Tuesday, March 28, 2017

Enminded body

I was recently entranced by Peter O'Sullivan's deft demonstrations of cognitive functional therapy at this year's San Diego Pain Summit. I wrote about him, here. I also went through his keynote presentation carefully and took screenshots of his slides, adding his comments, posted those to facebook and twitter. One of these days I will gather them all up and make another blogpost.
There were WAY more presenters and speakers than Peter though, and in case you were wondering, I have not stopped examining all the wonderful material from that summit; I'm simply sidetracked by life itself these days, getting ready for the classes coming up in Europe in a few weeks. 


This post is an interlude, a slight diversion about something else:
I see a lot of books and papers to do with embodied mind, and I want to turn it around for those of us who treat people in pain because I think it makes more sense that way. 

Therefore, let's consider the enminded body. 

Here was the impetus:

The host for the class in Rio at the end of June, sent me this today, an open access paper: Reflections on osteopathic fascia treatment in the peripheral nervous system. It is the epitome of a tissue-based reflection on manual treatment that stopped me in my tracks because right inside the paper it refers to clinical practitioners as "operators". 

Which, by inference, means the patient is being regarded as no more than a stretchy, still-warm corpse.
I mean, isn't that what you will have to turn into (hopefully with the help of a good anesthesiologist) if you submit to having an "operation"? On your tissue?
Which is fine if someone has to cut into you to save your life or limb..
But that is not what happens, not what should happen, in therapy settings.

Seeing people as fascia that happens to be animated does them no great service. 

Fascia isn't even alive - it's comprised of materials, strings of extracellular material, that were extruded from living cells.
If living body cells are the smallest units of human life, fascia doesn't even rise to THAT bar. If it's extracellular, by definition it's not really "alive."
What IS alive are neurons, embedded in it..

Anyway, I digress. It was a shock to see something this much against the grain. So physical, not therapist. SO FAR away from what Peter is all about, which is interactivity, intersubjectivity.

Just for convenience sake, here is the published letter that Jason Silvernail and I submitted a few years ago, Therapist as operator or interactor? Moving beyond the technique.
You may remember Jason as the guy associated with the phrase "Crossing the Chasm". 

Here is something I whipped up about that.

A new slide for 2017 presentations

Here is the original I had written earlier: 
What is the operator model? What is the interactor model?

I think a conscious aware person in pain is going to come in to see people like us because they want therapy, perhaps therapy that's a bit physical. 
They will not be anesthetized. 
Our attitude should have evolved by now into not viewing them as some sort of mere assemblage of collagen.

Quite possibly clinicians are trying hard to be completely objective, and think being strictly anatomical in their externalized views will make them appear that way, but c'mon... seriously: there is nothing more variable (probably) than individual anatomy, and as clinicians we have NO way of knowing any individual's anatomy when they come in to see us. 

All we can do is try to help them move toward having less pain and better movement. That's it.
They are enminded bodies, and they are not so happy about it when pain is what has become enminded in their bodies. And they don't know it. They think their bodies are still broken or fragile or deranged somehow, structurally, thanks to well-meaning but misguided and mis-guiding treatment models based on anatomical dissections and imaging studies that show in glaring detail every little bit of frayed whatever going on it there and blaming it for "pain".

I think that the tissue-based biomedical attitudes so well reflected in the osteopathic treatment paper, and so ubiquitous, are likely a cover-up for deep seated insecurities of the operators who are disinclined to treat their patients as fellow humans with pain problems (enminded bodies): instead they prefer to see them as chunks of walking anatomy and tissue (embodied minds?). Feels less messy or threatening to their own sense of self, perhaps. Creates a more comfortable distance between I and thou.

So, it's a subtle thing in terms of manual therapy. 

Do we treat people as embodied minds? 
Or do we treat them as enminded bodies?

I like the latter better than the former. 

If I'm thinking of my patient as an embodied mind I would likely expect them to take care of handling any discomfort my treatment might inflict, either inadvertently or deliberately.

If I take the position that my patient's mind extends all the way to the ends of the neurons in their skin surface (patient as an enminded body, especially someone in pain with a sensitized peripheral nervous system), I'll be more apt to be careful and conscientious in my application of physical forces, more inclined to slow down and be interactive with their nervous system, more open to feel it as it fixes itself, takes down its own unnecessary positive feedback loops, changes its own physiology, permits softening, warming, effortlessness of movement once again. 

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