"I Have a Meme..."

A PT colleague in Nova Scotia just wrote this resounding echo of Martin Luther King's famous speech on a discussion forum called SomaSimple.

It speaks to the effort people on that board (and I'm proud to count myself among them) are making to try to wake up our broader human primate social grooming community to the simple fact that nervous systems run bodies, that manual therapy researcher/clinicians spend far too much time obsessing over mesodermal minutiae and constructing science projects designed to flatter themselves and their mesodermal obsessions, Balnibarian-like. (You might remember Balnibarians from Gulliver's Travels. They specialized in inside-out and backward science:)

After requesting to leave the island, Gulliver is lowered to the continent of Balnibari and enters its metropolis, Lagado, where the crops are poorly managed, people wear ragged clothing, and the houses are in bad condition–except for the house of the governor of Lagado. He tells Gulliver that 40 years before, some Lagado residents visited Laputa and came away with a smattering of mathematics that caused them to undertake bold scientific projects and other heady enterprises. They even built an academy in which to carry out their projects. Now every town in Balnibari has an academy, and the people spend most of their time conducting experiments. For example, at the Academy of Lagado, scientists are attempting to do the following: extract sunbeams from cucumbers, turn human feces back into food, erect buildings from the roof down, plow farmland with pigs, make marbles soft enough to stuff pillows and pincushions, breed sheep whose entire bodies are bald, and have students learn mathematics by swallowing wafers on which formulas are written.
.......So absorbed in these enterprises are the inhabitants that they avoid taking part in almost all other activities.

A lot of the participants on this discussion board, SomaSimple, including me, just shake our heads and wonder what on earth we are doing in this profession that tests our sanity so, a little community of skeptics with the odd true believer thrown in to keep things rolling along (every discussion board needs dissent to keep it alive, I suppose). It's the small version of larger debates going on everywhere among those who like to think and those who want to simply believe.

Re-membering the Forgetting

PTs go to university to learn what there is to know about the human organism that can be applied to helping it improve its function. We all learn anatomy, physiology, pathology, neuroanatomy..

When we graduate, only those of us who end up having a talent and proclivity for "Neuro", a contracted concept that for us means treating patients who have profound functional deficit, profoundly damaged nervous systems from birth or through trauma ... only these graduates ever stay caught up in neurosciences. Metaphorically we all land on the same beach, then a stalwart few head inland to climb steep mountains.

The rest gratefully exhale post-graduation, allow their info base on neurosciences to drop away, erode, disappear, and turn their cognitive hard drive to learning more about biomechanics. They turn their attention to the stuff of the body, the mesoderm, under a large conceptual umbrella called "Orthopaedics", splitting off from the true functional organizer of the body, the nervous system. Metaphorically, these are all the ones who stay by the water and build piers out into it, preferring beach life, the equivalent of treating a host of issues in tissues that (mercifully) they can classify and reclassify to their hearts' content; the nervous systems of the people they treat are usually intact.

But what is gradually and steadily coming in like a tide is pain science. The pain science advance is forcing the beach boys and girls to pack up all our previous cognitive and conceptual gear and move further inland, closer to where our Neuro colleagues make their livings.

I say "our." I was a beach bum too, for a long time, although I like to imagine I'm already a bit further inland than some. It has only been in the last 10 years or so (out of a 35 year long adulthood as a PT) that I have learned to see pain sciences as a link that will (potentially) one day unite the profession, maybe all manual therapies, into a deeper level of real understanding. There are lots of other PTs on the same path, who have been on it much longer, and are much further along. Some are even working to widen the path.

Of great additional benefit to this whole scientific deepening of the profession would be a much deeper appreciation for EvoDevo, something our hands-on social grooming professions currently lack. If understanding human pain means having to grasp understanding of the human nervous system in all its complex multi-faceted glory, it will also mean understanding the place humans occupy in life itself, not just in multi-varied human culture.

C fibres and Autonomics

In this short essay, Kevin McHenry of
www.painonline.com
examines a likely culprit in the persistent pain circuit.

DermoNeuroModulation

At last, after several years of probing, searching, trying on and then rejecting one name after another for what I physically do with patients' bodies, trying to encompass the whole of the nervous system and the whole of one's interaction with it within a single name, I've settled on dermoneuromodulation.

It has these main important inclusions:
1. The "neuro" portion is the most important. It provides the concept that the nervous system is central to any treatment interaction, at any and at every level, the whole way from the attempt to include only slowadapting non-nocioceptive stretch receptors (Ruffini endings in the skin), to answering any and every question a patient may have, to providing an overview of how the nervous system works and how pain is generated, as a standard part of every encounter with every new patient.
2. The term "modulation" is what the nervous system is doing in response to an input. It modulates itself in response to any sensory input. It does this continually from its initial formation in utero until the moment it dies, at whatever age one dies.
3. The prefix "dermo" means, sensory input through the skin, kinesthetic sensory input. Other prefixes mean other things. For example "psychoneuromodulation" would lean more toward describing psychological input that could result in modulation delivered to the human organism via the (cultural, social) mind, as opposed to kinesthetic input that could result in modulation delivered to the human organism via the physically sensing brain. Not that both couldn't happen simultaneously, or don't all the time in manual treatment. (If we try to pretend they don't we're kidding ourselves.)

It has these important exclusions:
1. It is a brand new word combination that I've seen nowhere else.
2. It therefore carries no baggage.
3. It will never (as long as I am in control of this new meme I'm introducing) contain anti-scientific or pseudo-scientific ideas.
4. Most importantly, there is not a speck, not one hint of any reference to any mesodermal derivative embedded in this term anywhere. This means;
- no mention of mobilizing of any joints
- no reference to moving bones
- no suggestion of releasing fascia
- no talk of muscle lengthening
If any of these things happen during or after dermoneuromodulation, fine, but any changes in any mesodermally derived tissue will be as a result of the brain/nervous system of the patient in question deciding to modulate itself to allow such a thing to happen, not a direct result of a practitioner's applied force.

I have spent years working my way out of confusing conceptual traps by learning all I can about how the human organism with an intact nervous system actually works, how it can end up in trouble (i.e., pain), how it actually interacts with another system (e.g., mine) to its own benefit. The hits now outweigh the misses by far, because my own nervous system (including my own mind) and motor output has adapted over many years, has become the best possible human primate social grooming nervous system it can be, has learned to be slow and gentle and patient on the one hand, nitpicky and precise and persistent on the other, when treating other nervous systems.

This naming process has been a long time coming, mainly because those exact same personal traits carried over into it. It feels like a long-awaited birth has finally occurred, but (thankfully) not as exhausting as the teaching experience was.

Teaching

I'm awfully tired, pleasantly exhausted actually, after experiencing my very first teaching encounter, yesterday. The whole subjective resistance/inertia I've always felt about assuming the role of "teacher", of all the bits and pieces of personal history, self-esteem/vulnerability issues, simple laziness, conflicting feelings about the profession itself and my personal role in it, deep philosophical questions regarding the point of being here in human form at all, had all ended up jumbled together in a vague inner shadow aspect that I came to recognize and term "the daunt factor." Once I had a name for it, the clear task I faced was to overcome it and free my inner "teacher." Funny how we set ourselves up for deepening into life...

I took a first baby step, by selecting some interested and friendly people to teach, offering to teach them for free the first time, just so that I could practice getting past just the first inner obstacle (the first of many, all seeming insurmountable); that of actually organizing my own thoughts/gleanings on treatment and speaking them in real time while on my feet with people looking at me. Note that these tasks/challenges are motor-cognitive in nature.

It's the first time I had ever put myself in the category of "instructor", standing up in the front with a bunch of markers in my hand, making drawings and explaining things in real time to others who occupied (my previous and much preferred) category of "student." I feel like I've just experienced a trip, not just into, but clear to the other side of The Void. I feel discombobulated inwardly; in retrospect my mirror neurons took quite a beating when I reversed the familiar role play, but otherwise I seem to be fine. I didn't uncover any wellspring of inexhaustible energy, any sudden appetite for external glory and fame, any passion for being in the spotlight, or even any previously undiscovered proclivity or ease with being extroverted. Alas. Attributes such as these may well have more easily flattened both inward and outward obstacles.

I have still such a long way to go. None of this comes easy or naturally to an introvert like me, content for so long to sit, learn from others, ruminate, think and treat. I'm taking the pleasant exhaustion as an inward clue that the experience was growthful in some important way, to me as a person if nothing else; exactly how, I've yet to understand, conceptualize, or be able to explain to myself.

The students were Eric and Cory, thoroughly attentive, never seeming bored and never fidgeting much to my everlasting gratitude. We went straight from 8 AM to 7 PM with just one short break for lunch. I showed them all my best basic moves and they practiced on each other.

These two nice guys were simultaneously supportive, objective, and clear in their feedback about the instruction and material, and Eric even volunteered to be an assistant if I decide to teach again to a large class, so I'm not sure why today I feel like I'm in some sort of subjective dark burlap sack regarding the quality of the job I did or necessity of the role I took a stab at or the value of the material itself in the long run or the overall need of the profession to maintain any connection to its humble hands-on origins. Maybe it will all become clearer to me in days to come. Maybe all 'teachers' feel like this at times. Maybe the only meaning or value of any of this material is what I decide to assign/what the learners of it will assign.

Upside-down tree

One can view the human nervous system as an upside down tree: the "rootball" where "nourishment" is taken in - food for the body, oxygen for cellular respiration, stimulation for most of the senses - is at the top. The trunk is in the center, and has many branches, just like a real tree - an "espaliered" tree at first, then unpruned, expanding everywhere, and then .. some genetic programmed process stops tree's growth /branching and puts it in stasis for a lifetime.

These branches go everywhere, are multiply twigged, with a "leaf canopy" that ends up embedded in skin.

Skin is not “just” a 15-20 pound protective film wrapped round the outside of the body like living saran wrap. It has three dimensional structure. It is a sensitive raft floating on a sea of subcutaneous liquidy fat, tethered to a deeper layer of fascia by means of tough skin ligaments, hundreds of them, dense macroscopic structures that defy gravity (for a few decades anyway..). These ligaments permit movement in every direction, but not a lot of movement in any direction. Many of them are tubular, serving as conduits that convey vasculature and nerve to and from skin.

Skin is filled with varying proportions of different nerve endings, each with specific messaging capacity that can give the sensory cortex a layered perspective of how the skin is being contacted by the environment. The CNS can measure "threat" value, based on this incoming. Skin has palpable "behavior", all of it autonomic outflow in nature, enacted by smooth muscle effector cells. Through skin one can palpate tension in underlying structures. By interacting with skin, one can indirectly affect such tension toward improvement, greater overall relaxation of the organism, deeper breathing.

How is this possible? I maintain that if blind people can learn to "read" Braille, interpret a symbolic language based on a predictable system of raised dots on paper through senstive fingertips, allow their visual cortex to be taken over by kinesthetic interpretation, so can manual therapists use this same brain system to feel through someone else's physiological nervous system functioning by learning to "read" skin/motor response behavior. This has the added bonus of being an interactive form of "reading." Butler says, "Remember that just as you are sampling another's nervous system, their nervous system is sampling yours."

Skin performs many physiological functions, but from strictly a nervous system perspective, in light of what we want to do with it, we could view it as part of the brain’s sensor array, a “periscope” that completely surrounds the submarine of the brain, a window or door directly into the sensory cortex of the brain. To be invited all the way in, we must treat it respectfully and not barge our way right through it as if it did not exist as an organ of sensitivity in its own right. By attending to skin properly we can sway the patient’s nervous system to our intentions easily/effortlessly, and also, and more importantly, to the patient’s own non-conscious corrective mechanisms - correction away from a pain state. In the Melzack/Wall pain paradigm, you can minimize “threat” enormously, by handling skin properly.

It is useful to remember that both skin and brain and in fact all the nervous system, and the initial burst of immortal germ cells, all derive from ectoderm proper. In addition, early on, ectoderm gives rise to mesoderm, which makes everything our system uses to hold itself up and move along.. bones, muscles, blood, tendons, ligaments. Mesodermal structures are forever subservient to those of ectoderm, give ectoderm 'leverage' against the other forces in nature; by themselves, without a living tree existing throughout, they are just meat, matter, material.

Nerves themselves have their own "bark," or equivalent of "skin", a sensor array that protects them, called the nervi nervorum, intertwined with the feeding system to the nerve, called vasa nervorum. This signalling system lets the CNS know about potential problems before they develop, in particular any fall in oxygen levels (hypoxia). It is postulated by Butler and many others that a great deal of benign pain problems stem from simple local hypoxic conditions out in the "bark," about which the brain's alarm system has become sensitized.

Through skin, and by handling actual physical arms and legs and parts thereof, the living tree branches (neural structures) can be tugged, bowed, rolled, even slid through their mesodermal neural tunnels. This physical action changes internal juxtapositions of nerve container to nerve, and improves conditions sufficiently to allow new input to the CNS. The new input must be sufficient to allow the CNS to change its "output" (i.e. pain state) but not sufficient to cause it any threat, which would perpetuate and even compound the problem.

One of the perplexing attributes of the central nervous system is the way it has control of the volume knobs on pain; any little twig anywhere, trapped and hypoxic, can result in a pain state that seems way out of proportion, and which can be felt anywhere else. Furthermore, the CNS can create pain all by itself, as it does in cases of amputations and spinal cord injuries (phantom pain). One of the desireable attributes of a good manual therapist is that she or he knows this, will take a good history, and if the patient seems suitable, will comb through the neural tree, using his/her own developed kinesthetic senses to locate and help restore motion to anything that feels like it has less than adequate slide. S/he will use only enough force to get the job done and no more, all the while realizing that the CNS uses skin as a huge magnifying tool for all incoming, that it has its own perspectives on all incoming based on its own history of encounters with life outside itself. What if the patient is not a good candidate for manual therapy? A good manual therapist who is also happens to be a physiotherapist will have other hands-off ways of helping; listening, movement therapy, education, reframing, and encouragement.

"Nature via Nurture"

I'm busy with this book at the moment, by Matt Ridley, and am otherwise deep in personal study of embryology, how the body plan starts the unfoldment of its eventual self (once the proctodeum/stomodeum is in place) from the neck down and neck up at once, not in any linear manner but three- dimensionally.

This comment in his book (p. 33) has taken hold at the moment, made in the context of remarks about how few genes we have (30,000) compared to how many we had guessed we had (100,000):

The beauty of the system is that the same gene can be reused in different places and at different times simply by putting a set of different promoters beside it... To make grand changes in the body plan of animals, there is no need to invent new genes, just as there is no need to invent new words to write an original novel... All you need to do is switch the same ones on and off in different patterns. Suddenly, here is a mechanism for creating large and small evolutionary changes from small genetic differences. Merely by adjusting the sequence of a promoter, or adding a new one, you could alter the expression of a gene. And if that gene is itself the code for a transcription factor, then its expression will alter the expression of other genes. Just a tiny change in one promoter will produce a cascade of differences for the organism. These changes might be sufficient to create a wholly new species without changing the genes themselves at all. (Carroll, S.B. 2000. Endless forms: The evolution of gene regulation and morphological diversity. Cell 101:577-80)

I very much like the idea that timing and context are just as important as actual matter or code in this regard, just as much as they are in any regard.

Rules for flying

(These are from an email, one of those ones that gets sent around.. you know.. usually without any lasting merit. This one however caught my eye. I liked how applicable much of it is to life in an ordinary human antigravity suit.)


"Rules Of The Air"

1. Every takeoff is optional. Every landing is mandatory.

2. If you push the stick forward, the houses get bigger. If you pull the stick back, they get smaller. That is, unless you keep pulling the stick all the way back, then they get bigger again.

3. Flying isn't dangerous. Crashing is what's dangerous.

4. It's always better to be down here wishing you were up there than up there wishing you were down here.

5. The ONLY time you have too much fuel is when you're on fire.

6. The propeller is just a big fan in front of the plane used to keep the pilot cool. When it stops, you can actually watch the pilot start sweating.

7. When in doubt, hold on to your altitude. No one has ever collided with the sky.

8. A 'good' landing is one from which you can walk away. A 'great' landing is one after which they can use the plane again.

9. Learn from the mistakes of others. You won't live long enough to make all of them yourself.

10. You know you've landed with the wheels up if it takes full power to taxi to the ramp.

11. The probability of survival is inversely proportional to the angle of arrival. Large angle of arrival, small probability of survival and vice versa.

12. Never let an aircraft take you somewhere your brain didn't get to five minutes earlier.

13. Stay out of clouds. The silver lining everyone keeps talking about might be another airplane going in the opposite direction. Reliable sources also report that mountains have been known to hide out in clouds.

14. Always try to keep the number of landings you make equal to the number of take offs you've made.

15. There are three simple rules for making a smooth landing. Unfortunately no one knows what they are.

16. You start with a bag full of luck and an empty bag of experience. The trick is to fill the bag of experience before you empty the bag of luck.

17. Helicopters can't fly; they're just so ugly the earth repels them.

18. If all you can see out of the window is ground that's going round and round and all you can hear is commotion coming from the passenger compartment, things are not at all as they should be.

19. In the ongoing battle between objects made of aluminum going hundreds of miles per hour and the ground going zero miles per hour, the ground has yet to lose.

20. Good judgment comes from experience. Unfortunately, the experience usually comes from bad judgment.

21. It's always a good idea to keep the pointy end going forward as much as possible.

22. Keep looking around. There's always something you've missed.

23. Remember, gravity is not just a good idea. It's the law. And it's not subject to repeal.

24. The three most useless things to a pilot are the altitude above you, runway behind you, and a tenth of a second ago.

"Proprietorship" ?

I came across a chiropractic website recently whose creator, based in Oregon, has decided to appropriate the term "Neuromodulation Technique", own it, and move to protect it, apparently so that he can develop an empire of training and a stable of trained practitioners to help him move forth comfortably well-off into the future. From his site:

Neuromodulation Technique is a proprietary system of health care based upon a method of accessing and assessing the autonomic control system of the patient through muscle response testing utilizing verbal and/or non-verbal semantic questions and statements.

We use a unique form of muscle response testing as one convenient tool to query the ACS, thereby determining the errors in the way the ACS is controlling the body. Specific query statements are codified into NMT clinical pathways that constitute algorithms created to address particular areas of physiology like allergy or sensory/motor function. Based on the information derived by applying this investigation of the patient, these treatment algorithms define corrective information with with which the NMT practitioner is able to semantically reprogram and debug scripts. This process is further augmented and reinforced with percussive, or other stimulation of vertebral segments, specific breathing patterns, and other sensory stimuli. It is based upon widely accepted neurophysiological models. There are no vials, special reflex points, or potions used. It is the NMT proposition that the closest analogy to the human nervous system is the computer.

The NMT method is based on generally recognized principles of neurophysiology, physiology, psychology, linguistics, and anatomy. NMT constitutes a unique and proprietary system of health care protected by applicable laws United States copyright, and trademark laws. Patent is pending for the NMT process.

I have rolled this discovery around in my mind for a few weeks. As I read through the site I noted that his path has been through chiropractic training, and then through various winding "energy" trainings. It seems he did some reading, had a bright idea one day, and is now taking the term "neuromodulation" to mean (as near as I can make out) justification of "energy" techniques by calling them "neuromodulation technique", and furthermore, he wants to lay claim to the term, as if its origin had something to do with him personally. ("Shoehorning" is a word that comes to mind..)

In any case, ahem.. I beg to differ. Neuromodulation is a term that describes something quite specific and scientific, i.e., changing an input into the nervous system to facilitate a change in its output. Period. No one else to my knowlege has ever laid claim to the term especially in order to protect some perceived financial interest.

This article, Reality Check, will help those who are confused about what "energy techniques" are, to gain some perspective. A brief foray into some self-education about what pseudoscience entails, might be of interest. This page contains more information about pseudoscience. In particular, note the blue comparison columns further down the page. Here is another perspective on pseudoscience from Wikipedia. It contains many useful links, including one to Occam's Razor, a pithy term used in science to describe whacking away superfluity and decide what is a worthy basis for further investigation and what is not. Here is yet another link to a page that distinguishes pseudo from actual science.

A point I would like to make is that no one can "own" a term that describes something scientifically specific. This ambitious practitioner may be able to own the term "neuromodulation technique" as defined by himself, i.e. as a catchall term that covers "energy" treatment, e.g., one form of which used to require the purchase of vials of special water for the patient to hold, from which it could be determined (somehow) what the "diagnosis" was... and when the practice to "neuromodulation technique" suddenly purchase of said vials is no longer required..

... but he can't own a clear chunk of English that has a scientific meaning and is used within those parameters.

I will continue to call myself "Neuromodulator" and I will continue to argue for the term "neuromodulation" to be a free word without commercial strings attached. As long as the practitioner in question continues to attach the term "neuromodulation" as an adjective, modifying his own particular methods i.e., a noun, "technique," I will have no further quibble with him.

In closing, I would like to draw attention to this excellent essay, written by a British physician, entitled The Sea Monster and the Whirlpool which may be able to give you a glimpse of the seas science-based and science-respecting practitioners have to navigate.

Finally, I want to state that this chiropractor individual and I have nothing whatsoever to do with each other, and that's how it shall remain.

Homunculus

Why do the sensory and motor homunculi in the brain that represent our bodies appear upside down, scrambled, and distorted compared to how our bodies actually look? By incorporating embryologic information the puzzle can be solved to a large extent.

In general, as an embryo grows the body plan expands forward/upward (rostrally) and backward/downward (caudally) from the bottom of the brain. The area of the top of the neck/ bottom of the brain could therefore be considered a starting point, a ground zero, once the embryo has curled into a three-dimensional form: Certain structures are built there and drop down later, like the heart and diaphragm and beginnings of the gut, while the brain grows up from there.

It is useful to know first, that the brain develops medial to lateral, growing up and forward from its floor and expanding/falling outward to the sides: I propose that the homunculus is a mapping of developmental biology: As the 'unfoldment of the antigravity suit' proceeds out in the periphery, its progress would appear to become “registered” by homuncular “maps” of the body in the central nervous system. Picture the homunculus diagram draped over the cortex; think of travelling along the homunculus from its oldest represented body part on the outside bottom part, up and around to its most recent represented body part deep inside the medial sulcus.

As the gut tube starts to form, the anus end (proctodeum) forms first, then the mouth end forms (stomodeum) and a curtain is dropped down right away to separate the two; the rest of the gut will be built over the next several weeks, and these two end zones that are already in place will become widely separated. If you look at the cortical homunculi the anus is there on the outside of the brain, in number one position, the first (and most lateral) place, 'under' the number two part, the pharynx. The genitalia, bottom of the trunk, and legs form last in the embryo. We see the latterly formed body parts represented inside the medial sulcus. Embryology can help explain why anus and genitalia representations are so far apart on the cortical representative maps.

Anus is ectoderm, and has an obvious place in the sensory cortex. We need to be able to "sense" the process that happens there, and have some sort of conscious motor control of it, so that we can 'hold it' until we're not busy with something else. It likely evolved this way for all sorts of predator/prey, ‘waiting until we got away from danger’ sorts of reasons; however convenience is certainly an important feature in species that are as social as primates and humans, and appreciated in our companion species, e.g., dogs.

Next to develop is the neck and head, a big investment of time and embryonic resources. The neck, throat, mouth, face, rostral sensing apparatus (eyes, ears, nose, tongue), swallowing and breathing parts have to be built right, or survival will be drastically curtailed. Hence the throat and big lips/tongue/face on the homunculus, right after the anus.

At the 'top' of the brain maps are found the trunk and arms. Developmentally the hands poke out the neck zone first, and develop thumb first/little finger last. Then the arms grow longer, distal to proximal. All of this appears in proper sequence of ordinary depiction of the homunculi.

The trunk takes up little space on the homuncular maps. Why?

Anatomically a lot of trunk, the spine at any rate, (both representatively in the homunculus and anatomically in the actual body) is "covered up" by or overlapped with lats which are 'arm' muscles and traps which are branchiomeric (from the neck or cranium) muscles.

(I can't help but think it must be a bit confusing for the motor homunculus when the sensory homunculus has input from little dorsal cutaneous branches sticking out to the surface of the back, feeling the environment just fine, but the muscles that are run by the motor branches of those same nerves are buried completely by superficial sheet muscles. Could that be why back pain is so common?)

Legs come later after arms. My theory develops a problem here: I'm not sure why the knees are depicted curling around the central sulcus; feet and genitals are depicted close together, but feet come some time prior whereas genitalia is last to develop along with the thighs.

The feet actually form before the legs do, two little feet sticking out of the sides of the trunk with some primordial gentalia beween them. Then the feet shoot out from the body, carrying the peripheral nerves with them, and the legs grow to catch up, distal to proximal. Their representation is always shown down inside the sulcus. Perhaps the gentalia belongs there as it develops last of all, but I think on the homunculus the legs/knees should come after the feet, not before.

For my little theory to remain consistent with reality, more advanced future mapping will have to show arms and legs depicted as telescoped concentric rings, maybe ovoid, with the hands and feet in the center, all the rings touching on the lateralmost side. I would expect the representation of genitalia to be overlapped with the thigh representation, the medial side only.

In summary, the representations make more or less embryological sense just as they are. They can be reasonably considered a map of the body in the logical sequence in which it selfbuilds /unfolds, in both the classic sensory and motor cortical homunculi.

Motor activity is believed to be present before sensory pathways are built, so the sensory homunculus either may take its cues from the motor one right from the time of the unfoldment sequence, or possibly a lot of it is hardwired right from the start and simply awaits myelination.

Existence

In his book, Into the Cool, Eric Schneider discusses (along with co-writer Dorion Sagan) existence of life, both single and multi-cellular, from the perspective of the forces of nature needing a way to use up excess energy and create more entropy.

Working from the precept that "nature abhors a gradient," Into the Cool details how complex systems emerge, enlarge and reproduce in a world tending toward disorder.

Complex systems are both living and non-living; both obey the second law of thermodynamics.

This second law refers to energy's inevitable tendency to change from being concentrated in one place to becoming spread out over time. Although the second law is usually and correctly associated with molecular chaos - and thus with aging, loss and death - Schneider and Sagan show that it is also vital to life and complexity; it is behind evolution, ecology, economics and even life's origin.

There is a story behind the book's inception: Eric Schneider simply perceived that marine ecosystems needed deeper examination than what the current science culture was providing.

I feel the same way about the human organism, the fact that I also am one, quite aside for a moment: Is it not just another sort of ecosystem? Really? Does it not deserve the same sort of synthetic perspective, the same sort of respectful study and placement into the grander scheme of things?

Nerve lengthening

It's interesting to contemplate all the ways nerves can seem "shortened".. maybe it's a perceptual fantasy in a way, a finding that is nevertheless observable, measurable, play-withable and therefore has become conceptual fantasy as well. When we see a situation where a nerve seems "shortened", what are we actually "seeing"? Maybe we're just seeing that individual's brain's own perceptual fantasy, and getting caught up into that. As soon as that brain has changed its "mind" about what's going on out in the body, nerves seem to "lengthen" adequately along with most of the containment.

Skin stretching provides the sensorymotor cortex with new movement options IMHO. There could be some small or maybe not so small local physical effect... after all the PNS ends up, a lot of it, anchored in skin from below, miles and miles and miles of it.. easy to handle. One little stat about that, which unfortunately I can't confirm so far, is that each square centimetre of skin contains 3.54 metres of nerve. There are huge numbers of smooth muscle cells in skin.. It's never seemed much of a stretch for me (pun unintended) to imagine I can have a direct overriding effect on those by just planting my hands on someone, waiting for my fingerprints to stick onto their skin, then widening the distance between my hands slow and gentle, then waiting for up to 2 or 3 minutes, gathering up new slack once in awhile; you can practically feel the brain rushing in to take up residence again as you hold this process in process...but that's probably not even a sliver of what really happens. Given that the nervous system is built in a modular manner with old parts of high specificity as well as new plastic parts (Damasio), it takes time (but not too long) for the information to travel, sort itself and get into all the bits of brain that are relevant. But before long (perhaps 10 minutes) what needs to change, has, and entire body parts may clunk into new configurations while the patient lies there perfectly aware and relaxed and tracking. Bear in mind there has been very little verbal prep beforehand, just that the point of the treatment is to treat the nervous system, and the assurance that they will "feel" stuff, and that it's fine, and that it won't hurt. Frequently patients report that they can feel their limbs "get longer". Which makes me tend to think that there could well be some very funky homuncular shifts happening.

Whatever. Pain decreases. Thinking about all this stuff keeps me very engaged and engrossed in being a practitioner.

Dolor blog

Oh my gosh. This is a very, very good resource.
http://dolor.blogspot.com/

Adam, the blogger, is compiling materials for his doctrate. He looks at pain from all possible angles from outside in and from inside out. Did you know that there are five, that's right; five distinct kinds of congenital insensitivity to pain? Do you know why red-haired fair-skinned people are more sensitive to pain?

Did you know there was such a word as "pleonasm"? It means, superfluity of the verbal kind. The inverted word, "neoplasm," with which we are more familiar, means superfluity of the cellular kind.. (I love wordplay, please forgive.)
Link

November

Yesterday I felt a sense of relief that November was finally done and over with. A sudden flash of insight put things into perspective: The name should be changed to 'Yes'-vember... No-vember is just too negative sounding.

If there is a month of the year I particularly dread, it is this one. If life is one great big three-dimensional jig saw puzzle that we will never finish in time, November is that time of year when you sit there scanning for the right piece, staring at pieces that look like they should fit but don't make sense; you try to place a piece and realize you already have tried that piece in the same spot five times, and it never fit before, so why would it now.

My seasonal affective disorder is not especially emotional, although I do feel slightly crankier than at other times, and I hang out in front of a light box each morning.. I don't feel depressed exactly.. I perk up easily and can be led into having a good discussion. No.. this is a bit more.. hmm, cognitive. It's a sense of having a mental fog bank in the mind; the edges aren't as sharp and it's harder to keep a chain of thought linked through to a logical end. It's hard to think creatively. It's hard to find one's own familiar inner motivation. Thought becomes restricted to one thing at a time, whatever is in front of one's face, and whatever presents itself to one's face feels too much.. well, in one's face. Truly it is hard to see perspective; just as in fog objects loom due to way decreased focal length, in this state, life events loom suddenly without being able to access the usual anticipation/preparation time. And just as with fog, when you look behind at your chain of thought some of it seems to have disappeared, requiring extra effort and mental squinting to make out its shape. There's no other time of year that demands such trust that one will survive intact, than this time that feels so composty, entropic. Life becomes less an effortless pleasure and more a slog. Routine becomes both cage and comfort. It's restlessness coupled with torpor, lassitude coupled with longing.

The jigsaw puzzle analogy works in another way: Often you sit there staring at pieces and nothing works, you leave it, do something else for awhile. You come back, several hours later or maybe the next day, and inside ten minutes you've spotted and placed (effortlessly) twenty pieces. I think that must be an example of the power of gamma organization of the visual cortex. Same with this edgeless time of the year; distraction works wonders. A bit of brisk walking rights the world for awhile. Doing actual jigsaw puzzles helps too.

I find jigsaw puzzles the best therapy for this time of year. I did three to get through November, and noticed the rise and fall of my self-esteem as if it were a yo-yo whose string was attached to the successful outcome of putting pieces together into a neat rectangle with a coherent image. Thousand-piece puzzles seem to be about right. Highly recommended for winter blahs.

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.