Monday, October 21, 2013

"Biomusic" and Personhood

Nautilus magazine published this piece today on facebook, and I was immediately entranced by possibility:

A boy lies in a coma ward in a hospital in Toronto. He cannot communicate. 

"Thomas didn’t move, and hadn’t for two years. He suffered from a brain injury that left him profoundly disabled. He was incontinent, unable to eat, speak, gesture, or breathe on his own, and dependent on round-the-clock medical care. His parents realized they couldn’t give him the care he needed at home. This is how Thomas came to be in the Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada, in a hybrid unit that serves as both a permanent home and medical facility to similarly disabled children, who range in age from infancy to young adult. These “silent” children, as they are known, are not in acute life or death situations, but they cannot live without constant monitoring and medical care."
Caregivers look after him, but get no feedback from him. 

This is the fate of a large percentage of people. Babies fare somewhat better, with their big eyes, exaggerated reflexes and possibilities. People at the other end of life, not so much. Care homes for those with dementia are filled with people who once had full lives, but who are now treated as biological "objects" to be "managed." Input, throughput, output. Get them up, clean them up, sit them up, feed them, water them - leave them unattended for hours sometimes, because of doing the same for all the others, toilet them, put them back to bed, roll them over once in awhile. Add to that, the opportunities for abuse by frustrated underpaid caretakers. Language barriers. It can become a horror show.

Back to the article: A woman appears, Stefanie Blain-Moraes, an interesting cross between engineer and musician. She has volunteered for eight years at this facility. She noted the perfunctoriness that sets in after awhile, the detachment, the burnout, the treatment of these patients as objects to be dealt with. That happens naturally, to anyone, after years of never getting any real interaction or feedback.

So, she invented sound feedback - "biomusic"!!

"Biomusic sounds something like avant-garde electronic music. Generated using a Musical Instrument Digital Interface (MIDI), it has an ethereal, other-worldly quality. An underlying drumbeat represents heart rate. Skin conductivity—which varies with sweating—controls pitch. Respiration rate dictates the musical articulation and phrasing. The melody and chords are smooth and flowing through the breath, and soften towards the end of the breath. In the first minute of monitoring, the system takes a baseline reading and assigns the average to middle C. So, every instance of Biomusic begins with the same pitch and moves up or down from there. The overall key signature is determined by skin temperature, which changes gradually about 15 seconds after an emotional or physiological stimulus. States of stress, with fast and jagged breathing, sound different than states of relaxation, when the breath is slow and smooth. More subtle emotions can also be translated into distinct-sounding music."

Whoa! Suddenly, with critter brains able to indicate how they feel, caregivers have instant feedback on how their actions are affecting their charges, and can modulate - themselves! And furthermore, their own critter brains have a way to connect and affect this unconscious person's critter brain directly, without having to go through cumbersome, or non-existent anymore, strictly human brain language based social brain channels.

Brilliant. Freaking brilliant. 


My brain turned immediately to wild fantasies about how marvelous it would be as a tool for human primate social grooming, manual therapy. Imagine being able to bypass all the conceptual clutter and gaining instant feedback through "biomusic" on how a patient's nervous system is responding to your input. Think how the manual therapy recipient could use the feedback from their own critter brain/ nervous system to enhance their own relationship to it!

I love this idea. Just love it.
Can't wait until we can implement it somehow in our work. Truly interactive. No clunky "thought" objects to navigate anymore. Just hook up, get the music started, then all four brains - the two language-interactive human brains and two critter brains, the nervous systems themselves of both people, could have a nice involved kinesthetic conversation aimed at reducing pain.

Think of all the possibilities: 

1. Easy outcome tracking. You could do a baseline on that patient, in pain, before treatment, during assessment. You could record the whole interactive treatment process. Then another post treatment recording. Then compare. Wow. 
2. No more arguing over what I call "thought" objects (models of treatment). No more need to set up horribly complicated test situations or try to teach patients how to fill out complicated questionnaires and send them in. All the data flows in effortlessly, and can be pooled ongoingly. 
3. Instant feedback during treatment for the practitioner, who can easily and instinctively modulate themselves and what they're doing without having to go through all the "How does this feel?" and get a response you can't be completely sure of, because you have no idea to what extent the person understands what sort of feedback to provide, or might be trying to be nice, and not mention that you're inadvertently pulling their hair or something noceboic.. 

Another interesting part of this article: a definition of "personhood" that finally makes sense to me. 

"Perhaps it shouldn’t matter that children like Thomas cannot respond or show gratitude for their care.  And yet it does. When the nurse said that the biomusic reminded her that her charge was a “person” she invoked a concept with echoes in law, philosophy, and psychology: “Personhood” is a title for those whom we recognize as being like ourselves and worthy of our concern. The act of caring is a relation, not an attitude; it is a duet, not a solo."
Did you see that? 
"The act of caring is a relation, not an attitude; it is a duet, not a solo."

Personhood is an interaction, not a thing. It's a verb, not a noun. It's buried inside the biopsychosocial exchange. "Personhood" is a word, a concept, or a thought object, that represents this relationship and the connection embedded within it, between critter brains, acknowledged by human brains. It can be either inhabited, or abandoned.

We can provide better care by inhabiting the relationship. Therapeutically.

Sunday, October 20, 2013

The Skin as a Social Organ. Part 2h: Social bonding's broader context.

The paper, The skin as a social organ

Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself Part 2e: Touch early, touch often Part 2f: Human allogrooming Part 2g: Bonding aspects of social grooming. 

Next piece:
"Positive affect and hedonic feelings may be the glue which holds individuals, as necessarily physically separate beings, together in social bonds. Grooming, indeed, may reflect a generalized form of pair-bonding usually seen in reproductive or mother–offspring dyads across numerous taxa (Dunbar 2008). As such it may rely on similar neural and physiological mechanisms as the dyadic cases. For example, in addition to its role in maternal behaviors, the neurotransmitter oxytocin is also an important mediator of grooming (Drago et al. 1986), as demonstrated by the exaggerated grooming behavior that results when it is administered into the cerebrospinal fluid of knockout mice which do not express oxytocin (Amico et al. 2004). Endorphins may also play a central role in grooming. In both talapoin monkeys (Keverne et al. 1989) and rhesus macaques (Martel et al. 1995), opioid receptor blockade results in increased solicitations for grooming. Dopamine may also be important in affiliative behavior and bonding (Depue and Morrone-Strupinsky 2005)."

Drago F, Caldwell JD, Pedersen CA, Continella G, Scapagnini U, Prange AJ Jr (1986) Dopamine neurotransmission in the nucleus accumbens may be involved in oxytocin-enhanced grooming behavior of the rat. Pharmacol Biochem Behav 24:1185–1188

Amico JA, Vollmer RR, Karam JR, Lee PR, Li X, Koenig JI, McCarthy MM (2004) Centrally administered oxytocin elicits exaggerated grooming in oxytocin null mice. Pharmacol Bio- chem Behav 2004(78):333–339

Keverne EB, Martensz ND, Tuite B (1989) Beta-endorphin concentrations in cerebrospinal fluid of monkeys are influenced by grooming relationships. Psychoneuroendocrinology 14:155–161

Martel F, Nevison C, Simpson M, Keverne E (1995) Effects of opioid receptor blockade on the social behavior of rhesus monkeys living in large family groups. Dev Psychobiol 28:71–84


I know I'm losing interest in a project when I'd rather spend my time doing jigsaw puzzles on an iPad than blogging. Seriously.

Right now, I have no dopamine for this series. I do so dislike leaving things undone after I've committed myself to doing them.  But I'm also somebody who likes to fully utilize my own critter brain, especially in the motivation department, and right now, my critter brain doesn't want to do this anymore. I think it has become bored.

I won't close the project, but I will meander away from it, turn my back on it completely, blog about other topics for awhile. I don't know for how long. The way my brain recycles, and the way life presents intersecting criss-crosses in bits and pieces read here and there, I'm sure I'll wander back.

Topics in this paper left to cover:
1. Touch as communication
2. Pathways of pleasant touch
3. C-tactile fibres
4. Where pleasant touch lands in the brain
5. Intersubjective representation
6. How it all ties in with empathy.

These are all fascinating, but I've got to go do other things for a little while. I'm waiting for a new book to come, Neurobiology of Grooming Behavior. Well, not "new" - it was published a few years ago, but relatively new, and new to me. It might serve as re-inspiration. Or not. We'll see.

Tuesday, October 15, 2013

The Skin as a Social Organ. Part 2g: bonding aspects of allogrooming

The paper, The skin as a social organ

Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself Part 2e: Touch early, touch often Part 2f: Human allogrooming

[Hello! I'm back.]

I will pick up exactly where I left off:  The next paragraph of the paper:

In romantic partnerships, relationship satisfaction, previous experience of familial affection, and trust were positively correlated with self-reports of mutual grooming (Nelson and Geher 2007). The same study showed that individuals who scored higher on anxiety subscales of an attachment questionnaire also reported more frequent grooming behavior, suggesting that an anxious attachment style may be accompanied by behavior likely to lead to more secure bonds. It is also important to consider the stage of an affiliative and/or romantic relationship with respect to the role of intensive touching and grooming (Emmers and Dindia 1995). Indeed, different neural mechanisms may come into play during the initiation of an affiliative relationship and during its maintenance (Depue and Morrone-Strupinsky 2005). 
Nelson H, Geher G (2007) Mutual grooming in human dyadic relationships: an ethological perspective. Curr Psychol 26:121–140
Emmers TM, Dindia K (1995) The effect of relational stage and intimacy on touch: an extension of Guerrero and Andersen. Personal Relatsh 2:225–236
Depue RA, Morrone-Strupinsky JV (2005) A neurobehavioral model of affiliative bonding: implications for conceptualizing a human trait of affiliation. Behav Brain Sci 28:313–395

I don't know much about this; unmarried by choice, childless by choice... at least I knew what kind of life I didn't want.

A few stray thoughts about this paragraph:

1. maybe a higher proportion of people who have anxious attachment styles end up in human primate social grooming professions than in other walks of life.

2. proper treatment boundaries are very important, the thicker the better.

If I weren't a thorough person and if I hadn't made a deal with myself to make a blogpost about each and every paragraph in this paper, I would have left this one out as irrelevant to the art and science of human primate social grooming.