down "U" function - an optimal amount helps one navigate life, if not with pleasure, at least with a sense of success rather than defeat. (I've read and learned much from all the articles in Nature Reviews Neuroscience: Focus on Stress [2009])
One can manipulate, if not stress itself, stress-ors.. mostly by avoiding them or reducing them or eliminating them. What might be some stressors easily eliminated? Oh, most TV shows, smoking, drinking alcohol, etc.
Likewise, hanging around people who belittle you in any other way, or do not enhance your mental or physical life, is counterproductive, best avoided I find, at least for me.
E.g., I find boredom very stressful.
Freedom from the stress of boredom
If left to myself, I'm not bored. I can find things to do and read and think about. I can watch my brain machinate its way through perceived conundrums. I can plan (although I don't really like to be attached to plans, because plans have to fight a lot of external resistance and get changed as a result, much of the time) and organize (something else I'm not all that attached to) and learn (something I never get tired of) and think (about anything, everything) and write (about anything, everything). Or just breathe and not have to do anything with my brain. Unencumbered.
Social stress, boredom
I find it immensely stressful to be around people I consider boring, and I find most 'socializing for the sake of socializing', boring, so I am mostly a solitary hermit. I've never married or had children, because I find routine (outside my own easily changeable personal routines) extremely boring; the very thought of harnessing myself into a small group of other human primates forever dependent on my personal involvement with them, freaked me out completely as a young woman, so I just never went there or did that.
Now as I look back on life from the ripe old age of 60, I appreciate the instinct that kept me unattached, and the way I chose to combat and navigate but not give into competing instincts, such as wanting to belong somewhere or find 'lasting romance': I did live with someone for three years (ran a simulation of what marriage might be like); nice man, satisfying relationship in most of the important ways (from the perspective of a 22-year-old healthy female), but in the end found it boring and therefore stressful.
Having to continuously adapt to other peoples' needs and wants in exchange for 'belonging' to a domestic arrangement was something I knew intrinsically that I'd never ever be able to pull off successfully. It never looked like it would be a good bargain. I had instinctive fear of the avalanche of expectation that surrounds ordinary social domesticity. My nervous system's threat detectors have been allergic to social norms, and have therefore sounded pretty much continuously, all my life.
Gratitude
It's Thanksgiving here in Canada; it seems appropriate to include the fact that every day of my life I'm grateful that since I had to come into existence in the first place, with such strong personal proclivities in the second place, it was into a culture and era that permitted me, a woman, to retain control of my own physicality, in particular that physicality residing below the waist (...and enjoy it too, when/if I wanted..).
Most important has been social autonomy. I was born at a time when I learned I had the right to bodily autonomy, enjoyment of physicality, to wear whatever was/is comfortable, sensible shoes, no make-up. Or, on the other hand, the right to dress like a female caricature if I felt like it. Which I did sometimes, mostly in order to escape notice, to blend in, feel more invisible and be able to 'compete' successfully. Not that I ever won any prizes for looks, or captured any trophies of any other kind (a vision comes to mind of a marriage partner mounted like a deer head over the mantle, but more likely a spouse would be sitting on the couch, quite alive, watching sports no doubt..)
In most cultures on the planet, girls are groomed from birth to adapt to the fact that they are destined to become someone else's reproductive livestock, uteruses with arms and legs, that their humanantigravitysuits are not strictly their own - that instead, they do not have any right to enjoy ownership of their bodies, specifically from the waist down, ever, and usually not the space between their ears/above their eyes, either.
My family gently hinted at this, but never did I feel coerced toward enacting such a role. My life was mine to live however I chose - my body, all of it, was mine to do with as I wished, and the culture of the 1960's and 70's that surrounded me as an emerging biological woman made it real.
For this freedom, which I realize now is a true happiness, I'll be forever grateful to my mother. I think my dad probably had more restrictive, more male-biased, protestant-tent-religion-based, traditional views on the matter, but my mother, a lapsed catholic who never displayed any ambition beyond keeping a home and raising a family, somehow still managed to keep enough space open for me to run away through, out to 'freedom from family'. She has probably never really reflected on why she did that. I certainly have disappointed her in almost every way imaginable from an interpersonal or social point of view; I'm pretty sure she likely expected her oldest daughter to heave to eventually and contribute my share to the planet's overpopulation problem; but I never did - instead I took total advantage of the opening out into the brave new feminist-hardfought-and-won world of female autonomy, and sailed away.
On the other hand, it may have been that she just didn't care; I think the fact her first-born happened to be female, not male, disappointed her, and so it didn't really matter to her what I turned out like, as long as I didn't do anything too egregious like end up an unwed mother or in jail. Still, I remain grateful that she wasn't as overbearing as she could have been.
I did not copy her life, only half her genome. During all the years she spent on care and feeding and cajoling and 'training' (as she called it), and encouraging me at schoolwork, I also absorbed years of watching her be content with cooking/baking/cleaning/laundry/hanging clothes out on a clothesline/enjoying herself in the evening by knitting/crocheting/sewing/doing petit point/etc., reading "ladies'" lifestyle magazines (the only reading material that ever made its way into our family home, beside my dad's Commonwealth newspapers), and.. found it utterly boring. I repaid her maternal investment by not reenacting her existence.
Some judgey little part of myself, some mirror neuron biological part, no doubt, feels (weirdly to me) bereft, and despises me for what it considers selfish ingratitude, based on my having not replicated family life. But the rest of me forgives myself and moves along, knowing full well it would never have had a chance to surface at all, had things not gone the way they did. Plus, I spared all my unborn children the fate of having a mother who would have found child-rearing utterly boring and probably intolerable. I spared them the chore of existence itself. I spared them having to put up with someone as capricious and depressive as I, from being their mother. I saved myself (and them) a lot of stress. Furthermore, I made a colossal forward payment on my own carbon footprint by not replicating any more people.
CAPACITY TO REGULATE STRESS RESPONSE
Learning how to increase this has also been found to help to widen the proposed happy-gap.
It's something I'm finally getting around to, now that I know how crappy (opposite of happy) life can feel when this capacity diminishes. The single biggest ingredient of maintaining this capacity is regular exercise, so I'm led to believe.
Now, I haven't been exercising on a regular basis long enough to find out how I and me and myself will adapt to it - for now, it's still a stressor and therefore has not widened any discernible gap. But I do have faith it can, and will, based on a bunch of stuff I read about the endless benefits of exercise on physiology and brain health, and that it's never too late.
For the moment, I'm content that I finally discovered a place in which I can exercise with minimal psychosocial stress from exercise itself. I mean, there's still the issue of having to be in the same room as a bunch of other women, and having to put up with music I don't enjoy (this is Weyburn; country music about neon signs and green tractors etc. is mixed up with Katy Perry and Lady Gaga; on the plus side, it's a women's gym, so I have not noticed any loud head-banger music). In spite of minor distractions (music which I could avoid if I wanted by using an iPod or something) it feels like this is some sort of turning point for me, that someday soon I could actually enjoy exercise (i.e., not find it boring, or nociceptive), and instead of going through life just reducing stress at one end, I could increase the happy-gap from the other end too.
Saturday, October 01, 2011
Fixing up my own humanantigravitysuit
After two years and two winters of bracing winter air and sun, I have been feeling much better, ready to resume the overhaul on my own physicality I started 4 years ago. I lost a bunch of weight, then plateaued out for the last couple years, seemingly unable to overcome the inertia that would be involved in increasing daily aerobic exercise. The diet has been fairly good, weight maintained, but no more coming off. But I think I found the solution. Very conveniently located, a few blocks from where I live, a place for women like me opened up just a year ago, a nice clean, fresh-smelling place, a franchise called Inches A-Weigh. So, I joined last month, and so far, it's perfect.
The deal is, you pay a bunch of money, go into a program of cognitive behavioural therapy around food choice, follow a restricted calorie plan, be strictly accountable, hand in your food diary and be "counselled", regularly weighed (twice/week) and measured (every two weeks) for several months, eat their protein snacks (included), and work out on their equipment for 20 minutes, at least 3x/week, or as often/long as you want. There are elliptical machines, treadmills, and stationary bikes, all good quality and smoothly operating. There are TVs in front of the bank of machines, with DVDs of movies with subtitles looping all day long. No mirrors. None. Except in the bathroom over the sink.
OK, no big whup so far.. but there is another thing they offer, which I instantly became addicted to - along the other wall are a bank of beds that move you around, bend you, shake you, pummel the body. They feel fantastic. You do plenty of "exercise" on them, i.e., keep the abs tight, keep certain muscles contracted, arms overhead, etc. Sort of Pilates Lite. For the first several weeks that's the program. Then they increase the stuff you do on the beds, make it more complicated, adding heavy balls and light hand weights.
What I like is the feeling of being tossed around, 6 minutes per bed, 7 beds, a total of about 45 minutes. After that I feel good enough physically that putting out a 30-minute effort on the cardio equipment is no longer a daunting prospect. I think all the jiggling likely stimulates endogenous opioid systems or something.
What I know for sure is this: exercise never ever ever felt good to me before. I have a nervous system that always has found exercise painful, daunting, boring, an exercise in futility, incapable of dredging up the will power after a couple weeks, no intrinsic motivation to do any regularly, ever. In other words, exercise has never ever been a source of joy or pleasure or intrinsic motivation, the way it seems to be for people who seem to be comprised only of large bungee cords, and whose surface layer does not feel heavy or sensitive to them. So, the under-exercised corner of life was the one I found I had painted myself into, trapped by paint that refused to dry.
I think I (and many many others, mainly female) have more "feeling" (interoception) than bungee cord people do. I think the beds must anesthetize me/my interoception or something. Then, sure, I can go on some cardio thingy and spend a half hour keeping my heart rate up - I have even started liking the elliptical; never in my life before have I managed more than a couple minutes on one of those things. But one day, I found I had Achilles tendons that could recoil all by themselves! Nice thing to finally be able to feel, at my advanced middle age. I've been going every day. Moi! Maybe by spring I'll be thinner-looking and have a much more fit CV system.
The deal is, you pay a bunch of money, go into a program of cognitive behavioural therapy around food choice, follow a restricted calorie plan, be strictly accountable, hand in your food diary and be "counselled", regularly weighed (twice/week) and measured (every two weeks) for several months, eat their protein snacks (included), and work out on their equipment for 20 minutes, at least 3x/week, or as often/long as you want. There are elliptical machines, treadmills, and stationary bikes, all good quality and smoothly operating. There are TVs in front of the bank of machines, with DVDs of movies with subtitles looping all day long. No mirrors. None. Except in the bathroom over the sink.
OK, no big whup so far.. but there is another thing they offer, which I instantly became addicted to - along the other wall are a bank of beds that move you around, bend you, shake you, pummel the body. They feel fantastic. You do plenty of "exercise" on them, i.e., keep the abs tight, keep certain muscles contracted, arms overhead, etc. Sort of Pilates Lite. For the first several weeks that's the program. Then they increase the stuff you do on the beds, make it more complicated, adding heavy balls and light hand weights.
What I like is the feeling of being tossed around, 6 minutes per bed, 7 beds, a total of about 45 minutes. After that I feel good enough physically that putting out a 30-minute effort on the cardio equipment is no longer a daunting prospect. I think all the jiggling likely stimulates endogenous opioid systems or something.
What I know for sure is this: exercise never ever ever felt good to me before. I have a nervous system that always has found exercise painful, daunting, boring, an exercise in futility, incapable of dredging up the will power after a couple weeks, no intrinsic motivation to do any regularly, ever. In other words, exercise has never ever been a source of joy or pleasure or intrinsic motivation, the way it seems to be for people who seem to be comprised only of large bungee cords, and whose surface layer does not feel heavy or sensitive to them. So, the under-exercised corner of life was the one I found I had painted myself into, trapped by paint that refused to dry.
I think I (and many many others, mainly female) have more "feeling" (interoception) than bungee cord people do. I think the beds must anesthetize me/my interoception or something. Then, sure, I can go on some cardio thingy and spend a half hour keeping my heart rate up - I have even started liking the elliptical; never in my life before have I managed more than a couple minutes on one of those things. But one day, I found I had Achilles tendons that could recoil all by themselves! Nice thing to finally be able to feel, at my advanced middle age. I've been going every day. Moi! Maybe by spring I'll be thinner-looking and have a much more fit CV system.
Sunday, September 04, 2011
About treatment boundaries
Yesterday, I commented about treatment boundaries in this post. I want to elaborate. I want to explain how explaining pain to a patient can be woven straight into the constructing a safe psychological, social, therapeutic container to work within, while utilizing physical contact.
Guys, especially, seem very reluctant to take on gentle manual therapy. They are concerned they could be misinterpreted. (Maybe this is why they seem to head off in large droves toward ortho and other structural, manipulative technical approaches and away from physiological change approaches - they don't want their physical contact to be misunderstood.)
I say, then, make the situation be completely transparent. Ask for and get permission every step of the way.
Let's say you had a patient with some kind of pain problem. Let's make you a guy, and the patient female. Let's make her a tough case: anxious, known drug user/abuser. Chances are, you are scared of using gentle manual therapy. You worry that she might cling, rapidly become dependent.
You can avoid any danger of creating dependency by setting a simple but firm treatment boundary: Something like:
The next set of treatment boundaries involves explaining the patient's nervous system and how it mounts a pain presentation. This does a number of things:
These are little things, mostly good manners, but they add up into setting a treatment relationship/contract that is OK for either of you to walk away from at any time. It's egalitarian and fair. It should not give her any opening to become a cling-on. It permits the dance between nervous systems to develop to the point of helping the patient get out of the way such that his or her nervous system can resolve its problem, can fix itself, all the while, as you provide it with clear, boundaried messages and feedback, both verbal and kinesthetic, and ask for the same from the patient.
You have the right to end the (manual) treatment relationship if you sense it's not helping, and she knows from what you've said, that she has to carry a lot of responsibility for any success, and her nervous system carries the rest; if she doesn't get this, then I'd recommend stop manually treating her and move to other management methods.
Guys, especially, seem very reluctant to take on gentle manual therapy. They are concerned they could be misinterpreted. (Maybe this is why they seem to head off in large droves toward ortho and other structural, manipulative technical approaches and away from physiological change approaches - they don't want their physical contact to be misunderstood.)
I say, then, make the situation be completely transparent. Ask for and get permission every step of the way.
Let's say you had a patient with some kind of pain problem. Let's make you a guy, and the patient female. Let's make her a tough case: anxious, known drug user/abuser. Chances are, you are scared of using gentle manual therapy. You worry that she might cling, rapidly become dependent.
You can avoid any danger of creating dependency by setting a simple but firm treatment boundary: Something like:
Quote:
| "We could try to help the part of the brain that is making the pain figure out a way to stop. I'd like to try some hands-on work, if that would be OK with you. (Pause and wait for an indication the patient is interested.) "It may help, although I wouldn't know for sure, without us trying it first - it helps most people in a pretty straightforward way; what I am sure about is that if it we do a few sessions and it hasn't helped yet (changed the pain significantly right away, so that it is less severe, less bothersome, less frequent, stays away for longer periods of time, one of those things or some combination of those things) then it wouldn't be worth pursuing further. | "I'm saying, it's something we could try, and see what happens, and if it doesn't help, we haven't really lost anything by trying. So, what do you think? Would you be interested in seeing if it could help your brain to stop giving you this foot (or back, or leg, or arm) pain?" (Pause and wait for an indication the patient is interested) |
1. It explains pain to the cognitive part of the patient's brain, which will give her the idea that you consider her worthy of learning it and capable of understanding it (respect).The third set of treatment boundaries involves explaining the actual physical contact, what position you would like her to lie down in, what you are going to touch, how you are going to land, then what you're going to do once you've landed, what she can expect, what you'd like her to pay attention to, to breath, etc. Then before you actually touch her, ask her permission one more time.
2. It creates a conceptualization that "she" is something apart from the rest of her own brain, that you would ask for her cooperation in helping you, so that together, you (plural) can detach from the pain, watch the nervous system (with minimal input from you) solve the "problem" which is something in the rest of the nervous system (recruitment of patient's cooperation, mostly her dorsolateral prefrontal cortex).
3. It also gives her non-conscious brain time to mount reward expectation mechanisms and dopamine (if she has any of her own left), all that anticipation stuff. This wouldn't be a bad place to reassure her that you aren't going to hurt her with your handling, that you want her to tell you if anything you do, any grip, feels uncomfortable to her, because you aren't in there and can't feel her nervous system the way she can, and you certainly can't feel her pain experience, only its manifestations. So you are relying on her to help. You don't think it's prudent to have her nervous system, which is a learning machine, learning to have to deal with more pain, associated with you - your job, as you see it, is to help it learn how to feel less pain.(You are assigning her a job, a role, and indicating that she has locus of control over your handling, are giving her veto control over it, and therefore over all your physical contact with her.)
These are little things, mostly good manners, but they add up into setting a treatment relationship/contract that is OK for either of you to walk away from at any time. It's egalitarian and fair. It should not give her any opening to become a cling-on. It permits the dance between nervous systems to develop to the point of helping the patient get out of the way such that his or her nervous system can resolve its problem, can fix itself, all the while, as you provide it with clear, boundaried messages and feedback, both verbal and kinesthetic, and ask for the same from the patient.
You have the right to end the (manual) treatment relationship if you sense it's not helping, and she knows from what you've said, that she has to carry a lot of responsibility for any success, and her nervous system carries the rest; if she doesn't get this, then I'd recommend stop manually treating her and move to other management methods.
Saturday, September 03, 2011
What we don't even know that we don't know
LINK ->>> What Do We Know For Sure, Really? (For therapists)
The blog post is by Alice Sanvito, at www.massage-stlouis.com, a thoughtful massage therapist, interviewed lately by Will Stewart (who calls himself thrill96) on his blog-radio show: Russian Massage and Neuroscience: Interview w/ Alice Sanvito.
Alice is somebody who isn't afraid to change, who isn't afraid to think about things a bit differently, who isn't afraid of the unknown or of uncertainty. It's a rare quality in a manual therapist - most want to convey the impression that they are experts. Much of the time, I imagine, a patient can feel a level of expertise through their own somatosensory afferent system. If the attitude and the handling don't match, I think it's better that the handling be "expert" rather than the claim.
What constitutes "expert" handling? Well, every nervous system is different. Every pain problem is as unique as the person's fingerprints. So, rather than claiming some sort of "expertise" in some technique or other, i.e., a set of cookbook approaches learned at a class, it's way better to stay humble, let treatment be at the pace of the nervous system with which one's own is interacting, let treatment be more about exploring than performing, watch for settling, watch for deepening of breathing, watch for long periods of silence, encourage the same without being dominating. One lets processes occur until they stop. These are easy to feel through sensitive aware handling - warming, softening, sense of lengthening, pulsing, etc. All these indicate nervous system corrections. Let the patient become fascinated with feeling their own body's life. Let them describe what they can sense. Much of it will be a surprise to them. Give them room to enjoy new afferent experiencing, the feelings that arise when nervous systems self-correct in response to the most minimal and non-invasive input you can manage.
How does one become "expert" at handling another's nervous system? One learns manners, and boundaries, remembering to "ask permission", not just verbally but also kinesthetically. One maintains these throughout the entire therapeutic encounter. One adapts, matches oneself to the patient. Something as simple as learning to separate one's own breathing from one's own contact with the patient can buffer a lot of unintentional "noise" from a nervous system that is sensitive. This means, literally being aware of your own breath and controlling it, or resting elbows somehow so that breathing motion doesn't travel all the way down your arms to the patient's body. Little things like that.
Thank you, Alice Sanvito, for being a fellow traveler in the world of deepening into whatever it is we do. I don't think we can, or ever will, know anything for sure, because manual therapy is a verb, in the moment, not a noun, ever, in spite of how many conceptualizations are dreamed up to try to package it or analyze it or measure it scientifically. One thing is for sure, though: we cannot "touch" (directly) anything but the nervous system, as represented in the skin. All the rest is stuff we make up, an "as if" story.
Thursday, September 01, 2011
Understanding Pain and what to do about it in less than 5 minutes.
GREAT little video on YouTube - Understanding Pain and What to do about it in less than 5 minutes. on Facebook posted by Sandy Hilton, PT and Noigroup.
Unfortunately I can't embed it, can't find the code anywhere. So click on the link to see it on YouTube - well worth the minor effort. ---> LINK
 |
| "We now know that pain is 100% produced by the brain!" |
Unfortunately I can't embed it, can't find the code anywhere. So click on the link to see it on YouTube - well worth the minor effort. ---> LINK
Thursday, August 18, 2011
Dunbar on social grooming in primates and humans
The social role of touch in humans and primates: Behavioural function and neurobiological mechanisms
This is a (free access, download 9-page pdf) paper by RIM Dunbar of primatologist fame. Along with Robert Sapolsky I've learned more about human nervous systems from him than I ever knew from studying PT.
Dunbar points out that (abstract) "Grooming is a widespread activity throughout the animal kingdom, but in primates (including humans) social grooming, or allo-grooming (the grooming of others), plays a particularly important role in social bonding which, in turn, has a major impact on an individual’s lifetime reproductive fitness. New evidence from comparative brain analyses suggests that primates have social relationships of a qualitatively different kind to those found in other animal species, and I suggest that, in primates, social grooming has acquired a new function of supporting these. I review the evidence for a neuropeptide basis for social bonding, and draw attention to the fact that the neuroendrocrine pathways involved are quite unresolved. Despite recent claims for the central importance of oxytocin, there is equally good, but invariably ignored, evidence for a role for endorphins. I suggest that these two neuropeptide families may play different roles in the processes of social bonding in primates and non-primates, and that more experimental work will be needed to tease them apart."
This is a (free access, download 9-page pdf) paper by RIM Dunbar of primatologist fame. Along with Robert Sapolsky I've learned more about human nervous systems from him than I ever knew from studying PT.
Studying PT is being trained in how to use a toy pail and shovel. A lot of effort goes into explaining what shovels do and what pails are for, and how to scoop and dump, but almost no emphasis is placed on the vision of the huge expanse of beach one has been set loose to tackle, or what kind of castle to build, or the nature of sand itself, or how long one can expect to have to dig, or how easy it is for the sand castles to be washed back out to sea.
Once out on the beach, one generally heads over to where other castles are already under construction, and gets a job helping. Sometimes PTs head off to a secluded part of the beach and figure out how to make their own castle. Some PTs go into the business of making and selling ever more attractive pails and shovels, pointing out the inadequacies of the ones that exist. Many never ever get that building castles is futile altogether.
Long ago I threw away the pail and shovel, walked down the beach to the water, went into it, and figured out how to swim. I took all the time needed to learn properties of water, learn to float, swim, with and without goggles, learn to avoid sharks and other predators, and how to stay warm even as water sucks at my core temperature. It's been a very engaging life; even if it doesn't look like it has amounted to much from the outside, on the inside I'm very contented and feel fulfilled, all that. I love being a human primate social groomer, swimming around in other peoples' nervous systems, most of the time, most days.
Dunbar points out that (abstract) "Grooming is a widespread activity throughout the animal kingdom, but in primates (including humans) social grooming, or allo-grooming (the grooming of others), plays a particularly important role in social bonding which, in turn, has a major impact on an individual’s lifetime reproductive fitness. New evidence from comparative brain analyses suggests that primates have social relationships of a qualitatively different kind to those found in other animal species, and I suggest that, in primates, social grooming has acquired a new function of supporting these. I review the evidence for a neuropeptide basis for social bonding, and draw attention to the fact that the neuroendrocrine pathways involved are quite unresolved. Despite recent claims for the central importance of oxytocin, there is equally good, but invariably ignored, evidence for a role for endorphins. I suggest that these two neuropeptide families may play different roles in the processes of social bonding in primates and non-primates, and that more experimental work will be needed to tease them apart."
Tuesday, August 16, 2011
Killing Pain Part VI
Almost back to normal. I can now sleep comfortably on all sides.
I am including a picture of a slide I made for a presentation in June - it contains a very intriguing cylindrical 3-D image of how convoluted a nerve (which just happens to be musculocutaneous) is, inside its tunnel. They really do look like roots.
It's important to bear in mind these are comprised of neurons, each one of which, if its soma were the size of a tennis ball the axon would be a half mile long and the size of a garden hose, according to Jack Nolte, a neuroanatomist. Well, OK, he was talking about a motor neuron, from the spine to the big toe, but you can see the proportion. Maybe in the arm we'd be talking a quarter-mile long. That would still be a pretty long garden hose.
One can imagine that unrelenting stress on a noodle-y system like that would affect its vascular supply adversely. Eventually. One can think of adaptation, I think, as a bunch of nested buckets. The mechanical stress would be like a slow drip into the center smallest bucket; after a time it would overflow and the next bucket would start to fill. It might take a long time, but eventually, the last and largest bucket would fill and spill - then the system would mount an alarm strong enough to get one's attention. I think that's how it went down in my case.
I managed to find somebody to help me empty out the buckets again. Whew.
Killing Pain Part V
Killing Pain Part IV
Killing Pain Part III
Killing Pain Part II
Killing Pain
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
I am including a picture of a slide I made for a presentation in June - it contains a very intriguing cylindrical 3-D image of how convoluted a nerve (which just happens to be musculocutaneous) is, inside its tunnel. They really do look like roots.
It's important to bear in mind these are comprised of neurons, each one of which, if its soma were the size of a tennis ball the axon would be a half mile long and the size of a garden hose, according to Jack Nolte, a neuroanatomist. Well, OK, he was talking about a motor neuron, from the spine to the big toe, but you can see the proportion. Maybe in the arm we'd be talking a quarter-mile long. That would still be a pretty long garden hose.
One can imagine that unrelenting stress on a noodle-y system like that would affect its vascular supply adversely. Eventually. One can think of adaptation, I think, as a bunch of nested buckets. The mechanical stress would be like a slow drip into the center smallest bucket; after a time it would overflow and the next bucket would start to fill. It might take a long time, but eventually, the last and largest bucket would fill and spill - then the system would mount an alarm strong enough to get one's attention. I think that's how it went down in my case.
I managed to find somebody to help me empty out the buckets again. Whew.
Killing Pain Part V
Killing Pain Part IV
Killing Pain Part III
Killing Pain Part II
Killing Pain
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Sunday, August 14, 2011
Killing Pain Part V
Aftermath
This is the latest entry regarding my recent adventure on the other side of the mirror, being an acute pain patient with something that I would have instantly recognized in another person as "frozen shoulder".
I hate pain so much that I refuse to put up with it. That's really all there is to say.
I wanted to drop in here to say that I'm doing stuff today which 3 days ago would have been unthinkable:
1. Sleeping on that right shoulder*, my back, my front when I want, all comfortably, without waking up in pain.
2. Using my arm for anything, almost everything. E.g., did a couple loads of laundry, including sheets, made the bed
3. Used the iron (!) no problem
4. Lift heavy objects down out of the microwave.
5. Even carrying a cup of coffee.
6. Still can't get my arm behind my back for those annoying bra clips. Oh well. No pain. I'll get the range back after the neural tunnel syndrome is better and the CNS stops guarding it with movement restriction. Hey, I can actively abduct and elevate the arm, almost fully, and easily.. It feels weird, like I have the shoulder of a diving suit glued on and am painlessly restricted by it. But Kirsten will attend to that sensory delusion, no prob.
7. Personal hygiene behaviour no longer a problem.
I think there was likely vascular involvement. Coderre talks about mini-compartment syndrome in cases of CRPS. My presentation didn't manage to get that bad, but when one thinks about the complicated twists in the brachial plexus, how the vascular and neural bundles are intertwined, I can see how they could bother each other a lot, just mechanically. I suspect that acute "frozen shoulder" has nothing whatsoever to do with any "capsule" or "joint" issue, whatsoever - that would amount to conceptual hallucination, endlessly perpetrated/sold/taught by who knows who for who knows what reason.
*still can't sleep on the unaffected side - it's still too uncomfortable. Something happens to the nerves in my arm - some sort of adverse tension, so I know they need another go with Kirsten.
Killing Pain
Killing Pain Part II
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
This is the latest entry regarding my recent adventure on the other side of the mirror, being an acute pain patient with something that I would have instantly recognized in another person as "frozen shoulder".
I hate pain so much that I refuse to put up with it. That's really all there is to say.
I wanted to drop in here to say that I'm doing stuff today which 3 days ago would have been unthinkable:
1. Sleeping on that right shoulder*, my back, my front when I want, all comfortably, without waking up in pain.
2. Using my arm for anything, almost everything. E.g., did a couple loads of laundry, including sheets, made the bed
3. Used the iron (!) no problem
4. Lift heavy objects down out of the microwave.
5. Even carrying a cup of coffee.
6. Still can't get my arm behind my back for those annoying bra clips. Oh well. No pain. I'll get the range back after the neural tunnel syndrome is better and the CNS stops guarding it with movement restriction. Hey, I can actively abduct and elevate the arm, almost fully, and easily.. It feels weird, like I have the shoulder of a diving suit glued on and am painlessly restricted by it. But Kirsten will attend to that sensory delusion, no prob.
7. Personal hygiene behaviour no longer a problem.
I think there was likely vascular involvement. Coderre talks about mini-compartment syndrome in cases of CRPS. My presentation didn't manage to get that bad, but when one thinks about the complicated twists in the brachial plexus, how the vascular and neural bundles are intertwined, I can see how they could bother each other a lot, just mechanically. I suspect that acute "frozen shoulder" has nothing whatsoever to do with any "capsule" or "joint" issue, whatsoever - that would amount to conceptual hallucination, endlessly perpetrated/sold/taught by who knows who for who knows what reason.
*still can't sleep on the unaffected side - it's still too uncomfortable. Something happens to the nerves in my arm - some sort of adverse tension, so I know they need another go with Kirsten.
Killing Pain
Killing Pain Part II
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Saturday, August 13, 2011
Killing Pain Part IV
In Killing Pain Part III, I added visual study notes to do with afferent pathways. In this post I'll add visual study notes on descending modulation pathways, made from Ossipov's diagram, found in his chapter in his book chapter, Ossipov MH; Pain Pathways: Descending Modulation. Ed. Larry R Squire; Encyclopedia of Neuroscience 2009 Elsevier Ltd. It's a book I could read for the next hundred years, along with Ramachandran's Encyclopedia of the Human Brain, all four volumes. At the rate I learn, it would take another thousand years to absorb it, probably. Oh well. I don't have that long, so I tear along as best I can visually taking things apart and putting them back together.
(I think what happened with me had something to do with neural inhibition.*)
The first image is straight out of the book. It's nice, but I couldn't follow it as well as I wanted.
The other three are my own deconstructive line diagrams.
Click to embiggen.
Killing Pain
Killing Pain Part II
Killing Pain Part III
Killing Pain Part V
Killing Pain Part VI
*I was pleased to see the Scholarpedia article on Neural Inhibition was written by Dr. Gyorgy Buzsaki, Rutgers University, whose book, Rhythms of the Brain, I read and absolutely loved a few years ago. I blogged about it in Brain Oscillations: Ten part series.
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
(I think what happened with me had something to do with neural inhibition.*)
The first image is straight out of the book. It's nice, but I couldn't follow it as well as I wanted.
The other three are my own deconstructive line diagrams.
Click to embiggen.
Killing Pain
Killing Pain Part II
Killing Pain Part III
Killing Pain Part V
Killing Pain Part VI
*I was pleased to see the Scholarpedia article on Neural Inhibition was written by Dr. Gyorgy Buzsaki, Rutgers University, whose book, Rhythms of the Brain, I read and absolutely loved a few years ago. I blogged about it in Brain Oscillations: Ten part series.
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Killing Pain Part III
We're going to drill a bit deeper into some science relating back to the previous post, Killing Pain Part II. I'm a visual learner, so I like to make pictures in PPT and examine them closely, so that I can visualize pathways instead of trying to memorize them. Here are a set of notes I made from DD Price's 2002 paper, Sensory and Affective Dimensions of Pain, on pathways in the brain that are involved with pain production. These are not "pain" centers - really, there is no such thing as a "pain" center. There are, however, pathways associated with pain production and processing. The verb is not the noun. And this is one of the best papers on pain processing I've found so far.
Abstract:
I'm putting my notes here for anyone who is interested. Click on image to embiggen.
Killing Pain
Killing Pain Part II
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Abstract:
Clinical and experimental studies show serial interactions between the intensity of pain sensation, pain unpleasantness, and secondary emotions associated with reflection and future implications (i.e., suffering). These pain dimensions and their interactions relate to ascending spinal pathways and a central network of brain structures that process nociceptive information both in series and in parallel. Spinal pathways to the amygdala, hypothalamus, reticular formation, medial thalamic nuclei, and limbic cortical structures provide direct inputs to brain areas involved in arousal, bodily regulation, and hence, affect. Another major input to these same structures is from spinal pathways to somatosensory thalamic [ventroposterior lateral (VPL) and ventroposterior medial (VPM)] and cortical areas (S1, S2, and the posterior parietal cortex) and from these areas to cortical limbic structures (insular cortex, anterior cingulate cortex). This indirect cortico-limbic pathway integrates pain-perceptive (nociceptive) input with information about overall status of the body and self to provide cognitive mediation of pain affect. Both direct and cortico-limbic pathways converge on the same anterior cingulate cortical and subcortical structures whose function may be to establish emotional valence and response priorities. This entire brain network is under dynamic top-down (neural effects from higher-to- lower levels) modulation by brain mechanisms that are associated with anticipation, expectation, and other cognitive factors.
I'm putting my notes here for anyone who is interested. Click on image to embiggen.
 |
| Lateral pathways |
 | ||
| Overview |
 |
| Others (slower) |
 |
| Cortico-limbic |
 |
| ACC |
Killing Pain
Killing Pain Part II
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Killing Pain Part II
Yesterday I wrote a florid limbic account of my episode of "frozen shoulder", experiencing the crippling, spreading sort of pain for the first time in my life, how I coped with it, and managed to get my brain back on track, so it could defend properly and not give me a lot of pain noise I didn't need, that no one needs.
Today, I thought I'd deconstruct it all.
Here is what I've got so far:
This is a slide I made a few months ago for a presentation on the Neuromatrix model of pain. The overall gist of the presentation was rostral mechanisms and how they are involved in pain production and reduction. The subtopic for which this slide (and the next) was used, was Sensory-Discriminative; Descending Modulation.
Here we see flight/fight reponse, whereby an animal, or any vertebrate for that matter, including human, can defend itself to the death by deliberately ignoring cuts/bites/scrapes, with resolve fueled by noradrenaline. I really don't know that it's completely analgesic, but it likely allows the animal to ignore all the nociception with which it is being flooded in the moment. If it's being attacked (e.g., for food), it will try to escape. It still needs its wits to do that.
This descending modulation is activated by the hypothalamus based on input from more rostral centers which are reporting to the animal's brain about the direct context, what's going on in the environment in the moment - the dorsolateral portion of the periaqueductal grey is activated.
Here, we see a different kind of response, passing out completely.
This is activated when all hope is lost. Much more conserving of the organism's energy.
The ventrolateral part of the PAG is activated instead. The animal "escapes" by going unconscious. I guess enough possums have lived on to reproduce by doing this, that they've evolved this tactic as their primary defense.
Here are the thoughts about the encounter with pain that I've entertained today.
1. I needed a fight/flight response to kick in ("Kill" or "be killed"). My dorsolateral prefrontal cortex knew that I wasn't in any actual danger. It had to access this system however, even in the absence of any real danger.
2. I was in complete control of the process. I had complete locus of control of the event. I directed my therapist and she adapted herself to me.
3. I had a lot of pain education - i.e., I knew pain wouldn't actually kill me, regardless of how threatening it felt.
4. It was, actually, a novel experience to have this magnitude of pain. I'd never experienced anything like it in severity and pain restriction, especially this awful spreading quality. I think the spreading quality concerned/scared me the most.
5. I managed to take fear and change it to fighting fury (elicited a noradrenergic response). I asked the therapist to treat what I figured was the core of the physical bit of the whole problem (exerted locus of control). The pain spread like wildfire - I could feel it but I did not let it deter me (noradrenergic resolve). Then, but only then, I let the part of the threat detector/pain production system that is part of the frontal lobes (anterior cingulate cortex) take over and "run away" immediately following (permitted ideomotor movement), but only after "I" (my dorsolateral prefrontal cortex) showed it who was really boss, by controlling the timing.
6. Although I didn't collapse in an unconscious heap, some part of my brain might have, because the opioids finally kicked in. Perhaps the dorsolateral prefrontal cortex got mean enough (in a controlled environment) that both the dorsolateral part of periaqueductal grey AND the ventrolateral part of PAG were activated simultaneously: the DLPAG fought and snarled and ran, the VLPAG felt sufficiently attacked that it "fainted" and let go of a big gob of all the necessary opioids such that I got the much needed relief I wanted.
7. It all felt very life-and-death dramatic, but I entered the encounter knowing that these centers were the ones that respond to actual life and death stuff, so I didn't mind the heavy emotional powering up that occurred.
8. I was determined to come out the other end feeling better - so the dopamine was clearly flowing from the expectation, probably was a factor, may have helped via various pathways.
9. The therapist was great. No nocebo from her at all - no cholecystokinin was triggered, which would have interfered big time.
10. I was free, and felt free, to manage my PAG and stimulate it from rostral centers using
I've also learned that help is there when I need it.
Other posts on the topic:
Killing Pain
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Today, I thought I'd deconstruct it all.
Here is what I've got so far:
Here we see flight/fight reponse, whereby an animal, or any vertebrate for that matter, including human, can defend itself to the death by deliberately ignoring cuts/bites/scrapes, with resolve fueled by noradrenaline. I really don't know that it's completely analgesic, but it likely allows the animal to ignore all the nociception with which it is being flooded in the moment. If it's being attacked (e.g., for food), it will try to escape. It still needs its wits to do that.
This descending modulation is activated by the hypothalamus based on input from more rostral centers which are reporting to the animal's brain about the direct context, what's going on in the environment in the moment - the dorsolateral portion of the periaqueductal grey is activated.
This is activated when all hope is lost. Much more conserving of the organism's energy.
The ventrolateral part of the PAG is activated instead. The animal "escapes" by going unconscious. I guess enough possums have lived on to reproduce by doing this, that they've evolved this tactic as their primary defense.
Here are the thoughts about the encounter with pain that I've entertained today.
1. I needed a fight/flight response to kick in ("Kill" or "be killed"). My dorsolateral prefrontal cortex knew that I wasn't in any actual danger. It had to access this system however, even in the absence of any real danger.
2. I was in complete control of the process. I had complete locus of control of the event. I directed my therapist and she adapted herself to me.
3. I had a lot of pain education - i.e., I knew pain wouldn't actually kill me, regardless of how threatening it felt.
4. It was, actually, a novel experience to have this magnitude of pain. I'd never experienced anything like it in severity and pain restriction, especially this awful spreading quality. I think the spreading quality concerned/scared me the most.
5. I managed to take fear and change it to fighting fury (elicited a noradrenergic response). I asked the therapist to treat what I figured was the core of the physical bit of the whole problem (exerted locus of control). The pain spread like wildfire - I could feel it but I did not let it deter me (noradrenergic resolve). Then, but only then, I let the part of the threat detector/pain production system that is part of the frontal lobes (anterior cingulate cortex) take over and "run away" immediately following (permitted ideomotor movement), but only after "I" (my dorsolateral prefrontal cortex) showed it who was really boss, by controlling the timing.
6. Although I didn't collapse in an unconscious heap, some part of my brain might have, because the opioids finally kicked in. Perhaps the dorsolateral prefrontal cortex got mean enough (in a controlled environment) that both the dorsolateral part of periaqueductal grey AND the ventrolateral part of PAG were activated simultaneously: the DLPAG fought and snarled and ran, the VLPAG felt sufficiently attacked that it "fainted" and let go of a big gob of all the necessary opioids such that I got the much needed relief I wanted.
7. It all felt very life-and-death dramatic, but I entered the encounter knowing that these centers were the ones that respond to actual life and death stuff, so I didn't mind the heavy emotional powering up that occurred.
8. I was determined to come out the other end feeling better - so the dopamine was clearly flowing from the expectation, probably was a factor, may have helped via various pathways.
9. The therapist was great. No nocebo from her at all - no cholecystokinin was triggered, which would have interfered big time.
10. I was free, and felt free, to manage my PAG and stimulate it from rostral centers using
11. Even though I'd never done such a thing before, it worked. So I guess it can be done. Sample of one. Now that I've done it once, next time (should there be a next time - there may not ever have to be a next time) it should be easier. (Optimistic thought)
- emotions (HATING pain, determination, focus, no-nonsense, I WON'T put up with this, I WILL construct a boundary between me and this Pain) as fuel
- information (I won't die if I try this, pain is just my brain being freaked out about something, it's not likely any big deal, it's only pain, I didn't injure anything lately) as message containers
- social context/therapeutic contact (I'm appalled by so much of what I see in the world, and my own body is where I should have the right to feel safe (dammit)/ my therapist is here to help me, I have locus of control) as delivery chutes
I've also learned that help is there when I need it.
Other posts on the topic:
Killing Pain
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
Friday, August 12, 2011
Killing Pain
Initiated
OK. So now, finally, at the ripe old age of 60, I've finally joined the ranks of those who have had a visit from the horrid monster who produces, directs and stars in the horrid movie known as Pain.
About 4 days ago I developed hideous pain in my right upper quadrant. Hideous to me, at least. Completely invisible to others.
I'd been noticing crankiness at the shoulder but hey, what shoulder wouldn't be cranky given the amount of typing and mousing I do, and have done daily for the last couple years almost full time, and not much else? I kept going. I should mention that I type completely one-handedly, right hand.
About 4 days ago I found myself suddenly dealing with serious lack of range in the shoulder and acute pain on movement.
Um, I wonder where this is going to go, I wondered to myself. Where it went was into a full-fledged acute Pain experience, with no way to get comfortable, no position to sleep in*, no way to escape, really. I started taking aspirin, which made me feel like I was doing something to help myself, but didn't really seem to change the Pain much.
When I say, entire upper limb, I mean upper quadrant, including the right back, front and side of the neck (superficial cervical plexus) including upper chest and upper back, shoulder (front, back side), and entire arm (front, back, side) and all the major parts (shoulder, elbow, and hand).
He wasn't about to go away by himself. I realized I needed back up and moved as swiftly as I could to get some help.
Background
This is the story as well as I can recall it:
About twenty years ago I had a severe (to me at least) whiplash episode, with major headache and pain on movement and point tenderness, which all went away, brilliantly, in one session of manual treatment by another therapist, inside about 15 minutes. The therapist had taken a workshop in a type of handling which included passively positioning the body part into a painfree, tenderness-free position, and holding it there for a few minutes, then carefully moving the part back out into a normal position again.
This impressed me so much that I built a whole manual therapy practice around doing just that with patients, which sustained me for years.
Details of the crash
I was driving along a Saskatchewan highway, August 1989. About 3 PM, bright daylight, good weather. I'd just gassed up and was driving along, doing the posted speed limit, holding a coke in my right hand, steering with the left.
A truck pulled up to the highway on a side road, from the left side, slowed but didn't stop, even though there was a stop sign.
It was crossing the highway. Right in front of my car. I couldn't believe it hadn't seen me coming. I mean, it was broad daylight. I was driving a small car, white, and maybe the driver didn't spot me, maybe the sun was low enough to have forced him to squint, making my car indistinguishable, invisible.. anyway, he said he never saw me. This was in the days before running lights on cars. People were asked to use their headlights during the day, but it wasn't mandatory. I did not have my lights on - I hadn't turned them back on yet after getting gas, and my hands were full.
I turned left a bit, hoping I could swing around the back end of his truck: I couldn't avoid hitting him, however, so at the very last nanosecond I cranked the steering wheel to the right, so that the impact would be spread out along the side of the car rather than all at the front end. Then the crash.
I ended up with a painless restriction in shoulder movement, specifically internal rotation with arm in 90 degrees of abduction, elbow bent to a right angle. Think of a stick through a straw scarecrow's shoulders, emerging at the elbows; hands pointing up toward the sky is external rotation, and the hands hanging down toward the ground is internal rotation. My left hand could point down, but my right hand stayed up in the air, pointing forward. It was as though it was stuck there.
It didn't bother me much: when I attended ortho school for a brief time in the early 90's, I was told by an instructor that my humeral head was anterior in the socket, and he shoved it back. Very perfunctory. It not only didn't hurt, I felt nothing. Nothing. My brain learned nothing. The restriction was not changed by his heroic.
It didn't bother me much: when it did, once, giving me some minor grief back in 2001 or thereabouts, I went to a friend who was a massage therapist and had him noodle around at the lateral edge of my shoulder blade until it felt like I could move it easily and comfortably again. I was left with the internal rotation restriction, but what the heck. It didn't bother me much.
Back to present time
I knew I needed help ASAP. I contacted the PT who had contacted me when she moved to town in the winter, had organized the workshop I taught in June. She is quite keenly interested in pain and in helping people deal with it. She was a kindred spirit in that she had tasted ortho koolaid but hadn't gulped the whole glass. Both of us had instinctively known we didn't like the handling that was often involved, or the mindset, or the callous disregard, both interactively and conceptually, of the nervous system of the patients being handled, specifically their interoception and afferent capacities. Both of us were well aware of Pain.
She is also a midwife. She has had 4 children. She has conquered pain from all sorts of angles on several occasions, in herself and while helping others. I respect somebody who has given birth, endured the Pain of it, and lived. I never have. The very thought has always made me feel cognitively dissonant, as in, why would anyone ever willingly go through something like childbirth?, even as I noted that it's normal for Homo reproductus.
The shoulder
Weirdly, even though I realized this exact same presentation was labelled "frozen shoulder" and is common in women, especially older women, and I couldn't do anything with my arm, and pretty much everything hurt it, I continued working. Yes, believe it or not. As it turns out, I was reasonably comfortable while using my arm from the elbow down, and pressing on table tops or my bed or against peoples' bodies with that arm even felt a bit relieving. So I was able to fake my way along through Tuesday and Thursday fairly well. I was really anticipating my session though, yesterday after work.
The treatment
Kirsten allowed me the freedom to do whatever I needed to do in the moment. It was painful to lay on my back, but I knew I wanted her to take my arm off the edge of the table, into shoulder extension, lay it gently and slowly on a pillow, find the core of that monster, Pain, on the front of my shoulder, touch him with one hand, put her other hand behind my shoulder/upper arm, from underneath, at the bend, and press steadily up with the ends of her fingers using her lumbricals. Push him the hell out of me. As soon as she did that, I could feel a shifting going on.
So I endured/ignored all the screaming going on in all the other centrally sensitized nerves - superficial cervical plexus, distributed like the right half of a hijab. All the brachial plexus, the whole hand.
My goal was to keep Pain confined only to where it had already colonized me, not let it get any farther, fight hard to get back my body for me. I took the immediate increase in all the rest of the nerve distributions as confirmation that Pain was trying to fight back.
But I was relentless. I could still breathe. So I focused on deep breathing as the next couple minutes (that felt like hours) ticked by. I know the right length of time to spend on something, from decades of occupying the other end of the treatment dyad.
Kirtsten and I checked in with each other. She felt the softening happening at the front of my shoulder, and I knew that Pain had been stabbed in his heart, by her, by me, by our interaction; I knew that although he would not go down without a fight, or without trying to start more fires, he was eventually going to diediedie.
Finally I decided enough time had elapsed, that death of Pain was certain, and I needed to help the rest of my sensory cortex, indulge the anterior cingulate cortex by letting it express some escape behaviour. I got up on my feet, writhed about, wrestling with myself. Kirsten remarked that I looked like a woman in labour. I remarked that it felt like I was having a baby through my right upper quadrant. I said I was being an ideomotor moron. We both laughed. It was triumphant laughter, because I was letting my anterior cingulate cortex help my sensory cortex escape by giving it complete access to my motor cortex, and it was having me do some pretty remarkable moving. It felt a lot like contemporary dance might look, performed by a very inept and untrained dancer, kinda ugly-like; so, readers, best not to let your mirror neurons become too activated, because visualizing how this interior moving went down could be somewhat painful in and of itself.
But movement had to come out. Just like a baby comes out. Blood, gore (well, OK, no actual blood or gore), messy movement, biological and frighteningly primitive. But natural. And I killed Pain. I killed him with the help of my student, Kirsten, no stranger to any of this in that she has done movement like this herself while giving actual birth. Kind, steady, standing by, putting up with me, engaged, accompanying, permissive, calm, reassuring, letting me do what I needed to do, not interfering, accepting me in the heat of my battle no matter how ugly it was.
Right away, after about 5 minutes of this, the arm pain and superficial cervical plexus pain was much reduced. I could move the arm actively! A few degrees at least. We treated a few more places in a few more positions. I could now tolerate prone lying with the arm dangling. Kirsten sat on the floor and twisted the skin of my arm in slow snake-bite S's for delicious minutes and minutes and minutes. It felt like my arm relaxed and lengthened by inches. When I got back up it was truly better.
I had a great sleep. No more Pain. He's dead now, the miserable rapist bastard. At least for now. At least in me. But he still roams and assaults others, so I will hunt his sorry evil ass and help other people kill him for as long as I have breath.
I have my life back. I almost have my shoulder back. There is still restriction. I still have to use my non-dominant hand for certain personal hygiene which shall remain nameless, and I still have to put on a bra by doing it up at the front then twisting it around, and Kirsten will have at it again next week, but I doubt I'll have to gear up to go full-tilt psycho on whatever dregs still remain. It will be more just a mopping up process. I won't have to be the killer again - I'll be just the cleaner.
Life is painful. We try to keep at least one little corner of it, our own body, pain-free. No one should ever have to endure captivity by pain. People either kill it, or learn to live with it, adapt to its presence, peacefully.
I think people need to be encouraged to kill it anyway they can, if they can. People also have to know it will be entirely an inside job, requiring strategy, planning and often recruitment of someone to assist. They need to have picked somebody carefully, well in advance. It is a truly dorsolateral prefrontal cortex-led inner activity. They must know that they will need a story-line, starring them, that they will need to assume the lead role, and that it will be the role of assassin, if they want to have their life truly back again under their own auspice. They will be faced with win-or-lose, black-or-white, kill-or-be killed/raped/crippled/maimed/paralyzed by Pain. It's a choice, and by now I know, deeply know, emotionally know, that it must be made, can be made, by anyone, including peaceful 60 year-old women who love cats and don't ever try to hurt anyone. The urge to kill is inherent in all biology, all organisms, a birthright. It is the last and final defense for the "I"-illusion against any enemy, real or imaginary, physical and external or sensed, experienced, internal. It is socially forbidden unless sanctioned for use by army or law enforcement. At the personal level, one has the biological right to deploy it for a good reason such as this, engage it - strictly internally, and fully, without doubt or hesitation.
P.S.: My Kill Pain story-line has specific feminist overtones and undertones running throughout. It's the story I've been angry about all my life - power over, violation of, domination of physical bodies of helpless men, women or children. It's the story that gave me fuel to make myself get mad enough to become capable of committing murder. You'll need to make up your own story: Think of the grossest violation of your own bodily human rights you can imagine, feel how enraged it makes you feel, then fight back with everything you've got. Every claw and every fang. It's your right as a vertebrate with a human nervous system.
* I finally worked out a position in which I could sleep relatively comfortably, for a relatively long length of time; prone, on top of three stacked pillows, forelegs folded like a quadruped, head turned left. I had to wake up fully in order to move. I had to physically get up to rest from having been in that position for a few hours, then resume that position to get more sleep.
More posts on this topic:
Killing Pain Part II
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
OK. So now, finally, at the ripe old age of 60, I've finally joined the ranks of those who have had a visit from the horrid monster who produces, directs and stars in the horrid movie known as Pain.
Before, I'd only ever seen him only from a distance, across a crowded room, fleeting eye contact. I'd watched him, had tracked him, had stalked him, had found him, had assisted others as they fought him, but had never been formally introduced to or personally invaded by him.
Now I know how he feels.
Now I really, really know how Pain feels. To me. Raped by Pain. In the shoulder.
About 4 days ago I developed hideous pain in my right upper quadrant. Hideous to me, at least. Completely invisible to others.
I'd been noticing crankiness at the shoulder but hey, what shoulder wouldn't be cranky given the amount of typing and mousing I do, and have done daily for the last couple years almost full time, and not much else? I kept going. I should mention that I type completely one-handedly, right hand.
About 4 days ago I found myself suddenly dealing with serious lack of range in the shoulder and acute pain on movement.
Um, I wonder where this is going to go, I wondered to myself. Where it went was into a full-fledged acute Pain experience, with no way to get comfortable, no position to sleep in*, no way to escape, really. I started taking aspirin, which made me feel like I was doing something to help myself, but didn't really seem to change the Pain much.
What does it feel like to be raped by Pain in the shoulder? It feels like hot lava sploots and shoots in every part of the entire upper limb, with every move or breath or change in position. There are moments when it's possible to function and distract oneself, but he's always there, maybe a bit distant, but never not there. When a shift of awareness or focus occurs, bam, he's right there, inside every neuron, every molecule, taking up every bit of virtual space he can in the whole cortex, spreading inexorably, steadily capturing and controlling more and more of the meat puppet of the body each day. In deliberate fashion, he moves along raping successive nerves and muscles, twisting a spiral point into them, skewering them into submission, leaving them helpless and frozen in agonized contraction.
When I say, entire upper limb, I mean upper quadrant, including the right back, front and side of the neck (superficial cervical plexus) including upper chest and upper back, shoulder (front, back side), and entire arm (front, back, side) and all the major parts (shoulder, elbow, and hand).
He wasn't about to go away by himself. I realized I needed back up and moved as swiftly as I could to get some help.
Background
This is the story as well as I can recall it:
About twenty years ago I had a severe (to me at least) whiplash episode, with major headache and pain on movement and point tenderness, which all went away, brilliantly, in one session of manual treatment by another therapist, inside about 15 minutes. The therapist had taken a workshop in a type of handling which included passively positioning the body part into a painfree, tenderness-free position, and holding it there for a few minutes, then carefully moving the part back out into a normal position again.
This impressed me so much that I built a whole manual therapy practice around doing just that with patients, which sustained me for years.
Details of the crash
I was driving along a Saskatchewan highway, August 1989. About 3 PM, bright daylight, good weather. I'd just gassed up and was driving along, doing the posted speed limit, holding a coke in my right hand, steering with the left.
A truck pulled up to the highway on a side road, from the left side, slowed but didn't stop, even though there was a stop sign.
It was crossing the highway. Right in front of my car. I couldn't believe it hadn't seen me coming. I mean, it was broad daylight. I was driving a small car, white, and maybe the driver didn't spot me, maybe the sun was low enough to have forced him to squint, making my car indistinguishable, invisible.. anyway, he said he never saw me. This was in the days before running lights on cars. People were asked to use their headlights during the day, but it wasn't mandatory. I did not have my lights on - I hadn't turned them back on yet after getting gas, and my hands were full.
I turned left a bit, hoping I could swing around the back end of his truck: I couldn't avoid hitting him, however, so at the very last nanosecond I cranked the steering wheel to the right, so that the impact would be spread out along the side of the car rather than all at the front end. Then the crash.
I wish now I'd dropped the coke, but instead, as the collision happened, my arm was jolted, still holding the damn coke can, still mostly full. I distinctly remember feeling the jolt in the shoulder. Biceps were contracted because I was holding a stupid coke. Musculocutaneous nerve got jerked. It has never really had enough space in there, ever since.
I ended up with a painless restriction in shoulder movement, specifically internal rotation with arm in 90 degrees of abduction, elbow bent to a right angle. Think of a stick through a straw scarecrow's shoulders, emerging at the elbows; hands pointing up toward the sky is external rotation, and the hands hanging down toward the ground is internal rotation. My left hand could point down, but my right hand stayed up in the air, pointing forward. It was as though it was stuck there.
It didn't bother me much: when I attended ortho school for a brief time in the early 90's, I was told by an instructor that my humeral head was anterior in the socket, and he shoved it back. Very perfunctory. It not only didn't hurt, I felt nothing. Nothing. My brain learned nothing. The restriction was not changed by his heroic.
It didn't bother me much: when it did, once, giving me some minor grief back in 2001 or thereabouts, I went to a friend who was a massage therapist and had him noodle around at the lateral edge of my shoulder blade until it felt like I could move it easily and comfortably again. I was left with the internal rotation restriction, but what the heck. It didn't bother me much.
In retrospect, this was the open window. This was the body bit, the body function, neglected by me, that Pain found, cased, then eventually climbed in through, to invade my personal existence.
Back to present time
So, for whatever reason, whatever the way the moon lined up this month with the planets and stars, the weather, stress from too much recent interpersonal activity, my inexorable aging process, maybe a brain fed-up with a steady diet of mono-movement, maybe a combination - who knows - Pain found his way into my personal space and invaded my interoception, raped my shoulder, stole my movement, seemed to be threatening to set up permanent residence, was starting to use very creepy torture devices, ones that could only be interoceptively sensed, not seen or prepared for.
I knew I needed help ASAP. I contacted the PT who had contacted me when she moved to town in the winter, had organized the workshop I taught in June. She is quite keenly interested in pain and in helping people deal with it. She was a kindred spirit in that she had tasted ortho koolaid but hadn't gulped the whole glass. Both of us had instinctively known we didn't like the handling that was often involved, or the mindset, or the callous disregard, both interactively and conceptually, of the nervous system of the patients being handled, specifically their interoception and afferent capacities. Both of us were well aware of Pain.
She is also a midwife. She has had 4 children. She has conquered pain from all sorts of angles on several occasions, in herself and while helping others. I respect somebody who has given birth, endured the Pain of it, and lived. I never have. The very thought has always made me feel cognitively dissonant, as in, why would anyone ever willingly go through something like childbirth?, even as I noted that it's normal for Homo reproductus.
The shoulder
Weirdly, even though I realized this exact same presentation was labelled "frozen shoulder" and is common in women, especially older women, and I couldn't do anything with my arm, and pretty much everything hurt it, I continued working. Yes, believe it or not. As it turns out, I was reasonably comfortable while using my arm from the elbow down, and pressing on table tops or my bed or against peoples' bodies with that arm even felt a bit relieving. So I was able to fake my way along through Tuesday and Thursday fairly well. I was really anticipating my session though, yesterday after work.
The treatment
Kirsten allowed me the freedom to do whatever I needed to do in the moment. It was painful to lay on my back, but I knew I wanted her to take my arm off the edge of the table, into shoulder extension, lay it gently and slowly on a pillow, find the core of that monster, Pain, on the front of my shoulder, touch him with one hand, put her other hand behind my shoulder/upper arm, from underneath, at the bend, and press steadily up with the ends of her fingers using her lumbricals. Push him the hell out of me. As soon as she did that, I could feel a shifting going on.
Other nerves screamed as Pain ran around raping them, simultaneously, but I knew this place was his whole tap root, ground zero, the entrapment of the musculocutaneous nerve inside coracobrachialis, from 20 years ago, what the restriction had been all about, right from the beginning. This is what I'd neglected to go get treatment for lo, all these many years. This was all my own fault. This was my battle, not anyone else's. No one could rescue me but me.
I was up for mortal battle - I wanted to full-on murder that rapist bastard, Pain. I was angry, cold, calculating and not in a mood to take prisoners. This was between me and whatever my immune system had decided to dish me. If Pain was a movie, starring him, he was about to be vanquished, by Me, or at least by the "I"-illusion I call Me, because this is my body, my physical existence, my biological real estate, dammit. Life is crappy enough as it is, out there, and this my body is the only place I really ever have felt safe or at home. I own my own body, dammit. No matter what sorts of cultural ideas would try to deprive me of bodily sovereignty. I know them all in detail. E.g., "Right to Life" (whose fucking life? MINE!!)..
So I endured/ignored all the screaming going on in all the other centrally sensitized nerves - superficial cervical plexus, distributed like the right half of a hijab. All the brachial plexus, the whole hand.
My goal was to keep Pain confined only to where it had already colonized me, not let it get any farther, fight hard to get back my body for me. I took the immediate increase in all the rest of the nerve distributions as confirmation that Pain was trying to fight back.
But I was relentless. I could still breathe. So I focused on deep breathing as the next couple minutes (that felt like hours) ticked by. I know the right length of time to spend on something, from decades of occupying the other end of the treatment dyad.
Kirtsten and I checked in with each other. She felt the softening happening at the front of my shoulder, and I knew that Pain had been stabbed in his heart, by her, by me, by our interaction; I knew that although he would not go down without a fight, or without trying to start more fires, he was eventually going to diediedie.
Finally I decided enough time had elapsed, that death of Pain was certain, and I needed to help the rest of my sensory cortex, indulge the anterior cingulate cortex by letting it express some escape behaviour. I got up on my feet, writhed about, wrestling with myself. Kirsten remarked that I looked like a woman in labour. I remarked that it felt like I was having a baby through my right upper quadrant. I said I was being an ideomotor moron. We both laughed. It was triumphant laughter, because I was letting my anterior cingulate cortex help my sensory cortex escape by giving it complete access to my motor cortex, and it was having me do some pretty remarkable moving. It felt a lot like contemporary dance might look, performed by a very inept and untrained dancer, kinda ugly-like; so, readers, best not to let your mirror neurons become too activated, because visualizing how this interior moving went down could be somewhat painful in and of itself.
But movement had to come out. Just like a baby comes out. Blood, gore (well, OK, no actual blood or gore), messy movement, biological and frighteningly primitive. But natural. And I killed Pain. I killed him with the help of my student, Kirsten, no stranger to any of this in that she has done movement like this herself while giving actual birth. Kind, steady, standing by, putting up with me, engaged, accompanying, permissive, calm, reassuring, letting me do what I needed to do, not interfering, accepting me in the heat of my battle no matter how ugly it was.
Right away, after about 5 minutes of this, the arm pain and superficial cervical plexus pain was much reduced. I could move the arm actively! A few degrees at least. We treated a few more places in a few more positions. I could now tolerate prone lying with the arm dangling. Kirsten sat on the floor and twisted the skin of my arm in slow snake-bite S's for delicious minutes and minutes and minutes. It felt like my arm relaxed and lengthened by inches. When I got back up it was truly better.
I had a great sleep. No more Pain. He's dead now, the miserable rapist bastard. At least for now. At least in me. But he still roams and assaults others, so I will hunt his sorry evil ass and help other people kill him for as long as I have breath.
I have my life back. I almost have my shoulder back. There is still restriction. I still have to use my non-dominant hand for certain personal hygiene which shall remain nameless, and I still have to put on a bra by doing it up at the front then twisting it around, and Kirsten will have at it again next week, but I doubt I'll have to gear up to go full-tilt psycho on whatever dregs still remain. It will be more just a mopping up process. I won't have to be the killer again - I'll be just the cleaner.
Life is painful. We try to keep at least one little corner of it, our own body, pain-free. No one should ever have to endure captivity by pain. People either kill it, or learn to live with it, adapt to its presence, peacefully.
I think people need to be encouraged to kill it anyway they can, if they can. People also have to know it will be entirely an inside job, requiring strategy, planning and often recruitment of someone to assist. They need to have picked somebody carefully, well in advance. It is a truly dorsolateral prefrontal cortex-led inner activity. They must know that they will need a story-line, starring them, that they will need to assume the lead role, and that it will be the role of assassin, if they want to have their life truly back again under their own auspice. They will be faced with win-or-lose, black-or-white, kill-or-be killed/raped/crippled/maimed/paralyzed by Pain. It's a choice, and by now I know, deeply know, emotionally know, that it must be made, can be made, by anyone, including peaceful 60 year-old women who love cats and don't ever try to hurt anyone. The urge to kill is inherent in all biology, all organisms, a birthright. It is the last and final defense for the "I"-illusion against any enemy, real or imaginary, physical and external or sensed, experienced, internal. It is socially forbidden unless sanctioned for use by army or law enforcement. At the personal level, one has the biological right to deploy it for a good reason such as this, engage it - strictly internally, and fully, without doubt or hesitation.
P.S.: My Kill Pain story-line has specific feminist overtones and undertones running throughout. It's the story I've been angry about all my life - power over, violation of, domination of physical bodies of helpless men, women or children. It's the story that gave me fuel to make myself get mad enough to become capable of committing murder. You'll need to make up your own story: Think of the grossest violation of your own bodily human rights you can imagine, feel how enraged it makes you feel, then fight back with everything you've got. Every claw and every fang. It's your right as a vertebrate with a human nervous system.
* I finally worked out a position in which I could sleep relatively comfortably, for a relatively long length of time; prone, on top of three stacked pillows, forelegs folded like a quadruped, head turned left. I had to wake up fully in order to move. I had to physically get up to rest from having been in that position for a few hours, then resume that position to get more sleep.
More posts on this topic:
Killing Pain Part II
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part V
Killing Pain Part VI
Somasimple discussion thread about this post series.
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.
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