Saturday, December 31, 2011

"We're here, because we're here, because we're here, because we're here"

The title is a string of words that can be sung to the tune of Auld Lang Syne.

Last night I had a dream that I accidentally, serendipitously, learned how to fly. The details (setting, location, circumstances, others in the dream, etc.) are completely banal. After learning to fly, I got terribly excited, anything else that had been going on in the dream faded away, and I spent the whole rest of the dream practicing.

I learned to steer by pronating and supinating my hands and feet. I learned to do somersaults. Marvelously, I not only could make my own body weight disappear completely, but anything I picked up and flew around with became weightless as well, even something the size and weight of a human larger than myself.

I have no idea what any of it means - all I know is, it was a really cool dream. For a change.  Maybe it means my life-long grumbly mood/mild but constant depression could one day dissipate.

Thursday, December 29, 2011

Over the hump

I'm pleased to report the worst time of year (in my existential experience) is done, finished:

1. Winter solstice has come and gone.
2. Christmas, that annoying, overly-social, intrusive sensory event, is over.
It drives me nuts, every year - but this year the place I've been going to daily to work out played loud Christmas music, mostly Kelley Pickler, country music singer who was an American Idol contestant a few years ago. That, plus all the usual - TV ads selling stuff, news reports about retailers feeling anxious, sparkly glittered-up bling all over everything, light displays - all of it made me deeply empathize with autistic kids who don't deal well with over-stimulation. Uck. 
3. My birthday, which was yesterday, passed by uneventfully and non-socially, and is now over with! Yay!

Anyway, back to point 2. for a moment; sensory overload got so bad at that little gym that I decided to skip last week. Plus I indulged in Truffles, eggnog, and Bailey's. Oh, and an omelette with cheese, tomato, and buttered toast. And I ate some delicious dates. Plus other holiday food, like stuffing. And I did not exercise, at all, for a week. Up by a few pounds. Back at the elliptical  this week. My stamina has increased - up to an hour on that thing - probably had to do with being able to watch uninterrupted, Australia, with Nicole Kidman, Hugh JackmanBrandon Walters. It's not just interesting, it's well done, and a lot longer than most Hollywood movies. So, it has kept me going all week. I've watched large chunks of it for three days, and there are still parts I've yet to see.

Speaking of movies and cognitive distraction, I saw this awhile ago, How muscle fatigue originates in the head. Rather than blame the mesoderm (muscles) for fatigue, researchers are starting to look elsewhere, and have noticed how the nervous system inhibits muscle at various levels. In the brain, interruption occurs when the thalamus and insular cortex decide they have had enough. I seem to be able to shut out the din my thalamus and insular cortex try to mount, by watching 'Australia'. At least for a little while. Then I will need another movie I've not seen before.

From yesterday, The Fat Trap: It seems a bit depressing, but before I started all this business 3 and a half years and 40 pounds ago, I knew it meant:
1. I could never eat (completely) unconsciously ever again as long as I lived
2. I'd have to move a lot more, learn to sweat, learn to get my heart rate up, learn to like it. Somehow.

I had a long plateau in there, a couple years where my weight went up by ten, down by ten, but never went completely out of control. It was always around this time of the year, this nadir time. So, I'm pretty sure I can reach old age in fairly good shape, plus all the exercise is not just for weight loss but is good for a bunch of other stuff that has to do with health, brain function, etc.etc. Nowadays, I'm on the other side of the year's nadir, and (even with my dive off the wagon for a week) my weight is still lower than it has been in 15 years. I take heart from that.

I'm pretty sure, that like pain, obesity is biopsychosocial. It's not strictly a fault in character, or strictly about genes, or hormones, or strictly about bad habits (see picture). A calorie is a nebulous thing depending on what kind of human organism ingests it, what sort of food it comes in, and why it is being consumed. Everything exists in a multiply-leveled context, including a conceptual entity known as a calorie.

This notion, Fat may put the Hypothalamus on the Fritz, needs more work I think. It suggests that ingesting fat "causes" inflammation in the neurons around the hypothalamus, but Harriet Hall says, inflammation isn't always a bad thing.  Gumming up Appetite to treat Obesity proposes that special hormone-laced gum should be helpful. But I doubt there will ever be any kind of easy answer.

If I were to pick a single brain region to target, to investigate, to spin a theory around, it would be the suprachiasmatic nucleus (SCN). In fact, I already did. It has to do with sleep, with light levels, circadian rhythms, depression, hypothalamus, all sorts of things that are regulatory. The pituitary, part of hypothalamus, has to do with thyroid, which has to do with a bunch of hormonal and metabolically important outputs. I moved myself physically back to where my own humanantigravitysuit, myself as a human organism, grew up. Environmentally, climactically, photonically, my brain feels better here. This is what it remembers from its youth. The long slow dawns and dusks, bright fiercely blue skies, brilliant reflective surfaces, deep blue shadow. Sensorially, and socially, the surroundings are kinda dull, but frankly, I don't much care about lack of sensory or social stimulation; I'm used to it again; furthermore, I like to be by myself anyway, except on the internet, which is where I live, mentally, most of the time, so it doesn't matter. (Plus, I lucked out joining a weight-loss outfit that happens to suit me to a tee, and happens to ALSO be the only one of its kind - in the whole of Canada so far - imagine, humble little old Weyburn, Sask. has a one-of-a-kind thing that suits me to a tee, and I just happen to live here where it is. Amazing happy co-ink-a-dink.)

But back to causes of things, no one thing causes obesity, and everything combined causes obesity. Actually, the pursuit of "cause" in science (pharmaceutical science at any rate) seems to be a bit endangered in and of itself, according to Jonah Lehrer.

So, what then is "obesity"? Well, I would ask, what is a relationship that an organism of any mammalian multi-cellular sort has with its whole bio-psycho-social environment? What is stress? What is pain? What is learned helplessness? What is failure to move one's physicality sufficiently? All these things are "caused" by everything simultaneously, often overlap by a lot, and all influence each other. Mostly, we are biologically active bundles of multitudes of proteins without distinct boundary (other than those we dream up then feel compelled to defend fiercely), with a big microbiota with a big microbiome (especially in the gut tube) that tends to run our lives more than we care to admit, probably... all the single-cell critters of which evolve, have lives, reproduce and die according to what they get (what we give them) - to eat. It seems likely that they might have evolved ways of trying to harness us, their big vehicles that lumber forth to get groceries, so that they might get what they need in order to keep going. Not that we are obliged to feed them endlessly.. just knowing that the mammalian multi-cellular organism is more an ecosystem than it is a discrete entity gives me hope that I can explore, map, cultivate and tame my own - in the end, it's all I've got.  I live on a little mountain-top in there with a pretty good view. At least, my "I"-illusion does. It's a welcome bit of conceptual structure; another bit is provided by the idea, that biochemically their lives are completely controlled, attracted to, or repelled by chemical gradients, described in pretty good detail in Into the Cool. This knowledge makes me feel powerful, or at least, enough of an independent, detachable agent to be able to manage my own small corner of the universe, my body, to my own liking.

There is a psychological aspect to all this that must be mentioned - eating consciously means tracking what's ingested, counting calories, including those sweated off, and attending daily to all of it. This could lead to either OCD, or anorexia, or both. Yet, those are cognitive-behavioural constellations one must approach in order to lose weight/become healthier. What I've learned is that you can learn how to dance with these two things, but you must always be in the lead, never the one who follows. It's kinda goes against dance training in general, for females, but I seriously recommend remaining in complete control of everything, including short breaks like the one I just took.

Now I must go and drown my microbiota yet again in a whole bunch of vegetable matter, which I know it doesn't like much, and which will likely kill off some more of it, making evolutionary space for new kinds that might actually like vegetables. (AHHHHGH! Hulk destroy bad microbiota!)

Sunday, December 25, 2011

And here we go again

... Another trip round the sun.

I suppose, if we have to mark time, watching axial tilt of our "ship", and changes in sun-shinage upon its surface, isn't such a bad way to mark it.

1. If you click on What Christmas Is All About, some money will go to Doctors Without Borders. Yeah, it's from last year. I like it.

2. Here's Neil deGrasse Tyson on how we're all stardust, so considering the universe should help us all feel expanded.

3. Goodbye to Lynn Margulis, microbiologist whose work on symbiosis helped move evolutionary theory forward, and mother of Dorion Sagan, son of Carl. Goodbye to Christopher Hitchens, who lived life the way he wrote, fast with a lot of mistakes according to many.

4. Have I left anything out? Oh yeah, tons. But it's all fine. It's all stardust. It will all recycle itself unendingly.

Friday, December 23, 2011

Consciousness and control

Fabulous video of Antonio Damasio discussing (in under 19 minutes!) "The quest to understand consciousness".

Whatever it is, without it we might as well be dead.

If we accept the idea that we need to have a conscious mind, a mind with a "self" in it, then that self illusion needs the illusion of efficacy. Which brings me to the next link, Born to choose: the origins and value of the need for control, the most interesting paper (review, pdf) I've seen today and maybe all year (free access).

"Belief in one’s ability to exert control over the environment and to produce desired results is essential for an individual’s wellbeing. It has repeatedly been argued that perception of control is not only desirable, but is also probably a psychological and biological necessity. In this article, we review the literature supporting this claim and present evidence of a biological basis for the need for control and for choice-that is, the means by which we exercise control over the environment. Converging evidence from animal research, clinical studies and neuroimaging suggests that the need for control is a biological imperative for survival, and a corticostriatal network is implicated as the neural substrate of this adaptive behavior."

The authors move through the psychosocial/behavioural evidence first, then the biological.
Therapy is all about restoring choice to patients, helping them overcome learned helplessness, no matter the level at which it was learned.

Tuesday, December 20, 2011

Longest darkest night of the year

I have this week and next almost all to myself. Such a treat. Life, on the whole, is getting better as time goes by, I'd say. For such a lot of years it got nothing but worse, and I used to simply ignore by what extent it was getting worse, and just carry on.  I speak of my own seasonal affective disorder.
This time round, things are upswung: I'm half way to the arbitrary weightloss goal I set back in September, when I started exercising, and I can actually feel some ab strength. So that's nice. I almost have my new place to work at set up, so that's nice too. The new year will freshen the page.

Most stuff just floats by in this flood called life and the way it interacts with my soggy winter brain, but once in awhile something sinks in and leaves an impression;
Lately on FaceBook a dustup occurred on my page, to do with craniosacral treatment. The pattern of kuffuffle that ensues with alt-meds has become predictable. I take no offense anymore, just wait for it to blow past and be over. Each time this happens more and more people seem to come out of the woodwork and identify themselves as anti-woo, so that's good. 

The first link, the one that upset a few folk, was to a post by Mark Crislip at ScienceBased Medicine, about craniosacral therapy: Alas poor Craniosacral. A SCAM of infinite jest, of most excellent fancy, was pointed and funny and skewered CST completely and deserved more publicity. I posted the first FB link without comment, and moved on. But before long, there were 83 comments.

Deciding to continue with the topic I posted a second link to a report from a few years ago, about an infant who had died while undergoing "craniosacral" treatment. That one got 107 comments. 

I put up a third link to a very fair objective overview of it all written by a massage therapist, 

A case of moral distress: defending counterfactual anatomical claims in CST

 It's still perking right along. 

None of this is novel, so it doesn't interest me as much as the perspective offered by Mark Changizi, in his recent blogpost, "How not to get Absorbed in Someone Else's Abdomen". 
"Synposis: Anglerfish are metaphors for how creative communities can eat your brain and kill your creativity."  

That's what happens to us, as humans. Exactly. You could even say the world humans have created has become one big abdomen with many entry points into which we dive willingly for safety and so we don't have to think anymore, and can let our brains resorb. 
"Communities of people have bulls-eyes on them that are irresistible to us humans." 
Read it! It's a great blogpost. Changizi compares the behaviour of the anglerfish (the male one, anyway) to the way humans (neotenous apes that we are) need to have approval and feedback and support and eyes on us for every little thing we do in the world. Our need for external approval overwhelms our need to stay connected to our own cognitive linkages; all too easily are we severed from them, led into believing whatever somebody says is true, whatever nonsense they might be selling. We default straight to trust. We believe purveyors of nonsense, because they said it was science-based and why wouldn't we accept what they say? They're the teachers, right? 

And I saw this: "Doctors disagnose diseases as if recognizing objects", by Mo Costandi. It stuck in my head for some reason. I figured out, oh, it stayed in my head because they (doctors) are themselves lost in the abdomen of their own profession. Ah. No wonder we're in such trouble, us PTs who try to balance all the biomedical whatnot with our own whatnot. Because, what about pain? It has to be diagnosed, but it isn't "objective". It's not an "object". It's biopsychosocial. It's not physical. Pain science is the keen edge of the knife separating us from that abdomen we thought was "real" and "safe" but instead is a big (biomedical) fish net capturing health care dollars. We need to be discerning. We need to know what's useful for us, compared to what's useful for them. Not get mixed up about our role. Swim outside that big medical belly our profession seems to like to mix it up with. But never ever get sucked into/attracted toward other nice-looking abdomens. 

That default move (diving into a pre-existing conceptual abdomen) is not the best default move, but it's the quickest, and it's understandable: Why? Because we have huge, probably mostly unmanageable brains. Our executive function (dorsolateral prefrontal cortex) isn't even fully myelinated until we're close to thirty years old, then it takes awhile after that before we learn how to use it properly. Seth Grant says, 
"it has been said the number of synapses in the human brain is about a million billion, but something we’ve discovered about the molecular composition of the synapses, is that they have over 1000 different proteins within this, and we have done sort of a back-of-the-envelope calculation about the computational power of the human brain, based on what we know about the molecular circuits and these neuronal circuits, and we’ve come up with this very simple estimate: and it is that one human brain is more powerful than all computers on the internet put together, times one hundred."
That's a lot to keep any sort of handle on, seems to me. Seems to me, insecure humans diving for the nearest collective conceptual abdomen is like iron filings diving toward magnets - automatic, pretty much irresistible. Not to excuse those who lazily persist, who don't learn to resist the compulsion.


Finally, on a seasonal note, I read and very much liked Less Wrong's solstice celebration blogpost: Ritual Report: NYC Less Wrong Solstice Celebration. 

It sort of puts the whole thing into a bit more perspective. The whole notion of sharing stories and candles going out until only one candle was lit, enough light to read the last story, dredging up enough collective courage to face what could be a long hard winter. 

"We honor those people, those first astronomers, and all the laborers and scientists and revolutionaries who have come since, for creating the world we have today.
And then we look to our future. Tiny stars in the distant sky, unimaginably far away, surrounded by black seas of infinity.
We will stare into that Abyss, and the Abyss will stare back at us. But we will go crazy-meta and challenge the Abyss to a staring contest and win the hell at it, because we’re aspiring rationalists and good rationalists win."

And, to tie all this in once again to craniosacral therapy, I leave you with this video, which reminds us all of how vertebrates are often extraordinarily kind to one another and anything with sensitive paws can do cranial effectively - it isn't necessary to imagine a lot of complicated implausible mechanisms, when you care enough to want to do something helpful with another nervous system you can sense is not very happy with itself. 

Have a nice smooth holiday, an uneventful exit from this year to the next; may your next trip round the sun also be uneventful or maybe even growthful. 

Saturday, December 17, 2011

"Contextual Architect" - Cory Blickenstaff

Recently Cory wrote a letter to the editor of the Journal of Manual and Manipulative Therapy, which I've decided to quote in full (and hope I'm not breaching any copyright by doing so):

"Therapist as ‘contextual architect’ 
I would like to thank Bialosky et al. for their excellent article clarifying and discussing how and why to maximize placebo in manual therapy(1) practice. I would like to consider here the implications that placebo, conditioning, and expectation have on our roles and responsibilities as manual therapists. 
As pain is the primary complaint of many patients seen by the manual therapist, the potentially ubiquitous involvement of placebo in the ways we might approach these problems makes understanding such issues of vital importance. 
The authors operationally define placebo as the context of interactions between patient, therapist, environment, and intervention. A useful way to conceptualize these modes of interaction in the therapeutic encounter would be to consider three conceptual spaces: the subjective spaces of each the patient and the therapist, and the third shared ‘inter-subjective’ space (consisting of the environment and the intervention in the model of Bialosky et al.). Let’s examine how each space contributes to the ‘context of interaction’. 
The subjective space is private. Quintner et al. argue that the lived experience of pain is an example of an aporia, (2) a space to which an observer is denied access.(3) We lack a usable language to have access to the subjective experience of another (4) (such as the pain experience) and must therefore rely on indirect interpretation as exemplified by tools such as the visual analog scale, self-report disability scales and on our own interpretations of the interaction. All of these must be drawn from the shared inter-subjective space. 
The shared inter-subjective space represents the place where we can and do impact the other person through shared environments (including the intervention). When we interact with another, we become both the observed and the observer,(2) as we impact their subjective space and vice versa. 
Relevant to the inter-subjective space in therapy is the idea of soft paternalism that states that we cannot help but influence those with whom we interact. In other words, you can ignore the impact you have on context, but it will not ignore you, nor will it ignore your patient. This is a point the authors successfully drive home in their review, and Jacobs and Silvernail defended with the introduction of the ‘interactor’ approach in a previous response letter.(5) We should therefore strive to affect the interaction in specific and predictable ways, aiming for certain outcomes while respecting the rights of the individual involved.(6) As the authors point out, the evidence of impact of care gives us some insight into predictable outcomes of various forms of interaction. As we are attempting to build a specific context of interaction in the inter-subjective space to bring about predictable outcomes, we as manual therapists reside in the role of contextual architect. 
Our responsibility as contextual architects is to be purposeful in our influence in a responsible manner as prescribed in our code of ethics,(7) using predictable methods (when available) and plausible explanations consistent with best evidence with the patient’s individual goals and best interest as the guide.
Cory Blickenstaff PT, MS, OCS Forward Motion Physical Therapy Vancouver, WA, USA
1 Bialosky JE, Bishop MD, George SZ, Robinson ME. Placebo response to manual therapy: something out of nothing? J Man Manip Ther 2011;19:11–19.
2 Quintner JL, Cohen ML, Buchanan D, Katz JD, Williamson OD. Pain medicine and its models: helping or hindering? Pain Med 2008;9:824–34.
3 Williamson OK, Buchanan DA, Quintner JL, Cohen ML. Pain beyond monism and dualism. Pain 2005;116:169–70. 
4 Scannell K. Writing for our lives: physician narratives and medical practice. Ann Intern Med 2002;137:779–81. 
5 Jacobs DF, Silvernail JL. Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther 2011;19(2): 120–21. 
6 Thaler RH, Sunstein CR. Libertarian paternalism. Am Econ Rev 2003;93:175–9. 
7 American Physical Therapy Association. Code of Ethics [docu- ment on the Internet]. Alexandria, VA: American Physical Therapy Association. Available from: uploadedFiles/APTAorg/About_Us/Policies/HOD/Ethics/Code ofEthics.pdf#search5%22Code%20of%20Ethics%22."
I made a picture of this awhile ago, that I call the 'therapeutic domain'. It's a not-yet-completely-satisfactory imaging of the interactor model of physical/manual therapy, taking into account the reciprocity of sensing that goes on between therapist and patient, which hopefully helps the brain of the patient resolve its pain production. 

I really like the term "contextual architect" - it provides room for creativity, and challenges all the other conceptualizations of manual therapy in existence that operate in "guilds" - i.e., here's the way it's done, do it this way, with these bricks, or you can't belong in this guild (how medieval is that?)

Way to go Cory - way to carve out more conceptual space for all those of us who are permanently dissatisfied with the current, inherited, mesodermalist climate that permeates most of manual therapy. Way to go, Journal of Manual and Manipulative Therapy, for holding open a door to new avenues of thought. 

JMMT is available online, but not accessible by me. Cory's letter appears in Vol 19, No 4, 2011.