Thursday, November 29, 2018

The importance of STORIES

So many threads in my head coming together today.
Just one of those days I guess...
They are rare enough and welcome when they arrive.
Days when I feel inspired.


1. An interview Mark Kargela has just done with Peter O'Sullivan and Joletta Belton (about an hour long on Facebook). Peter describes how important the patient's story is - the narrative they will offer (if you just ask them to tell it to you!) will contain all the bits needed for them to move on. Joletta concurs.
He is trying to develop a way of teaching clinical interaction in his work as an instructor, continue having a clinical practice, and how something had to give so it was the traveling/teaching workshops around the world, for a year*.  If anyone can manage to do it in a way the profession itself will notice and adapt, it will be him!! Go Peter go!!
In it, Mark mentions manual therapy that is "supportive, not corrective" and comes across that way to the patient. Very important, if you are out there in the world doing manual therapy and trying to cross the chasm from being operative toward being interactive. If you are trying to deal with a predictive brain, you have to set it up so it thinks recovery was its own idea.
(Here is a blogpost I did about Peter's workshop on Cognitive Functional Therapy at the San Diego Pain Summit a couple years ago.)

2. Monic Noij's wonderfully evocative blogpost, her story about how it felt/feels to do just that, cross the chasm, deal with cognitive dissonance, change the way you were taught how to 'be' (i.e., operative) into something else almost entirely (less operative), and the feeling of the ground disappearing out from under you as you step through the necessary cognitive changes.
It reads like a real adventure story fraught with danger, disappointments, eventual survival and after that, who knows?
Just read it:
What's on the path ahead? Adventures in crossing the chasm.
(Her blogposts are all very well-written - read them all.)

3. A wonderful description of the biopsychosocial model by Julie Tudor
The entire post is good, but this part is my fave, her story about how BPS model is like a lava lamp:

"We all see BPS or SPB (or PBS, for all I know) as being represented by this neat little Venn diagram of overlapping circles, each of the same size and importance. This is a fantasy, created by people who were still seeped in the priority of the biomedical approach. In reality, there are NO clear delineations.
Those borders are smeared and loopy and smudged inextricably. It looks more like a triple colored blob inside a lava lamp, entangled in a constant ebb and flow, with little bubbles of each breaking off and dancing in and out of each other, while larger clumps may loll about at the base or flow up to engulf their errant offspring. One blob may appear bigger than the others, and then collapse into the weight of another color. These primary colors may also blend with those, and create a rainbow effect with no discernible beginning or end (...and no pot of gold, either)."
I really like the metaphor of the model described by her as being an impossible-to-ignore-or-manipulate verb, not a static, easy-to-manipulate-and-make-assumptions-about-or-ignore-entirely noun.

 4. A glowing book review by Harriet Hall of the book by James Alcock, Belief: What It Means to Believe and Why Our Convictions Are So Compelling.
For sure, this resonates with the whole cognitive dissonance experience (see point 3. above) that lays waste to any cherished beliefs we may have previously clung to as practitioners. It sure does suck bigtime, and hurts. You have to figure out how to grieve your own ego, then let it go.
The part that jumped out at me most in this book review however was Harriet Hall's account of the author's description, his story of three types of healing: 

"Belief and healing:  Feeling better after a treatment doesn’t necessarily mean we actually are better. Suggestion is powerful, healing rituals are persuasive. He covers Mesmer’s “animal magnetism,” placebo effects, sham surgeries, learned responses, expectancy effects, conditioning, social learning, and theological placebos. He says there are three types of healing: natural healing (the body heals itself), technological healing (drugs, surgery) and interpersonal healing that depends on context and personal interactions and that leads to improvements in illness but not in disease."

I had never thought about healing that way. It makes sense though - the third category is what most of us are in, as allied health professionals.
I hope we are all there for each other that way.

5. At last, this: The Difference Between Fixing and Healing, the transcript of an interview with Rachel Naomi Remen, a medical doctor and author of Kitchen Table Wisdom and My Grandfather's Blessings. She discusses how important the stories are - it's through the stories that people can find their way. Find their way out of pain (Peter O'Sullivan and Joletta Belton). Find their way across chasms (Monica Noij). Find their way to understanding something complex and abstract (Julie Tudor).
Her own story is that her mystical grandfather, a rabbi, told her a creation story when she was four years old. It was (roughly paraphrased) about how the light of the world broke up into many pieces, how humans are here to put the light back together, how each human has a little bit of that original light to bring to the effort. When she was 15 she was diagnosed with Chrohn's Disease, and her mother reminded her of the story her grandfather had told her when she was a little girl. It strengthened her. She went on to become a medical doctor, which is a chasm of its own kind, and now she walks (my take on this) with one foot on each side of that chasm, being both a medical doctor and a "healer"- counselor of gravely ill patients - on the other. Plus a fabulous writer. She acknowledges the operative side of medicine and does a great job or highlighting the interactive side. Of the chasm.
Really, not to diminish anyone's journey across their own chasm, because it will always feel huge and insurmountable, but the size of the chasm she has successfully navigated with so many gifts to bring makes me feel like the one I crossed a few decades back (then had to find language to describe) was more the size of a scratch with a twig in the sand at the beach.



1. Mark Kargela's interview with Peter O'Sullivan and Joletta Belton (2018)
2. What is the operator model? What is the interactor model? (2011)
Ownership and agency in a predictive brain, implications for manual therapy (2017)
4. Peter O'Sullivan San Diego Pain Summit 2017 blogpost (2017)
5. Monica Noij's blogpost on crossing the chasm (2018)
6. Julie Tudor's essay on the biopsychosocial model (2018)
7. Harriet Hall's book review of James Alcock's book on belief (2018)
8. The interview transcript with Rachel Naomi Remen (2018)


(*I am thinking about giving up traveling too - maybe just for a year, maybe longer - it really grinds down one's gears, physiologically. It gets to the point where it takes so long to recover from the traveling that one's entire life becomes scheduling recovery time between workshops, and feeling quite out of it for days. That is no way to waste one's physiological capital let along build upon whatever one managed to glean by way of being stimulated in a new context. Just no way to consolidate any thoughts or themes - too much recovering to do, too tiring. Sucks away whatever tiny shred of creativity one may possess.)