Saturday, August 23, 2008

Brain as Composter VI

Building upon Brain as Composter V:

Time to turn our attention to Guy Claxton, who wrote a very elegant little book several years ago, called Hare Brain, Tortoise Mind: How Intelligence Increases When You Think Less (1997).

He's an educator, so I guess it's fair to say that he's worked with "nature" in the form of figuring out the best way to not just convey information into young minds, but to extract thinking from them. (It also does not surprise me to learn that he is apparently a practicing Buddhist.)

Chapter 11 is titled "Paying Attention"; in it he explores 4 different ways of 'slow seeing'.

1. Attentive Resonance:
"The habit of attending closely and patiently to the evidence, even - sometimes especially - to tiny, insignificant-looking shreds of evidence, is characteristic of skilled practitioners of a variety of arts, crafts and professions, prototypically the hunter. From a bent twig, a feather or a piece of excrement the expert hunter can recreate and animal, its age and state of health; and he does so in an apparently leisurely fashion in which these scraps of information are allowed to resonate, largely unconsciously, with his mental stock of lore and experience. You can't rush a tracker. Each detail, slowly attended to, is allowed to form a nucleus, an epicentre in the brain, around which associations and connotations gradually accrete and meld, if they will, into a rich, coherent picture of the animal and its passage. As Carlo Ginzburg, author of a fascinating essay on 'Clues', has surmised, the hunter squatting on the ground, studying the spoor of his quarry, may be engaged in the oldest act in the intellectual history of the human race. Many other feats of vernacular connoisseurship - telling an ailing horse by the condition of its hocks, an impending storm by a change in the wind, a run of salmon by a scarcely perceptible ripple on the river, a hostile intent by a subtle narrowing of the eyes - are of the same kind. Each is an act of high intelligence, bringing to bear on the present a complex body of past knowledge, and accomplished by the eye, with little if any assistance from deliberate thought."

He could be describing clinical thinking in this passage. In fact he does:
"It is interesting to observe.. the changing context to medical diagnosis over the course of the last two hundred years. The process of detection and identification of disease these days is often devoid of this leisurely resonance of attentive observation with the working knowledge of a person's lifetime's experience. The modern general practitioner makes a succession of snap decisions as to either the nature of the disorder with which she is confronted, or what further objective, 'scientific' tests to order. She is now so rushed, and so enchanted (as we all are) with technology, and technological ways of thinking, that she generally prefers to trust a read-out from a machine over a considered clinical judgement. An instrument gives us 'real knowledge' about the patient, whereas the poor doctor on her own can offer nothing more substantial than an 'opinion'. Reliance on informed intuition seems increasingly 'subjective', risky and old-fashioned.(...)

Yet through out the history of medicine, the doctor has functioned more like the tracker or the detective than a technician."

I (often, usually, nearly uninterruptedly) feel a bit sad that my profession has decided to let go of this. For the most part, to sit and look and think and evaluate and wait and touch/handle/noodle tissue around and wait some more, in silence, or else while quietly chatting with a patient about some observation or perception they have about what they are sensing.. two people quietly thinking together out loud, while observing "nature" in the form of a nervous system that is malfunctioning somehow... this precious time to build a therapeutic relationship upon which everything transformative may actually hinge, is considered useless, unproductive, a waste of taxpayer's money within a health care system struggling to survive. This is the art of PT that has become all but lost. It certainly is not explored or encouraged or passed on during clinical training, and all economic factors weigh in complete opposition to it.

The one (maybe the only) thing "nature" needs to do its job, is time. Good compost takes time. Natural processing takes time, and yes, it might seem like it would be a boring thing to pay attention to, but it also can be very relaxing and fascinating, depending on how you view it. And the act of observing closely, and in the process teaching one's patient how (especially for pain problems), can catalyze the process toward resolution somewhat, most of the time. This is, I think, somewhere in the vicinity of helping someone's conscious part of their nervous system improve a relationship they are having with the nonconscious parts of their nervous systems.

The next way of slow seeing Claxton describes is focusing.

2. Focusing:
"The second fruitful way of paying attention is similar, except awareness is now directed inward, towards the subtle activities and promptings of one's own body. The ability to "listen to the body" is very useful in gaining insight into a whole variety of personal puzzles and predicaments. This ability has been dubbed focusing by the American psychotherapist Eugene Gendlin. Back in the 1960's, Gendlin and colleagues at the University of Chicago were involved in large-scale research projects designed to discover why it was that some people undergoing psychotherapy made good progress while others did not, no matter who the therapist was or what she did. After analysing thousands of hours of tape-recorded sessions, Gendlin uncovered the magic ingredient, which could be picked up even in the first one or two sessions, and which could be used to predict whether the patient would make progress or not. It was not anything to do with the school or the technique of the therapist, nor, apparently, with the content of what was talked about. It was the client's spontaneous tendency to relate their experience in a certain way."

This is just like the situation we find ourselves in as manual therapists. We have people in pain, no really slick way to catalogue them or differentiate them; it barely matters what we do to them, what matters most is how they respond.

"The successful clients were those who spontaneously tended to stop talking from time to time; to cease deliberately thinking, analyzing, explaining and theorizing, and to sit quietly while, it seemed, they paid attention to an internal process that could not yet be clearly articulated. They were listening to something inside themselves that they did not yet have words for. They acted as if they were waiting for something rather nebulous to take form, and groping for exactly the right way to express it. Often this period of silent receptivity would last for around 30 seconds; sometimes much longer. And when they did speak, struggling to give voice to what it was they had dimly sensed, they spoke as though their dawning understanding was new, fresh, and tentative - quite different from the tired old recitation of grievance or guilt which frequently preceded it."

In my world, which is almost a perfect overlap but not quite (because I do not make any sort of regular practice out of exploring the emotional side of peoples' lives), the people who are able to change their pain output are those who learn to sense their bodies in new ways that are not painful; they manage to set aside their habitual responses to their stream of body angst/pain and look (deliberately, long, thoroughly, painstakingly) for something ELSE to sense instead.

"Gendlin called this hazy shadow which they were attending to and allowing slowly to come to fruition, a felt sense, and it was quite different both from a string of thoughts and from the experience of a particular emotion or feeling. It seemed to be the inner ground out of which thoughts, images and feelings would emerge if they were given time and unpremeditated attention. It appeared that many people lacked the ability, and perhaps the patience, to allow things to unfold in this way. Instead they would, in their haste for an answer, pre-empt this process of evolution, creating a depiction of the problem which told them nothing new, and which gave no sense of progress or relief."

What Claxton refers to as Gendlin's "hazy shadow", felt sense, inner ground etc., I've often sensed merely as a void, or maybe even "the" void. It requires a bit of courage to walk straight into at first, because to navigate it, one must give up completely to it, suspend every sense for a time, give up "certainty." It is like a dense cognitive fog; you can no longer see or sense the usual "ground." All ordinary cues vanish. New ones begin to appear shortly, however, for one who is determined and patient and trusts the process, which is to remove the brakes and let one's nervous system start over again while remaining completely conscious. (To link back to Burton's book, this is possibly the initial discomfort of uncertainty, a voluntary suspension of the "feeling of certainty" that one must learn to feel comfortable with if one is to become a true critical scientific thinker/checker/tester of ideas about what might or might not constitute "reality.")

Two of the finest tools there are for reducing physical pain are sensing and movement, (or moving and sensing, take your pick). Just be deliberate, fearless, kind, slow, adaptive and responsive to yourself. But determined. One must be consciously determined, no matter how long it seems to take. Yet, simultaneously, one must never convey determination or impatience to one's own non-conscious pain processing. It's quite the balancing act, but once learned it will pay off over a whole life-time. Everyone needs to learn to be able to access their tracker ability to get through physical existence with less rather than more of the attendant suffering that is inescapable from time to time, the price we pay for being embedded within physicality. It's in there for free - we evolved using it - we can dig it out again for use on occasion, maybe by meditating..

My profession should be one of the main ones out there, teaching this skill set to those we treat, but alas, in PT training most of us were never taught that it was important to begin with - like most things in life and learning however, it's never too late.

More to come from Claxton's book, and a tie-in with Burton's book, I promise, no matter how tangential this post may have become.

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