Neurodynamic Solutions

Michael Shacklock is likely about to wing his way back to Australia sometime this morning, following a final weekend workshop here in Vancouver; he was at the end of a three and a half month tour of European and Western Hemisphere cities spent observing surgeries, consulting neuro researchers, and teaching his own unique vision of treatment of the neural component of the physical movement system. I've just had the pleasure of attending his upper limb workshop and give him credit for not seeming exhausted at all.

Neurodynamics took quite a bad rap after its initial rise in fame in the late eighties, early nineties, mostly in Australia. Shacklock says, "I went back to square one with the concept" because in his view it needed to be redeveloped, revamped, then reintroduced with a much different emphasis. He has succeeded in this regard. Gone are the verbs "stretch" and "tension" from the language used to explain the technique to the patient, although "slide" was allowed to remain. Introduced are many ideas on how to sift through patients to determine which ones are appropriate to test and treat in this manner and which ones are not. Also introduced is the notion of testing and treating at precise minimalist levels that do not irritate, that can be determined through sequencing of application, and how to differentiate neural symptom from tunnel symptom. All this precision requires good therapeutic rapport, and patient education/cooperation; Shacklock provides thorough grounding in how to achieve this.

The class is mostly devoted to developing handling skills: This includes thorough grounding and loads of practical handling tips in applying the standard tests and then in all the many variations that can be adopted, featured in precise categories; first to determine if the problem is neural or interface (differential diagnosis), next to help change the physiology of the nerves themselves if need be, and finally as treatment to address the pathodynamics of neural containers and musculo skeletal interface. Woven throughout is the basis of the concept, the basic science underpinnings and examples from his own many years of clinical practice. In addition to raising a family, running a practice and teaching worldwide, he found time somehow to write a book and produce a CD of real time ultrasound imaging of neural movement at the wrist, shoulder, and ankle.

Michael Shacklock is enthusiastically determined to see that good handling of the peripheral nervous system and spinal cord enjoys the comeback it deserves, and becomes a familiar and preferred treatment choice for all manual therapists. He is confident that this manner of handling patients will produce more precise, accurate research and a strong profession world wide.

Check out his site: http://www.neurodynamicsolutions.com (linked through the title of this blog piece). The book is comprehensive and the CD is a marvel. You can see the median nerve at the wrist moving freely in a normal subject, with lateral neck flexion compared to a patient with carpal tunnel. Shacklock is also the author of Moving in on Pain, published in 1995.

"Inner Maestro", "Inner Freedom", "Beyond the Prefrontal Cortex", "The Brain's Enigma"

A bit lengthy today, but juicy. Here is the last piece in Skoyles/Sagan's Up From Dragons chapter.

Inner Maestro
We have a world within that exists because our brain organizes its actions and thoughts with internal cues. Some philosophers, however, deny the existence of such an inner place. According to them, our inner feel is a “beetle hidden” in a box we cannot open and so is not meaningfully there. To them, to see consciousness and mind as things inside us is to see ghosts in a linguistic mirage generated by the misuse of words. Perhaps they are right within the context of their philosophical reasoning. But it would seem that they ignore the prefrontal cortex and its vibrant life of inner cues. Philosophers never see any need for the brain to make its actions and reactions independent of the outer world, for they imagine us to have mushy brains, not assertive ones with inner cues. They are the neuroscience equivalent of medieval scholar monks counting angels on neurons, blissfully ignoring twenty-first century science and its discovery of the subtle logic of our bio-computers.

As you think, recall, and imagine, you are, in a sense, your inner cues. They may not be the actions taken in the outer world, but it is through them that we act, if only in the inner world of our memories and imaginations. Perhaps the act and the actor are the same? If the brain can create an intensely “me” sense of embodiment in limbs that no longer exist, then what of mental actions orchestrated inside us? They may not offer us three- dimensional embodiment, but, as shown above, extension is not needed for the “me” feel of embodiment. What is needed is some control feedback relationship. And, as with social presence, the relationship need not be physical. It would seem that the inner cues guiding actions, recall, imagination, and thought are part of our sense of being a “me.” Here are a multitude of control and feedback processes and cues flipping motions, memories, images, and ideas in and out of existence.

There are in fact clues that the preparation done by our brains before we act is linked with consciousness. One thing prefrontal inner cues do is initiate thoughts and actions – we are anything but vegetables. We are constantly doing things, if not with our bodies then with our minds. But few actions and thoughts arise fully formed. Before we voluntarily take even the smallest action, our brains prepare.

Such preparations have different durations. Some, taking half a second or less., happen in the parts of our brain dealing with movement. Before we move, our motor cortex draws up programs as to how to act in a complex process that involves linking motor memories together into sequences, or motor programs. And few actions happen without feedback control: Ongoing sensitivity to feedback requires subtle preparation so that our actions can be integrated and so guided by sight and touch. This is all brain work, a labor done silently by our motor neurons in the half-second or so before we act. And it is not done alone. Overseeing this work, the anterior cingulated cortex attends to the consequences of our actions, focusing up to 2 seconds before we act. And before that, other neurons, in the prefrontal cortex, may start up one or many seconds earlier, depending upon the task (Singh, Knight 1990). They ask when and where the movement should start, and under what conditions. Is this the time to act? Such prefrontal preparations come not only before actions but before we reach a mental conclusion, or face an expected event or punishment. Our minds are always looking ahead and anticipating. There are whole families of processes being loosely summarized together here. But they share a brainwave “signature.” The details of how they do this are just being discovered. What we know is that before we act there is a general shift in the electrical activity of our brains. Temporally extended action requires the slow potentials described in Chapter 5 that are under the prefrontal cortex’s control (Brunia, Damen 1988; Rockstroh, Elbert, Birbaumer, Lutzenberger 1983; Rockstroh, Elbert, Canavan et al., 1990). They are also required for intentions that are never carried out, arising not only before we try to move but also when we seek to relax (Terada, Ikeda, Negamine, Shibasaki 1995). This is where our sense of willing things may come from. Involuntary actions – tics, for instance – are not preceded by such readiness potentials (Fahn 1993: 13).

A person senses the conscious decision to move his or her little finger about a third of a second after the onset of the motion’s readiness potential (Libet 1985). It is a negative potential linkd to the preparation made by our supplementary and other motor cortices before an action. It is hardly a major act of will, but it is an act of will nonetheless. But if the consciousness of making an act arises with the act itself, what of the other brain preparations? Do not the other potentials tied to our prefrontal cortex also give rise to a sense of consciousness as we think ahead and prepare – intend? After all, this part of us is focused on making and supervising the inner cues organizing our actions and thoughts. Scientists can see this on PET scans: Blood surges into part of the dorsolateral prefrontal cortex (Frith, Friston, Liddle, Frackowiak 1991; Jahanshahi, Jenkins, Brown et al., 1995). when people will actions- and only when they will them. This does not happen when our actions are guided from outside, such as when we copy movements. We do not “will” such actions.

Another possible link between consciousness and the focusing and willing of our brains is our gamma (40-Hz) oscillations (Sauve 1999). We experience our senses as a unity even tough the brain does not process them as such. That unity seems to come from the linking done by gamma. But gamma is not only found in our sensory cortices; it is also found when our prefrontal cortex guides our focusing on touch and when we prepare to do things (Desmedt, Tomberg 1994; Kristeva-Feige, Feige, Makeig et al., 1993; Murphy, Fetz 1992; Sanes, Donoghue 1993). In these cases, gamma, instead of joining our senses, binds the various processes that let us attend and do things. So gamma may unify not only perception but also our otherwise varied senses of doing – intention and will. Some evidence for this comes from anesthetics.

“The consciousness was terrifying… the… terror of trying to signal one’s conscious state to someone, but unable to even twitch a bloody eyelash” (Kulli, Koch, 1991: quote, 6). To wake up during an operation is a nightmare worse than any other. (Fortunately it is very rare; you are more likely not to awake at all after the operation.) But very, very exceptionally it does happen. Anesthesiologists seek to give us the lowest effective dose of an anesthetic, since the drugs can kill and the safe dose range is small. Once in awhile they are over cautious and underdose the patient. Added to some anesthetics are drugs to stop involuntary movements by the patient, which might cause problems for the surgeon. At too low a dose, these paralyzers may work but the anesthetic itself may not. It is a nightmare: paralysis and consciousness on the operating table. The anesthetist needs a way to know when a person becomes conscious even though paralyzed. The easy clues, such as heart rate and blood pressure, are not reliable. But one thing in our brains seems to be – gamma activity. The drugs that have been given the patient paralyze the body at the level of the muscles, but they don’t stop the initiation of thoughts in the brain. A person knowing that the surgeon is operating has a brain alive to that fact. The binding of its thoughts and experiences can be monitored. When gamma responses weaken and disappear, consciousness vanishes as well (Kulli, Koch, 1991; Plourde 1993; Schwender, Madler, Klasing et al., 1994).

All this adds up to a picture of gamma’s linking to consciousness. As with attention-to-action and a sense of “me” buried in our thoughts and intentions, gamma seems to be a primary mindmaker. As two leading brain scientists, Rodolfo Llinás and Denis Paré, suggest, “Those aspects of brain function which form part of our consciousness must occur at the same time, most probably with 40-Hz activity” (Llinás, Paré, 1991: 531). Francis Crick, the co-discoverer of DNA, similarly asserts that such activity’s transiently binding fleeting attention to short-term memory makes for “vivid awareness” (Crick, Koch 1990; Koch , Crick 1994).

Inner Freedom
While it binds our attention, our memory, or even our preparation to do things, gamma itself might be just a correlate – a shadow, not the substance – of consciousness. Other brain activity may be inseparable from consciousness itself. At issue is what it is that gamma binds to create a “me.”

Our brains are constantly animating an embodied private life. When we are blindfolded, earplugged, and at rest, our prefrontal cortex still uses more energy than other parts of our brain, indicating that the mind is highly active (Roland 1984; 1993: 472). What is it doing?

It may be busy embodying a “me” feeling created around an inner world of questions about where we are and what is happening, or going to happen. Our brain is born to be constantly alive with such insistent queries. The world is perpetually changing around us. We must keep up with it: What does that comment mean? That tidbit of information? Or sound? To survive and learn, brains – we – must continually attend to the changes happening around us, which might be to our advantage or not.

Inner cues have a life of their own. Ideas play actively with each other, coming together in statements and questions. Consider the main inner cue used not only by your mind but in this book, indeed, in all books – words. Words empower us to describe and articulate, anticipate and question, better than we could with, say, images. They help us work out expectations and focus our concerns. Here, in the sketchpad of our thoughts, we hold court about what is happening within ourselves (Dehaene, Naccache 2001; Jack, Shallice 2001). If the prefrontal cortex enables the brain to organize its awareness by internal cues, many of them come from this inner conversation. We sense these cues as a voice – our inner one. Without speaking aloud, you hear yourself say “I.” Who is speaking?

It is you. According to the American philosopher of the mind Daniel Dennett, our inner voice is linked with consciousness. He suggests that this is a place (which is not really a place) where the brain tells itself stories about existing. To use one of his phrases, we have a “narrative center” (Dennett 1992). It is a sort of bulletin board or workspace that emerges from neural networks as the brain tries to keep track of its plans and concerns. According to Dennett, our continuity as a mind comes about as these self-told narratives unfold. We tell them to ourselves in inner speech. They organize and structure our actions and ambitions, the stories about ourselves that we tell others. They – we – are the inner prose our brains use to tell themselves and others what kind of person they are and want to be.

Here embodiment, subjectivity, and inner voice come together. As much as with our physical extension, we do things in our inner world so that we embody our inner voice with a sense of “me.” Gamma, binding the various threads of our inner voice with what is happening in the rest of our brain, may well be involved. Here, in doing this, the brain does, feels, and knows it exists. It acquires a first-person experience.

Part of the experience of consciousness is not only that this “me-ness” exists but that t acts as a free agent. Perhaps this reflects the brain’s concern with control. A brain that is awake to its opportunities and restrictions, after all, must always be attending to questions about the causal environment in antecedents and effects. We must spot how things happen. What follows my actions, and what determines them? Am I a causer, or am I caused? How can I gain control and escape restrictions? We seek the boundaries of our choice and our limitations. We attend to the scope of our intent and volition, and not just our own but those of other people as well. Social psychologists and those studying apes and monkeys find social position is determined by who can do what to whom. Low ranks are controlled by higher ones, never the other way around. We need to see causation for our welfare and survival.

Discovering how to make others respond to us (which often comes down to learning how to respond appropriately to them) also enables us to socialize. Think of 8-week-old babies. Although they can hardly manipulate the world, they can smile, laugh, and move their heads from side to side. Malcolm Watson, a psychologist, placed a mobile above the cots of 8-week-old babies and observed their movements (Watson, Ramsey 1972). Watson found that they laughed and smiled at the mobile, even before they had laughed and smiled at their own mothers. As infants grow up, they constantly seek ways of mastering their environment and engaging with things. We learn to play games like peek-a-boo. Finding islands of predictability gives us a sense of control even as it keeps us on the lookout for further surprises.

Some things clearly shape our actions. Take, for example, the laws of physics, the knife to our throat, the dictates of tyrants, poverty, and social obligations. But many things are within our control, if we wish to make them happen. We can move our hands, focus on the whiteness of this paper, plan a meal, cook it, and invite guests with whom to eat it. A previous generation might have sought such control in magic. We value it in the modern conveniences by which we have mastered our environment, such as the remote control, the private car, and the mobile phone.

Our thoughts are constantly focused on those things that might block our freedom and on how we might overcome them. We seek liberty of action, space in which to do whatever we want. To the degree we find it, we fee free; to the degree we do not, we feel trapped. Freedom affects our emotions; a stressful noise that we can turn off is not as stressful as one over which we lack control (Glass, Singer, Friedman 1969). A child feels fear of a toy when it cannot control it, but pleasure in it when it can (Gunnar-Vongnechton 1972). Children, not surprisingly, have a strong urge to gain a sense of mastery of things (Yarrow, McQuiston, MacTurk et al., 1983). They feel frustration when things that were controllable stop being so (Lewis, Sullivan, Ramsay Alessandri 1992). As adults we get frustrated over the aggravations and hassles of life. We bear them if we chose them; if not, we resent them or we try to gain control over them. In this way, our brains are steadily sensing out and, if possible, enlarging our “elbow room” (Dennett 1984). The prefrontal cortex is making its inner cues, after all, for a purpose – to give itself freedom from being limited by other people and what goes on around us. Here the brain searches out how to make things go along with its plans and desires. Thus, we wish the world to be contingent on us, not us on it (Brehm, Brehm 1981) We seek to do our own thing, not be the means to the ends of others. We desire to be the supreme causer in our affairs, not a puppet of events, pulled and pushed by necessity.

We can experience control through our prefrontal cortex’s internal cues. The outer world may frustrate us, but here inside, hidden from it, we are embodied in a “me” that feels at total liberty. We – our brains – therefore feel ourselves as agents in the world, even if it is only privately.

You can, for instance, think any thoughts you wish. You are entirely free in your mind. The only limits on your inner voice are your sense of logic and your imagination. You may lack the wings of the birds, but if you close your eyes you can be up in the air with them. Maybe your imagination is not always free – if you stub your toe, pain pulls your attention constantly to it, however much you seek to focus your mind elsewhere. That is a reason we dislike pain: It rules our attention! But when pain-free, we can focus with great liberty on such things as planning a date or writing a book. And we can do something else: Our minds can engage the senses to focus on the inputs into the brain’s experience. For instance, we can stop and attend to the whiteness of this paper or the blueness of the sky outside. Philosophers call this qualia – the whatness of experience. Your prefrontal cortex does this by manipulating and tuning its links to shift the attentive processes by which your visual cortex experiences what is before your eyes.

As we live through our inner cues and brain modulations, we can feel free and independent of the physical world outside the brain. But this interest in freedom is not only about physical limits. This brain experience we call “me” is as active in questioning its own constraints on its knowledge as in testing those it encounters in the physical world. It seeks to find freedom in the models and stories it tells itself. We tell stories that emphasize how we overcame restraints and how we determined what we did. We love tales of David against Goliath, Papillon escaping Devil’s Island, heroes who fight against the odds and succeed. In our lives, we play down how things shaped us. We may have been slaves to fortune, money, and others’ dictates, but we would rather tell ourselves stories in which we were not.

Is this true only of the stories of our everyday lives? Is it not also true of those with which we orient ourselves in the wider world of human knowledge? Within its embodied inner reality, the brain wants to tell itself stories tat it lives in a “metaphysical” world, one beyond nature. Here lies the threat we feel from those 100 billion cells in our skull. We fear that our inner volitions, in some distant way, are merely those of their matter, making us contingent to the physical world and its laws. No, we shake our heads, no, we – our brains – are separate, and somehow different, from mater, and so free. Material explanations of mind are experienced as traps; they threaten our prefrontal cortex’s embodied sense of having inner freedom. Our brain would rather not know that beyond its immediate senses it is merely another physical thing in the universe, that the restraints that limit and rule the outside world also, in a hidden way, limit and rule it. Our brain would rather tell itself stories that something exempt from outside influence makes it a free “me” or “I.”

This need to be free of the physical makes our brains sensitive and threatened by life’s end. We see loved ones decay in their brains, go demented and stop being the people we knew. We see them die, and know that the same fate awaits us. Here lies the horror that each brain faces in decay and death. Our freedom may have an end. It is a story our brain would prefer not to hear.

Beyond the Prefrontal Cortex
The prefrontal cortex cannot be the whole story of consciousness. People can injure their prefrontal cortex and still exist. They may lack empathy or an ability to plan or focus. They may not be inner driven and instead be tied to the world around them. But that does not necessarily mean they are not conscious. It might mean that they have a different experience; they may be less conscious but still have a kind of consciousness.

Also, as noted in Chapter 5, meditation puts the prefrontal cortex on standby without stopping consciousness. The calm awareness of meditation slows and halts its incessant activity. Yet here, with the prefrontal cortex turned down or off, consciousness still exists. Obviously, it is a different kind of consciousness. Indeed, it may be better in some ways richer in its attunement to the external experience to which normal consciousness gives short shrift.

Allegedly, practiced meditators can go beyond such calmness and experience transcendence. You might think that a book like this should not talk about such things, but some research requires that we should. The experience, according to meditators, goes beyond words. So it can only be hinted at. Gurus wave their hands, suggesting it is something like the knower, the known, and the process of knowing becoming one. They claim that ordinary experience is distorted and that only in meditation do people become truly aware of things. The problem, according to them, is that our lives are full of petty cares. While they are the necessary stuff of living, they also blind us to what exists beyond them.

Curiously, something happens to the brainwaves of meditators during “transcendence.” The prefrontal cortex does not stay turned off. When meditators who are wired to record their brain activity have signaled their entry into “transcendence,” gamma activity returns over their prefrontal cortices. In some meditators the activity appears not just in the prefrontal cortex, but all over their brains (Banquet 1973: 146; Sheer 1976: 77). Nobody knows what to make of this, but it suggests that a still unknown link connects the prefrontal cortex, gamma, and what Buddhists call nirvana.

The Brain’s Enigma
Is anything mentioned here or earlier in this book really you? In some ways all these phenomena seem to be. But it could be that they all touch just a little upon what it is to be, so that while none of them individually makes our minds, each makes its own, subtle contribution to consciousness, all dove-tailing into a unified experience of being alive. As the fragmented visual cortex appears unified in our vision, so it may be that the various activities of the mindmakers come together in the “I” of our mind.

Our minds must be distributed around our brains. It would seem rather odd if scientists were to announce they had found a square centimeter of our brains – the “me cortex,” say – that was solely responsible for consciousness. The individual processes involved are very diverse. We have been wholly ignorant of many of them until recently, and many more are yet to be discovered. But simply knowing that they exist demands that wee reverse philosophy’s understanding of how the brain relates to consciousness. Many philosophers hold, for instance, that the key fact of our experience is its apparent unity. Using this as a starting point, they investigate the nature of our being. But this could be a trap, misleading us into thinking that we are seeking one mysterious link between mind and brain. There may be no one such link. If anything, the problem is turning out to be one of too many mindmakers.

In the past, philosophers were just not in a position to have any deep insight into who we are. That may sound arrogant, but think of our bodies and the speculations of ancient doctors about blood, cholera, phlegm, and black bile – the four humors – before modern physiology and anatomy. Ancient doctors were hopelessly wrong. Until recently, philosophers were paddling upstream in the same boat with regard to brains. Medieval philosophers thought mind was in the brain’s ventricles. Descartes saw free will in the pineal gland. Taking an opposite approach, behaviorists denied consciousness existed; some twentieth-century philosophers even attributed it to an artifact of language usage. Without scanners to picture brains as they think and feel, how could anyone have started a serious investigation of what underlies our sense of who we are? The crucial information as to what went on in the brain was simply not there. But now lights are beginning to shine. As little information as we have, it dwarfs the cumulative knowledge of previous centuries. Embarking on a quest to the gray continent of the brain without this knowledge is as foolhardy as trying to make sense out of MRI scans of the body using Galen’s theory of the four humors.

To understand consciousness, we need to freshen our imaginations and free ourselves from the old stories about who and what we are. After all, it would not be the first time. To take one example, when we think that starts are made of matter like our Sun, we do something people 3000 years ago could not have grasped. For them, they were gods and spirits. It took the Greek Anaxagoras (500-428 BC) to break with this and suggest that the Sun might be a burning stone and that the moon might have a landscape of hills and ravines (Barnes 1987: 237). Old views of what is material and what is not have changed,, and we must be prepared for them to change again.

It is only now, after the turn of the third millennium, that humans can fully grasp what a wonderful thing the biocomputer in our skulls is. We are, in many ways, the first people in a position – thanks to neuroscience – to probe the key question of what it is to exist. But we need to be prepared to change some of the ways in which we expect that question to be answered.

So much food for thought.
So much to consider if we want to become not just adequate physical/physiotherapists, but superlative ones, who can help people be embodied, better.

"Subjectivity"

The chapter moves on. It is a prelude to the grand finale which I will post tomorrow.

"Subjectivity
The brain still goes on existing even when alone or in sensory deprivation, which means that there must be other kinds of “me” embodiments beyond the physical and social. We have memories of ourselves and others, not discontinuous ones but ones that flow from past experience to join with the present. Things, places, and people, including ourselves, may change, but as we have seen, with our memory headers, we are skilled at experiencing the continuities and identities below surface alterations. The hippocampus and associated limbic areas in the temporal lobes seem to orchestrate continuity, organizing our memories and our sense of existing through time.

In its limbic parts, a brain knows something apart from its body and its senses; it has a feel for life, a continuous sense of embodied “me” throughout the chaos. According to the neurologist Paul McLean, “without a co-functioning limbic system, the neocortex lacks not only the required neural substrate for a sense of self, of reality and the memory of ongoing experience but also a feeling of conviction as to what is true or false (MacLean 1990: 578). Here, perhaps, lies the neurological center of our subjectivity, the feeling of “me” that is not that of our body but of our existence and being.

But do our physical or social embodiment and our subjectivity make up consciousness? They may be thought to cover various of its aspects, but consciousness, as the Dennett and Minsky quotes at the start of this chapter suggest, is a fickle thing. We are still left with the question of why our experience seems so unlike that of being matter. Being an embodied “me” comes from the experience of doing (or having done) things in the physical world (and, we suggest, the social one). Subjectivity is passive – it is something sensed. But we actively feel we are conscious. So what is the source of this sense that we embody intentions, actions, thoughts, and feelings, and how does it link to the sense we have of being a “me”?"

I am still considering the part that stated that we have 32 brain areas that combine to create the illusion that we have a single visual perception, and that we have 7 brain areas that combine to create the illusion that we have a singular sense of our body through space/ time/ gravity. What a marvel.

"Social Embodiment"

In this section of Chapter 12, Sagan/Skoyles refer to human evolution from a "fission-fusion ape." Both humans and chimpanzees evolved from the same ancestral stock. Both behave in like ways, socially. "Fission-Fusion" specifically means the ability of individuals from both species to carry the "troop" around "inside the head"; even when not in its actual presence receiving direct signals such as visual, sound, tactile, and smell input, we can still respond emotionally to the "troop" and retain a sense of connection to it, to other individuals or family members within it.

"Social Embodiment
Evolution made us not out of clay but from a fission-fusion ape. We inhabit not only an external, physical world but also, as argued in previous chapters, a social one. As William James put it, “A man’s social me is the recognition he gets from his mates.”

The sociability that gives us this recognition, of course, does not arise magically. The brain has to work to get recognition from others. Moreover, human bonds are not passive or fixed, as they have to be actively kept alive with simple, often overlooked actions.

Do you not chat? Do you not smile and laugh with your friends? You don’t do this mechanically. While sitting alone in a café or on public transport, try some people watching. Just look at the human species as an alien would. Look at how people greet each other. One moment there are two dead faces, and then suddenly they burst into life. As they say “Hello,” their eyes, faces, and hands become a duet of responses that echo between them. Our faces are brilliantly animated, skilful, and sensitive social contact organs. Unfortunately, in psychology, it is taboo to marvel at them. We are not supposed to be awed at our ability to be social. Perhaps the camera is partly to blame. In magazines and advertisements, we are surrounded by expressions that stare out of paper – they could be of waxworks. Photography falsifies our awareness of how alive we really are. In reality our faces are never static and dead but interact with others continuously with split-second timing.

We also express our being with others through body movement, the tone of our voices, and the sensitivity of our hands when we touch and hug. All these can powerfully connect us with others. Indeed, the rich expressiveness of much music may be an extension of such human connection with melody, beat, and tonality (Clynes 1977).

All these forms of expression are actions – social actions, done with great sensitivity, sending and echoing in a chamber of social and hoped-for social recognition. Our expressions seek an audience, some kind of social reply. We smile to other faces – ones that smile back. (Musicians likewise need to play to listeners.) The use of expressions gives our brains a means to keep alive our presence in our social world. If no one responds, if a group stonewalls you, then you are out of their social world. You are not one of them. Our expressions fight against this to keep us part of others’ lives. We wield our “me-we” sonar. We try to echo the smiles and expressions of others.

Our sociability has a goal: to let us know we are not alone. People respond to us, and we learn how best to socially interact with them so that they do. Sociability is an essential link made between our brains and others’. There is no such thing as negative publicity, say the media. No solitary animals, we like to get noticed, preferably favorably, by others of our kind. And doing that requires plenty of skilled brain work.

Thus, as much as motor actions have sensory feedback, so is sociability guided by feedback. Touch the movement of your face when smiling spontaneously with others. Doesn’t part of the feeling of being “me” lie in it? Suppose your face turned into a wax mask and your hands and body turned into one of those clever automatons animated by hidden mechanisms found in “dark ride” exhibits at amusement parks. And what if your voice were changed too, to become a synthesized deadpan computer monotone. With a waxwork face you could not make even the slightest hint of a frown or smile. With automaton limbs you could, robotlike, get a cup of tea but not wave, pat anything, or offer a handshake. Nor could you, with your monotone voice, intone a subtle hello, or laugh. Such a condition is imaginable, but it would be a psychological hell. We could do without our legs and hands, but could we do without the expressiveness of our faces or of our voices and gestures? Without expression, we would be cut off from that which makes us what and who we are.

If physical actions performed in the physical, three-dimensional world give us a sense of physical extension, could not those performed in the social world likewise give us a sense of extension – social existence? Expressing ourselves to others through our faces and otherwise is crucial to our reality, not in the physical world so much as socially, embodying our identity and presence. It gives the brain a strong sense of “me.”"

This social embodiment, alas, can translate for humans, into social oppression, cultural oppression. It can interfere with our own relationship to our own bodies, our own physicality. It can interfere with our own ability to reestablish a sense of well-being that feels as though it rises up from our bodies. It can interfere with our natural right to move in ways that are natural, that throw off accumulated tension, because honest movement might look a bit weird to our 'troop': In a deft move, our social embodiment sets us up and can continuously trump our inherent right to access our own personal physical embodiment to the point of our developing chronic pain somewhere.

Most chronic aches and pains would not even arise if it were not for this default, this all too human "fatal attraction" we have for regarding the troop's imagined needs at the expense of our own. Our proclivity for adhering to social dictates and lives and understandings, other people - all the things we deem to be "cultural" - cost us, cost our bodies. How do we begin to turn it around for ourselves? We have to bite down on some facts:

1. We exist not only in a virtual world of others and comings and goings, we are also physical manifestations of cellular life.
2. Our cells need to access and burn up oxygen, all of them, especially our nervous systems. (Our nervous system, including brain, spinal cord and all the peripheral nerves, comprises only about 3% of our physicality, but uses up 20% of all the oxygen we take in, most of that by the brain.
3. Where our attention goes, so does neural firing and blood flow. Motion is lotion.
4. If we attend to our own creaturehood by allowing it to move us, even just once a day, even for just a little while, our nervous systems can balance our motor clutter, muscles can elongate and stop being isometrically contracted, the whole body will be able to breathe better.


Of course, "we" as individuals have to choose to make this personal sense of well-being and resilient physicality a priority over our "social embodiment" for awhile every day. It could be viewed as a form of movement meditation, perhaps. In any case, choosing "self"(including physical substrate, tuning into it, letting it express whatever movement it wants) over "the troop" mentality, for 10 minutes a day inside one's own mind, doesn't mean one is selfish or wrong or bad. It means one is an autonomous adult in control of one's own faculties, including maintenance of well-being in a body. Regardless of where we believe we may fit in a perceived social heirarchy, we are each the sovereign of our own physical life, like it or not. We are each the mayor of our own "city" of 65+trillion cellular "citizens." We are each the leader for life of our own physical domain. Are we going to be a wise and beneficent leader, visiting the citizens regularly, asking them kinesthetically if there's anything we can do for them, anything they need, celebrating life with them? Or are we going to be absent from our bodies, abandoning them to their fates, hanging out with the rest of the (mental/social) troop, only tuning into our bodies when it becomes impossible because of bodily discomfort, to tune them out?

Make a choice to learn move regularly from your body's own sense of its own self, not from some outer reference. To do that, you need to shut out the troop, go in, just for a little while, be solitary, and let movement come over you. Wait for whatever comes up, then let it express itself physically, from everywhere at the same time or from anywhere sequentially. Allow the movement your body produces to present itself to your awareness - be a spectator, not the director. Allow yourself to be taught by it, how connected your body parts are to one another, how they flow into each other. Marvel at how easy this seems, how good it feels, how restorative it can be. Your body is self-correcting in the moment at hand and you are privileged to observe. Let it show itself off. You will know things are on track when you feel the following: a sense of warmth flowing somewhere/everywhere, a sense of effortlessness, a sense of surprise or marvel, and a softening or melting away of tension. Are these not good things to feel? Does everyone not deserve to feel these things in their physical existance? Once a day, for just a little while? Our physicality supports our virtual existance; don't we owe it something in return, a chance to learn to feel good?

"Weird Bodies"

Chapter 12 of Up From Dragons: The Evolution of Human Intelligence (Skoyles and Sagan) continues:

"Weird Bodies
We also sense feedback related to our movement as in happens in the space around our body. The brain’s sense of this physically nearby space is made in our parietal cortex, and it is part of our egocentric orientation to the world. Interfere with the working of the parietal cortex – as can happen in migraines or epilepsy – and people experience a distorted sense of embodiment in the outer world. During attacks or seizures people might feel themselves as very small or large. It is called “Alice in Wonderland syndrome” (Rolak 1991; LePlante 1993) after Lewis Carroll’s book. Charles Dodgson (the real Lewis Carroll) suffered from both migraines and epilepsy, so it is likely that Alice’s experiences of growing tiny and huge were based on his own experiences of size change during attacks of migraine or epilepsy, or maybe both. Jonathoan Swift, the eighteenth century satirist, is also thought to have had elpilesy, so size change experiences might have influenced him to write about Lilliputians (miniature people) and Brobdingnagians (mammoth ones) in Gulliver’s Travels (Laplante 1993: 69). Such size change experiences are linked with disruption, particularly to the right posterior parietal lobe.

This suggests not only that neurons create our sense of embodiment but that disturbances to them can change how we feel in our bodies. To take another example: Changes at the neuron level can affect the physical experience of sex. A person with a phantom foot can feel it as an extra “sexual organ” during intercourse. One man reported “that his erotic orgasmic experience ‘actually spread all the way down to the foot instead of remaining confined to the genitals’ – so that the orgasm was ‘much bigger than it used to be…” The reason for this is that the map in our brain for our sexual organs is next to those for our feet. (It is believed to be a developmental “fossil” from the time when the brain laid down body maps in the embryonic stage. During this period the genitals, due to the way the fetus curls up in the womb, are next to the feet (Farah 1998).) Remember the example mentioned in Chapter 3 of people who feel that water dripping on their face is also dripping on their phantom fingers? In such cases, due to neural plasticity, the face map has invaded the hand map. Which, due to the amputation of the hand, is no longer receiving hand input. In the man described here, it seems that for the same reason his genital map has started to invade the nearby one for his missing foot! The scientists who reported this genital-foot link suggested that neuron activation may also spread in those with intact legs; they commented, “It has not escaped our notice that this may provide an explanation for foot fetishes” (Ramachandran 1993: 10417). But do not think of cutting your leg off in order t have more interesting sex. Sexual excitement is not the only thing that spreads to the feet from a person’s genitals. Those with phantom legs also find them stimulated – often painfully so – when they urinate.

Distortion of embodiment can take even weirder and more frightening forms. After suffering multiple strokes, people may claim that they have two left hands, or even three heads and six feet (Weinstein 1954). They may say they have a nestful of fingers under the bed sheets. One man, following a right-hemisphere stroke, when asked about his left hand explained, “My mother has it in a suitcase and there are at least three pairs of fingers in there, and they’re all functional.” “How did that happen?” “We brought them in through customs.” “And where are they now?” “My mother has them. There should be a leg, and there should be three pairs of fingers… from the left side” (Halligan, Marshall, Wade 1995: 178). One woman complained of having an extra hand. Once, in response to a query concerning her left hand, she said, “That’s someone’s hand, someone forgot it – that’s funny, you read in the paper about people losing purses but not a hand” (Weinstein, Kahn, Malitz, Rozanski 1954: 47). She persistently complained about being kept on a neurological ward when her only problem was her hands.

Embodiment can cease to be tied to our bodies. Goethe, after he left his fiancée, wrote: “I saw myself, not with the eyes of the body but with the eyes of the mind” (Lhermitte 1951: 474). Such a visual body-image delusion is called autoscopy, or out-of-body experience. Hallucinations of the self are not uncommon in near-death situations, such as when our heart stops, or in emotional crises, such as Goethe was going through at the time. Certain people are prone to them. They are characteristic of “schizotopy,” which describes the personality type of those who tend to be reclusive, suspicious, and prone to “magical thinking” and experiencing visual illusions. (Schizotypy is badly named, since although schizophrenics score high on tests for it, so do many other people.)

Embodiment, in spite of being a product of the brain, is felt as totally real. While no necessary link exists between it and our bodies’ real extension, it is still a remarkably powerful “me” experience. After all, we feel that we are our bodies. There is no doubt or hesitation about it: Hurt your hand, and it is “I,” not some scientist’s neural network model, that feels the pain.

Indeed, this feeling turns out to be more fundamental to us than our knowledge that we are extended. Merely knowing that we are attached to a limb does not make it part of us. The neurologist and writer Oliver Sacks tells of a young man who had found a “severed human leg” in his hospital bed. The only way he could explain it was as a “rather monstrous and improper, but very original joke.” “Obviously one of the nurses with a macabre sense of humor had stolen into the Dissecting Room and nabbed a leg, then slipped it under his bedclothes as a joke.” He tried to throw it out of bed – but he was attached to it. It was no good explaining to him that it was a part of him. “A man should know his own body, what’s his and what’s not” (Sacks 1984: 50-52). People in such a confused state will try to attribute the alien limb to the doctor examining it. One American woman in the 1930s, after two strokes, denied that her paralyzed limbs were hers. When asked whose they were, she said, “Yours.” A three-limbed doctor made more sense to her than the idea that that “thing” was part of her body. Shown that her arm merged with her shoulder, she observed: “But my eyes and my feelings don’t agree, and I must believe my feelings. I know they look like mine, but I can feel they are not, and I can’t believe my eyes” (Neilson 1938: 555).

These are other such cases lead us to one conclusion: Our physical sense of being is made by our neurons. It is not just our sense of extension but also the sense of “me” that goes along with it. Here we have come halfway to answering the problem of consciousness. Embodiment may not be consciousness, but the brain, in making it, also makes this inseparable sense of “me.” If our brains can do this for our physical bodies, might they not also be able to create a sense of “me” in a nonconcrete reality? While such a question does not answer the problem of consciousness, it does suggest a new approach.

The approach lies in answering a rather simple but overlooked question: Do our brains give rise to a sense of “me” in more than our physical extension? We have shown above that embodiment arises from our brain’s doing things with or bodies. Are there other things in which the brain might feel we exist that are not physical? If we look, there are several things done by the brain that could be “embodied” with a feeling of “me-ness.” Here, starting with sociability, we shall discuss them, stretching and challenging our quest for an answer to the question, “Who are we?” "

These were all the inner challenges my patients faced as I struggled as a young therapist to do my job, help them regain function, learn to roll over, stand in 4-point kneeling, 2- point kneeling, sit up, stand up, walk.. basic body control in space and gravity. Looking back on those days I think I'm glad I didn't have as much sensitivity then as I do now, or know as much.. but the thought that these people were experiencing shades of what is described above, on their own, with no real understanding or accompaniment from me, still makes me feel sad. At least the information is more accessible to everyone these days, compared to 30 years ago..

More to come.

Here is more from Chapter 12 of Up From Dragons (Skoyles and Sagan):

"Action Extension
Our brain is so flexible it actually allows us to experience ourselves in the artifacts we use. A surgeon feels extended to the tip of her scalpel. An operator handling radioactive material using remote-controlled “hands” feels embodied in his robotic arms. Perhaps when seated behind a steering wheel you have felt a physical sensation, a kind of wince centered in your head or in your spine, in anticipation of an automobile scrape; we have. Such body extension occurs even with phantoms. Among those who have lost legs, some feel the phantom – even if it has shortened into a stump – extend into an artificial leg (Riddoch 1941: 199-200; Simmel 1956: 644; Mitchell 1872/1965: 352). Some people with such phantoms embodying their artificial legs even report being able to feel coins or the shape of the ground underfoot. They not only feel it but can incorporate feedback from it into their motor control. The there is the Neilson illusion (Neilson 1963; Ramachandran and Blakeslee 1999). You put your hand in a conjurer’s trick box that contains a window through which you can “see” your hand. Of course, it is not your hand that you see but, through the clever use of optics, the hand of someone else hidden by a screen. The surprising thing is that you embody what you see, even when you attempt to move “your” hand and find that the hand that you are looking at remains motionless. Logically, you should realize that what you see is not your own hand. But instead, you experience a feeling that your arm is paralyzed. You have embodied yourself into the visual feedback generated by the sight of a stranger’s arm.

A variation of this phenomenon can be evoked using mirrors so that you see your right hand when you think you see the left one (or vice versa). That is not very interesting if you have two arms, but the effect can be enormously beneficial for those with a phantom arm. Recall that many phantom limbs are painful because the arm is in a twisted or impossible posture and so suffers “clenching spasms.” Shown their “real” arm in a mirror, people felt their phantom being touched when they saw “it” being touched. Some who had never been able to move their phantom found that they could, with visual feedback from the mirror. Some experienced a paradoxical effect in which the sight of their “lost” arm caused them to lose their phantom sensation, as if their brain needed them to see the missing limb as real in order to reorganize itself to let it “disappear (Ramachandran, Rogers, Ramachandran 1996; Ramachandran, Blakesee 1999).”

Why should this be so? The reason is that our brain’s experience of existing in our body does not arise from our body’s consisting of pieces of attached anatomy but through our brain’s ability to do things with them. This results in a “body schema” built up using the daily feedback from our body. As noted, people may feel a phantom leg existing, but only in the parts of it that move. (The internal organs – bladder, womb, and rectum – in which we can have phantoms might be thought to be exceptions, but they are muscled, even if it is only to let us empty them.) People are more likely to feel phantoms of the parts of the body that stick out. The sensation of a phantom breast or nose often will exist only at its tip, where there is most physical contact (Riddoch 1941: 207; Melzack 1990). We may not be able to move these parts, but our brains need to know they are there so that they can avoid bumping them.

Embodiment, therefore, does not directly map that which lets us move – bones, sinews, and joints. Instead it arises from the activity of populations of neurons distributed throughout the brain, using feedback that guides our movements in the external world. This is logical from the brain’s point of view, since the brain has no direct knowledge of exactly what our bodies are made of. The brain is very knowledgeable, however from sensory feedback, about the ability of its bones, sinews, and joints to change position, articulate, do things.

The part of our brain that guides the motion of our bodies is called the motor cortex, but it might more properly be called the “motor-control-under-tactile-supervision cortex.” As the neurologist Edward Evarts makes clear, injuries to the primary motor cortex particularly affect those movements made under guidance by somatosensory inputs (Evarts 1987).” Supporting this link is the fact that brain scans of people discriminating by feel with the right hand the length of objects (but not their shape) show that they activate their primary motor but not their somatosensory cortex. Oddly, it is the motor cortex of the right and not the left hemisphere that controls the right hand (Kawashima, Roland, O’Sullivan 1994). Our primary motor cortex is thus also a “somatosensory cortex.” The premotor cortex (found in front of the primary motor cortex) is likewise not a motor cortex but one that guides and organizes movement under visual and other sensory feedback (Flament, Onstott, Fu, Ebner, 1993; Grazino, Yap, Gross 1994). Neurons in the F5 area of the premotor cortex in monkeys discharge both when a monkey performs a hand action and also when one sees the same action done by another (Rizzolatti Fadiga, Galese, Fogassi 1996). PET imaging detects activation in the caudal part of the left inferior frontal gyrus of the motor cortex when people look at hand actions. It thus processes not only feedback about its own limbs but also that of others.

The supplementary motor cortex, another part of the motor cortex, guides our movements using inner scripts and plans (Goldberg 1985; Tanji, Shima 1994). Further, there is no sharp division in the brain between the cortex which receives sensory input from our bodies and that which sends motor signals; they are all part of a common process, differing only in degree of specialization. The somatosensory cortex, which is usually seen as the cortex that receives touch input, also has, for instance, its own projections to motor neurons in the spinal cord (Galea, Darian-Smith 1994). These projections are functional: Cool the motor cortex and the sensory cortex can take over the control of movement (Sasaki, Gemba 1984). Our sense of touch is, therefore, intimately bound up with motor control in both the somatosensory and primary motor cortices.

What is conspicuous by its absence in the brain is anything like a “muscle cortex” (Schieber 1990). No cortical neurons have been found that act upon individual muscles in the way piano keys activate the movement of piano strings. Instead, all motor neurons in some way map what can be done through the muscles (Scheiber, Hibbard 1993). Thus, it is through our doing things with our body that we get a sense of being in a body."

So, there is no 'anatomy book' in the brain. It couldn't care less which muscles we use to do things with. It is up to us to learn to "feel" our bodies as we do things, to practice sensing ourselves doing things, so that we can keep our brains/awareness informed about its own output, our bodies out of pain.

If we consider the body as not at all separate from our brains, but rather our body parts as simple extensions of brains, this should help quite a bit. ("The body as the 'blob on the bottom of the brain', rather than the brain as 'the blob at the top of the body'.")

Our sensory input systems aren't there to plague us with annoying discomfort, instead they are there to help guide our activity so that we don't sit in the same position for hours on end. (Even if the prefrontals are having a good time thinking, other parts of the brain are likely getting very bored from the lack of stimulation.) In fact, sensory input is so completely integrated into the motor output side of the equation, that it isn't possible to move a hand even a slight amount without your brain sensing that movement, and in many places, even on the ipsilateral side of the brain, being able to adjust that movement.

"Who Are We?"

So is titled Chapter 12 of Dorion Sagan's and John Skoyles' excellent book, Up From Dragons: The Evolution of Human Intelligence. What a read.

This chapter in particular deserves careful reading from physiotherapists, in my opinion. I plan to bring it here in proper quotes, in dribs and drabs, footnotes inserted for the benefit of any who would want to look up originals...

Why do I think we should read it carefully? Because it brings together a great many threads that pertain to our work. It discusses movement, the brain's sense of an "I" or a "me", consciousness, where "will" and "volition" might be found (nowhere especially), how our environment is an extension of ourselves, how we extend ourselves (our consciousness) into our environment, our social extensions and our physical extensions, phantom limbs and other bits, our sense of embodiment and control, of efficacy, of self. It has everything to do with what we do, what we consider our profession to be experts in assisting people with. Yet, as I read this chapter I felt the ground move under my mental feet, like a mental earthquake, as I realized most of what we think we "know" is based on .. well, not a lot. Nothing in depth.

I offer it up as food for thought. And so we begin:

Chapter 12: What are we? p. 159

It is all odd and not a little unbelievable, the story of this book. Here we all are, touching physical things, the pages of this book or the seats we are sitting on. Scientists tell us that although we feel solid, we are in fact made of trillions of atoms. They tell us also that we live on a spinning planet, not the static flat world we see with our eyes. Your body, they go on, is not the flesh you feel with your hands but is made up of trillions of cells, each of which holds strands of information, DNA, the blueprints of your life. And further, in your skull there exist 100 billion (10 to the 11) cells intricately wired together – your brain. All this is overwhelming; nothing you intuit about yourself or the world is true. But perhaps nothing is so bold and beyond belief as the idea that that brain feels this astonishment! How can your consciousness be made of matter?

It is a problem as hard to pin down as it is to answer. Here are a couple of quotations to hint at it, the first from Massachusetts Institute of Technology computer guru Marvin Minsky: “There’s something queer about describing consciousness: whatever people mean to say, they just can’t seem to make it clear. It’s not like feeling confused or ignorant. Instead we feel we know what’s going on but can’t describe it properly. How could anything seem so close, yet always keep beyond reach?” (Minsky 1987: 151).

The philosopher Daniel Dennett says that it “is both the most obvious and the most mysterious feature of our minds. On the one hand, what could be more certain or manifest to each of us that that he or she is a subject of experience, an enjoyer of perceptions and sensations, a sufferer of pain, an entertainer of ideas, and a conscious deliberator? N the other hand, what in the world can consciousness be?” (Dennett 1987:160).

Hold your braincase and dip your fingers into it again in your imagination. Fondle your neocortex and do some wondering. Go touch your anterior cingulate, palpate your hippocampus, and tickle your frontal lobes. And ask yourself: What do these neural organs have to do with this feel, so immediate, intangible, and elusive of being “me” and alive? How could science make physical this incessant feeling that we are not physical but quite the opposite, something that is definitely not part of the material world? There seems to be an unbridgeable gap between the physical and what it is to experience consciousness – not just on first sight, but however deeply we think about it. All there is in the brain are neurons, plus the information their synapses store, plus the totality of their neural network interactions. How could anything mental arise out of them? Science might find the most extraordinary things, but it cannot discover magic, not even “neuromagic.” The alchemists tried to turn base lead into gold. Are we not seeking to do something similar: turn matter into mind? And even if this is possible, what kind of theory could imaginably let us understand and explain it?

The earlier chapters of this book were not written with the intention of giving an answer to this question. We have sought to understand our origins, not the fact that we are conscious. Indeed, we would rather not write this chapter and so enter the heated fray about this, the biggest question about the mind. But there is a temptation to go beyond looking at the workings and odyssey of the mind to examine this link. To omit it would, in any case, leave these chapters devoid of something. And like it or not we have, without seeking to, begun to offer a hint of an answer.

What are all these mindmakers, these parts of the brain, discussed in previous chapters? Let us look at them again, in terms not of what they do but of how they add to consciousness. Alone, none of them seems to us to satisfy the notion of “mind” or “brain.” All stand instead, in some way, partway between the mental and the physical. The activities of the mindmakers are more essential to our feeling of self than other, more familiar brain-directed skills such as sight, hearing, and the ability to move; we may be born (or become) blind, deaf, or handicapped but still feel fully ourselves. Mindmakers give us an intimate sense of who we are. Indeed they are so fundamental that we are not ordinarily conscious of the gruntwork they do in maintaining our feeling of self.

The unified mind – our sense of self – is, we believe, most likely an artifact or illusion, the seemingly singular result of what are in fact multiple underlying processes. Consider the sight-brain link. It takes up to 32 different areas in each cerebral hemisphere somehow working together to produce what we experience as sight. However far apart they are in the brain, we experience vision as a unified phenomenon. The same is true of the seven maps of our body’s sensations; we experience those seven homunculi not as seven bodies but as one. This suggests something quite profound. However much the functions of our brain are parceled out, the experience they give us still has a sense of coherence. The mind, we suggest, is experienced likewise. As with vision, it is not quite the unity of experience that we imagine it to be; under it lie many different mindmakers in numerous areas spread throughout our brain. Individually, they do not make our mind, any more than those individual areas of vision can create our experience of sight on their own. But collectively they may. Together they create the feeling that Minsky and Dennett observe as so indescribable and difficult to pin down.

More mindmakers await discovery. Some parts of our brain have been named – such as the claustrum (found below the temporal lobe) and habenula (on the inner side of the thalamus) – but we have few hints of what they do. And there are other uncharted territories. Deep in our brainstem are groups of neurons with odd names: nucleus basilis of Meynert (“Meynert’s base nut”), locus ceruleus (“blue place”), raphe nucleus (“seam nut”), and ventral tegmental area (“belly covering area”). These areas send axons up into our cortex, which secretes neuromodulators – brain chemicals affecting how neurons fire. The names of these chemicals are nearly household words from books on psychiatry and psychoactive drugs – acetylcholine, norepinephrine, serotonin, and dopamine. Even if you do not know their names, you have surely heard of the drugs that mimic them or stimulate their production: nicotine (acetylcholine), beta-blockers (norepinephrine), LSD (serotonin), Prozac (serotonin), ecstasy (serotonin), cocaine (norepinephrine, dopamine), and amphetamine (dopamine). They obviously touch the very essence of what underlies experience. All these aspects of our brain may therefore be key to who we are, yet we cannot quite grasp in what ways. Fortunately, our brain is an area where science is making rapid advances. In future years our understanding of its unknown parts and its neuromodulators will no doubt sharpen, but there will be a wait. Until we have developed the generation after next of brain scanners (and perhaps even the generation after that), what we do not know will vastly outweigh what we do. At present, all we can do is stretch our imaginations in considering what hides within our skulls. We are as people were at the beginning of the sixteenth century with regard to the physical world. The New World had just been discovered. The map of Africa showed little more than a rim of a coastline. Australia, Antarctica, and the vastness of the Pacific Ocean might as well have been on a different planet. The full exploration of the globe was to stretch centuries into the future. Now we are in the same position with regard to our minds: We have begun to see the outlines of the vast continent, the slippery and fascinating and wildly inhabited mindscape beneath our skulls.

Embodiment
The best place to start investigating consciousness is with our bodies. If nothing else, each of us has a body (Cotterill 1998). We feel our emotions in our bodies. Where do we feel sick or disgusted? Usually in our stomachs. Fear is felt as a bodily freeze rather than as a mental thought. It hits us where we act. If we do anything, it is our bodies that do it. Minds by themselves never do anything physical – telekinesis has never been shown to exist. However, every minute of our lives our brains move and do things with their – our – hands and feet. Without our bodies we cannot live. They are yoked to our minds as constant companions, continuous with us from birth to death. Our names may change, we may move, lose our closest friends, and replace our lovers. But our bodies never leave us. No one can divorce them. They do not mysteriously and disloyally leave us only to unexpectedly return. Nor are they like cars that we can sell, borrow, exchange, and then leave in the scrap yard. However much we may daydream about it, we cannot hire for a few days, to try out as our own, the body of Arnold Schwarzenegger or this year’s supermodel. Body swapping is out. Even if our consciousness is lost during sleep or when we are anesthetized, our bodies remain much the same. You will never wake up with the body of someone else. It is one fear we never entertain.

But there’s a problem. We are not our bodies. Remember leaving the dentist with an odd feeling in your mouth after you had a local anesthetic for a filling? Perhaps you never thought much about it, but your mouth’s numbness presents a minor brain puzzle. For a start, what could be more real and part of you than the feel of a slightly bloated and tingling cheek and gums? It is a feeing of “me-ness” – though a little odd – in your mouth. For a short time the local anesthetic stops input into your brain that comes from the nerves of your teeth and mouth. But that means your brain is not experiencing that area of your mouth, as its nerves have been knocked out by the local anesthetic. But if your brain is not receiving inputs from it, what are you feeling? Nothing? But what you are feeling is something. Oddly, what you are experiencing is a phantom, a neural extension of feeling (Patrick Wall, personal communication; Melzack 1992: 91, 95). It is usually a short-lived inconvenience, but many people suffer persistent phantoms after a dramatic life event.

Following an amputation, “the patient often wakes up from the anesthesia and asks the nurse when he’s going to be operated on. On being told that his arm or his leg has already been removed he may not believe it until the covers are removed (Simmel 1956:640).” Input to the brain does not necessarily cease after nerve damage. Cut off a limb and you cut off the information that it once sent to the brain, but that does not end a sense of its existence. A leg or an arm that has been surgically removed still feels as if it extends from the remaining stump (Habel 1956; Melzack 1990; 1992; Mitchell 1872/1965; Riddich 1941; Simmel 1956). Sometimes the feeling is vague, but most often, in spite of some “tingling,” it still has the feel of the limb that is no more. Over the years this will change. At first a phantom leg feels as though it is made up of a foot and a knee positioned like a real foot and knee but with gaps – vacuums – between them. Gradually, the parts telescope together. Indeed, after many years the foot withdraws up into the stump (Simmel 1956: 643). (These perceptions are probably related to neural plasticity changes in the maps of these parts on the brain.) But in spite of these changes, the phantom still feels like “me.” Sometimes phantom limbs are felt as static extensions of “me,” and sometimes people, such as Paul Wittgenstein (the pianist mentioned in Chapter 3), sense that they are moveable. Phantoms happen in the brain. Remember motor alpha, or mu, activity? It disappears when people move their limbs, not only real ones but phantom ones as well (Gastaut, Naquet, Gastaut 1965). They do not need their bodies to be able to feel them, or at least their neurons do not.

Like a real limb, a phantom can feel that it is burning, excruciatingly and exhaustingly cramped, or in other ways severely painful. But unlike pain in a real limb, it is unhealing pain. Worse, it is a hidden suffering. It is easy to get sympathy for a burned limb, which is visible, but not for pain in a limb that no longer exists except in one’s mind. Its pain is often related to the time of loss, as is the position in which it is experienced. A soldier, for instance, might feel his hand holding the bomb just prior to the moment that it exploded prematurely (Riddoch 1941: 203). A phantom may also perpetuate the more mundane sensations of the former limb. A person may still feel an old bunion; as one reported to his doctor, “I feel the ring on the finger that isn’t there (Habel 1956: 632).” Others feel watches keeping time on wrists that are no longer there.

It isn’t just legs and arms that become phantoms but also noses, tongues, and breasts. One in four women experience the phenomenon after a mastectomy (Aglioti, Cortese and Franchini 1994; Melzack 1990: 89). The nineteenth-century neurologist Weir Mitchell noted briefly the report of a case of a phantom penis that sometimes became “erect (Riddoch 1941: 207; Hanowell, Kennedy 1979; Mitchell 1872/1965: 350; Melzack 1990:89; Fisher 1999).” Some people with severed spinal cords report orgasms, during dreams, in sexual organs no longer linked to their brains (Money 1960).

You do not need to lose part of your body to experience phantoms. Have an accident that breaks your spine, and you will most likely be quadriplegic for the rest of your life. Not only will you be paralyzed in every limb, but your brain will be cut off from the sensations coming from them and from the rest of your body below the neck. Yet your sense of your body will not go away. In place of your limbs, you may feel phantoms of them as they were just at the moment when your spine was injured. The paper (Ettlin, Seiler, Kaeser 1980) from which we obtained these details contains illustrations of people’s accidents and the positions they now feel their phantom limbs to be in. A person thrown by a bull feels that his legs are forever splayed above his head. People sitting with crossed legs just before their car turned over feel that they remain so. Their embodiment has come apart from their still-surviving bodies. Curiously, if a person was unconscious at the time when his or her spine was broken, no phantoms arise and they lose any sense of existing below the neck. Instead of having a phantom body, they feel that they exist bodilessly, as only a head and shoulders.

This is all rather mysterious and shocking, a side of surviving accidents many would prefer not to know about. But it is overwhelming evidence that our brains invent the sense that our bodies are real and with it the surety that “we” are real. We know they do this because there can be a separation – as with phantom limbs – from actual physical embodiment. Our everyday experience is thus wrong: Our sense of being a body does not rise directly from our physical self but from our neurons. It is a conclusion with profound consequences for how we understand the nature of the relationship between our brain and our experience.

If you doubt that the brain creates the illusion of physical embodiment, then consider the following. It is a phantom movement illusion discovered by Vehe Amassian of the State University of New York (SUNY) (Amassian, Cracco, Maccabee 1989). Amassian stimulated his motor cortex with rapidly alternating magnetic fields. This triggered it into sending two sets of signals, one to make a motor movement and another – to the parietal cortex – to tell it the fingers were about to move. He then cut off inputs to and outputs from his hand using a tourniquet on his arm, so that his hand went numb. The signal triggered in his brain was thus unable to produce any body movement, and the brain could not tell whether any had been made (at least by feel). But the motor cortex had also sent signals to the parietal cortex to tell this part of the brain that the hand and fingers were about to move. Now, if our sense of existing is purely neural, then Amassian should have felt movements in his fingers. Indeed, he (and various others who have gone through this unpleasant procedure) did feel his fingers move when the magnetic fields were applied, but if he had looked, he would have seen that they had not. Thus, whatever happens to our bodies afterward, it is the initial transmissions in the brain that gives rise to a feel of “me.”

I will eventually bring the entire chapter here, and will add thoughts as they come up. For now, I think it is best to simply contemplate the matter. In digestible chunks.

Online Book Heaven

I'm spending a lot of time these days at NCBI, enjoying all the online books there. For someone with a hefty appetite for factual information about the body and its processes, this site is beyond wonderful.

Not only are there hundreds of books there (fifty more added just since yesterday), you can use a little search engine that is available on alomost every page. You can put in a query, e.g., "neural crest".. and presto, you've made your own "book" on that topic, with dozens of "chapters" to read. The information is a wonderful entangled web of easily accessible material that you can examine from any angle, slice however you want. Brilliant. A boon for those of us who have a larger thirst for knowlege than we have space for actual books.

In the Beginning

"Cells that give rise to the gametes in both male and female mammals (including humans) originate within the primary ectoderm of the embryo during the second week of development.. They then detach from the ectoderm and migrate by ameboid movement into an extraembryonic structure called the yolk sac. At first, they may be distinguished within a mass of extraembryonic mesoderm at the caudal end of the embryo, and then within the endoderm of the yolk sac wall. These cells are called the primordial germ cells, and their lineage constitutes the germ line. Primordial germ cells can easily be recognized during their migration because of their distinctive pale cytoplasm and ovoid shape and because they specifically stain intensely with reagents that localize the enzyme alkaline phosphatase."

Thus begins Chapter One of Human Embryology by William J Larsen. Several associations immediately spring forward in my mind. Number one is, wow, ectoderm. Ectoderm makes the nervous system and a lot of the skin. And it makes the germ cells, at least something known as "primary" ectoderm does.. maybe there is more than just one ectoderm... I imagine if there is more than one sort of ectoderm I'll find out as I go along..

Second thought is, hmmnn, they are amoeba-like. How curious. I recall reading about macrophages and neutrophils, fibroblasts too, and how they use the same locomotive means, streaming into their little pseudopods and hauling themselves through the body, looking for bad guys and garbage to eat.. There is something about that way of a single cell moving deliberately that definitely has always grabbed my imagination. I recall an account I read somewhere while learning about integrins, how live skin cells separated in a blender and strewn over the bottom of a petri dish, would begin to crawl around, feeling for others.. when they found each other, would reunite and become tissue again.

Third thought: the germ cells form, then they have the sense to get the heck out of the construction zone until the coast is clear. Very wise.

The text continues:

"Between 4 and 6 weeks, the primordial germ cells migrate by ameboid movement from the yolk sac to the wall of the gut tube and from the gut tube via the mesentery to the dorsal body wall. In the dorsal body wall, these cells come to rest on either side of the midline in the loose mesenchymal tissue just deep to the membranous lining of the coelimic cavity. Most of the primordial germ cells populate the region of the body wall adjacent to the 10th thoracic vertebral level that will form the gonads. The primordial germ cells continue to multiply by mitosis during their migration. A few cells may become stranded along the route of migration or at inappropriate sites in the dorsal body wall. Occasionally, stray germ cells of this type may give rise to a type of tumor called a tetroma."

So they wander back to the body, using established supply routes. Good enough route I suppose, in that just about everything inside the body (i.e., organ system) hangs off the inside of the thoracic wall eventually..

They amoeba their way back in, and know where to go. They increase their numbers during their long journey. Some get lost along the way. A few of those may turn into troublemakers a long way into the future.

The next bit of text is titled:

"The Germ Cells Induce the Formation of the Gonads in the Dorsal Body Wall".

So, they arrive on the dorsal body wall in front of T10, somehow see it as the end of the trail, and start to set up a permanent settlement. They find tissue there that is willing to be morphed into germ cell condos, or 'gonads'. Later, the gonads themselves slide down through the body and end up where they're supposed to, male or female or in-betweener.

Take-away point from the little story: Ectoderm makes nervous system, skin, and germ cells. This is an important point.

Self or Culture? Battleground for control

Had a tough case lately. She's had tightness/stiffness/soreness for six years, no particular incident that started it, used to be a runner and so on, can't now, has been everywhere and seen everyone for everything, including IMS. Nada. No help. This was her 3rd visit to see me. Last time I saw her I did a great job on her leg, pain all gone, taped her here and there, she left in a relatively painfree state, but the next visit she came in and said, it started hurting again as I walked down the street.

I thought to myself, gosh, how adverse can a nervous system be tensioned (i.e., how much arbitarily fluctuating pain can someone endure) and the person still be coping with life?

We started with simple contact/simple continuous movement for a good ten minutes or so; after, I asked her, so how did that feel, how do you feel, and she gave me the WESS answers (warming, effortless, surprising, softening) but she seemed oddly unenthusiastic for some reason. It was apparent to me that even though her body had responded, and her brain, she hadn't. In fact she seemed defeated. She said she felt sad. She, her sense of self, wasn't getting any joy out of having moved so easily and restoratively.

So I switched hats a bit.

While she lay face up and I handled her neck, we chatted, and I asked her why she felt sad.. she said she felt she couldn't do this sort of movement, that she felt obliged to prevent herself doing it.

I won't relate the entire story, but it turns out she's had lots of cognitive therapy, but nothing that ever helped her be in her body before. She has apparently been trying to embody 'the big split' for a very long time. It is being maintained, of course, by her practice of taking her body off to see body people and her mind off to see mind people. She said she felt driven by a big inner cop who is always teling her to move along, move along, and a sense of fear, so that she actually feels safer if she never relaxes.

I talked to her a bit about culture and how if we let it, it will impose itself on our bodies.

I told her my little vision of the body, how it's the only sovereign bit of ourselves we really have, that we can't afford to let culture interfere with our relationship to our inner ecosystem. I went on for awhile about the right we have to exist however "we" want, at least part of the time, "we" referring not to some constructed idea we have of ourselves and how we think we should want to move, but rather letting 'the inner creature' move us instead.

I told her about how evolution has never thrown away anything that proves useful; about how non-monolithic our brain is, how it is comprised of bits of all these different creatures and nervous systems we've evolved through, how we can let those parts move us, how we can develop a new relationship to them, how important they are, how they've been around for a great deal longer than we have had human layers patched in, how they keep us alive by making sure our breath and heart beat and digestion take place, how those parts of our brain share our bodies with the human bits, and we could do worse than to let them have a chance to stretch our bodies for us.

I suggested that she has full right to take control away from the inner robocop (culture) and give it back to herself (her body and brain). That is wasn't only her right, it was a duty too.

It turned into a discussion of what individuation means, what it could accomplish. I asked her if she'd ever read anything about Jung and depth psychology, all the inner characters that our culture imposes on us and that we have to come to terms with to be "free" in ourselves. To me, "free" means even-tensioned, not too much, not too little; it means taking up our space, taking back our right to co-exist with existance itself, both culturally (broadly speaking, emotionally and interpersonally) and physically (emotionally and intrapersonally).

By the end of the session she could see the point of practicing some loose, unchoreographed, pleasurable, ideomotor movement every day, not just for the physical feel good side of it, the reoxygenation of her peripheral nervous system, the stress release, but also as a symbolic act of taking back her Self, dancing for a few minutes a day with the idea that she didn't need to suffer with the pain of too much tension, extracting herself gradually from this trap, this illusory prison in her mind that projected itself out onto her body, caging her in much too small and much too painful a space. I reminded her that every second of her life, ten million of her body cells died and ten million new innocent ones were born, who knew nothing about inner cops. That these new cells would give her a fresh start if she allowed them to experience a few minutes of movement freedom daily. That she could build a sense of freedom of movement in to herSelf and into all these cells and their existance, in just a a few minutes of practice every day.

At the end of our session together she seemed a lot less sad about the idea and more animated, enthused. I have no idea if she will be able to follow through, but we made a "therapeutic contract" where she promised me she would do a bit every day, and would report to me in a week's time, and we'd see where we were at. (I'll be the good cop on the outside, for awhile.)

I offer this little story as an example of how sometimes as physiotherapists we might need to provide a bit more in the way of therapeutic containment than merely a physical solution to an ostensibly physical pain problem. We must remain aware that however hard people may struggle to comply with outer expectations imposed by their context (in this case a therapeutic situation with a supposed physical therapist) there may well be gargantuan conflicts raging within them just below the surface, appearing as physical pain states. They may or not be aware of them: It isn't usually our place to reveal them to people.. in this case, I was lucky because this woman was already so aware of her own issues. Sometimes we are physical therapists, other times we have to shift focus slightly and become physical therapists.