Saturday, December 31, 2011






Thursday, December 29, 2011

Over the hump


1. Winter solstice has come and gone.












Sunday, December 25, 2011

And here we go again

... Another trip round the sun.

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

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

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

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

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

Friday, December 23, 2011

Consciousness and control

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

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

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

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

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

Tuesday, December 20, 2011

Longest darkest night of the year

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

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

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

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

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

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

 It's still perking right along. 

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

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

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

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


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

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

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

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

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

Saturday, December 17, 2011

"Contextual Architect" - Cory Blickenstaff

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

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

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

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

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

Monday, November 28, 2011

A little bit closer..

I blogged a bit about my new space, Almost there. It's the time of year when I feel the most blah, and I feel blah, even though I do seem to have enough steam build-up-ability to get through the days. The weather's pretty good, above zero and dry streets, blue skies, so that helps, a lot..

Today it occurred to me I'd need business cheques, so I stopped in and got a new business account started. It also occurred to me I was going to need a phone for that groovy new phone number I'm supposed to be getting tomorrow, so I stopped in and bought one at the local Sask-Tel store. I got new business cards and new stationary and three signs, one for each outside door and one for my own door, ordered.

On the whole, a busy day and a fair bit accomplished.

Yet I feel so blah. On the inside.

I suppose it doesn't matter two slices of bread around the outside of a sandwich how I feel, inside. The miracle is, I can function OK. I can get up early on a Monday, go to the "gym", work out, come home, go out and do errands, on foot, remember things that need to be done, do them, come home and sit and puzzle over why it all feels so.. blah to me. I just do not feel any thrill inside about any of this. I think part of me is still disgruntled at myself for having caved 4-5 years ago with SAD, and for dragging it back to a place it thought it had escaped and would never have to go back to except to visit.

Whatever. I'll get through this. I usually do. None of it really matters, what matters is that I create a new frame around what it is I do, treat pain in other people, and get on with it, and not ruminate on any small bits of it overmuch. Because, really, none of it, in and of itself, matters much at all. In the treatment moments, when someone will come in, and I treat them, and they get that "aha" look over their face, that will make all of this worth it.

I could have just continued treating other patients for other people and letting those faces show me their "aha" looks. But you know what? I really do not like working for and around other people much at all anymore. I don't have much to say to them, I'm kinda-sorta not very interested in whatever it is they think they have to say to me, and I'm not especially interested in any deep bonding with any of them. The only thing I live for anymore is that "aha" look on my patients' faces. And I can arrange my life to have less intrusive interruption, more quiet space for "aha"'s to appear. So, that's why. That's my motivation. No-frill, no-thrill (for me) motivation.

In other news, I've been going to the "gym" every day. I've lost 25 inches, about 15 pounds. So that's nice. It would be nice if "feeling great" would kick in one of these days.

Sunday, November 27, 2011

Why Things Hurt: Lorimer Moseley TEDxTalk

Lorimer Moseley did a TEDx talk recently about 'why things hurt' - here it is - just 15 minutes long. Lorimer is great speaker - his snakebite story is legendary by now.

Friday, November 25, 2011

Almost there

Today I popped in to my new 'location', a room I've rented in a neighbourhood spa. I'm a completely independent operator, just renting a room there, not affiliated with the spa in any way; just paying rent.

It's been a slow process - the phone isn't quite hooked up yet. Sask-Tel has to be the slowest phone company the world has ever seen. I have had the room rented from Nov 1st, but getting a phone hooked up seems to take a full 3 weeks. The line won't be in until the 29th, in the afternoon. But once it is, I'll be able to move in.

The office store here in town outfitted me with a desk, a desk chair, some waiting room chairs, a file cabinet (three drawer lateral).  I have to keep patient files for 10 years in this province. Ten. YearsTEN!.. so I got a long file cabinet, which will hold many. But it's a good thing I have also outdoor storerooms off my balcony at home to use if needed.

Still to come: a treatment table. It won't arrive until in January sometime. It is an official osteopathic table, coming all the way from Belgium via Quebec, a company called "Gymna". I saw the bed in Whistler, in the trade fair at Congress in July, and fell in love. It has a head rest that bends completely down, completely out of the way, arm and shoulder pieces that can be moved away to allow full, comfortable, prone-lie arm-hang, nice high density foam cushiness, a heating option, some sort of thing you can stick in to rest your elbows on, and best of all, a foot rail that goes all the way round the bed, with which you can raise the bed up or down from any location. No more having to interrupt a treatment in order to find the stupid foot plate, which is always somewhere outside foot range and on the other side of the bed, which means you have to let go of your patient, interrupting the incredible insight into his or her physiology you've just wandered into, go back into regular brain mode, get up and go looking for it. Treatment interruptus. I'm really looking forward to this baby, I can tell you. Meanwhile, though, I'll be borrowing a regular no-frills massage table. Which, although not easily adjustable, will be just fine for a few weeks. It will be a terracotta colour.

Another thing I'm waiting on is a panel, a room divider, which will be moveable, covered in tasteful low-maintenance fabric, and will separate the 'office' part of the room from the 'treatment' part: such luxury.

Anyway, today I went in for the first time since the furniture was delivered last night. Ken, the office guy, had very kindly assembled the desk, and the chairs,  for me! Such a kindness.

The room has been repainted; it used to be some sort of turquoise, which I can't stand on walls, but now is a warm tan colour, much more livable. The desk is a rich reddish cherry colour, with drawers that lock; the floor is a heavy durable brownish lino or vinyl tile with reddish and tan patches. Yes, this will all work, I think. We will work on getting a window installed, to get in a bit of natural light; until that happens I'll have to use a lamp. We'll see how that goes. If a window doesn't appear, and a few years slip by, I'll have to move to somewhere with a window. There is a glass block window into the hallway which lets a bit of natural light in from the outside door not far away, but it won't be nearly enough.

I have the keys now, so it all feels a lot more real now.

Saturday, November 19, 2011


Just because it's tough out there and we're all here to help each other.

Friday, November 18, 2011

Not for sissies

It struck me today that being a human awareness inside a humanantigravitysuit or any sort of awareness inside any biological kind of antigravity suit is not for sissies. Which is why, I suppose, that defensive mechanisms evolved in the first place.

The nervous system is not monolithic.
I say this every day to patients, as I try to help them understand what the inside of themselves, the inside of their own operating system, is like.
I tell them a story about how it's like a farmhouse that might have started out as a simple cottage in the days before electricity, but that over the decades new bits were added, a second story, a garage here, a new wing there. Before long the original cottage was completely buried by additions. Had it been an actual farmhouse, the sensible thing would be tear it down and start completely over with new wiring and plumbing. However, as a nervous system, it didn't turn out that way: nature never got rid of anything neurological, it just added more layers over top.
So, now we have the original, probably the enteric system, autonomic system, and a bit of somatomotor, covered over by faster, bigger, more complex inhibition systems.

Skin is weird, because it comes from ectoderm, as do all the nerves. Neural crest cells make up all the nerves that go to and from skin, as well as - get this - they make teeth. Teeth. I read earlier today that teeth evolved from skin. Or at least, from neural crest cells in skin. Or, at least, outside the mouth, which makes good sense, if the whole point of life and its evolution is to transform energy from one form/state to another to reduce energy gradients. I mean, to transform other organisms into sources of energy, it's necessary to rip them into tiny bits to be digested.. teeth come in handy, whether inside or outside the "mouth"..

Exaptation accounts for a lot of the preservation one sees in nervous system function.

Seth Grant in Australia has built an entire career on studying synaptic proteins, some of which have been conserved from original yeast-like single-cell ancestors.

Take-home point: Nature does not toss out anything that has proven useful, especially when it has to do with the operating system, i.e., the nervous system.

So, we ended up keeping everything that was there from the beginning, and added on. Now we have brains five times bigger than they need to be to run a creature/humanantigravitysuit our size. They suck away 20% of all our metabolic energy. Even though they comprise only 2% of our physicality. A measly 2%. Sucks up 20% of the energy. Think about it. It's no wonder we get distracted.

So, I was thinking, to actually turn it around enough to pay inward attention to our bodies, themselves, the physical creatures we inhabit, with attention and awareness, is so different from normal life, so ... non-social, kind of, so... outside a culture that pays the body almost no mind except to dress it up, or have it relate socially. To go in there just to find out how it's feeling, just out of interest, is not really supported by this culture. This generic North American culture. This culture is anything but introspective. Anything but intero-spective.

So, I'm thinking it takes courage.
It takes courage to go in and check interoceptive systems.
No wonder, then, that cultural systems that appear to have successfully navigated these strange waters are adopted holus-bolus, for the most part - things like yoga, meditation, acupuncture - with no translation. They are interoceptive practices, and mostly non-verbal therefore, anyway, except for the packaging, which is usually spiritual veneer of one sort or another.

What happens when a nervous system is probed, even by the awareness it gave rise to? Well, it might be important to remember that in any given individual parts of the nervous system may not get along with each other perfectly. If you are an "I" illusion inhabiting a particular brain, and you decide one day that you want to probe your own interoception, and your culture has never supported such a notion or behaviour, you find yourself swimming against a tide. You either graft a system onto yourself or you go it alone. You may find yourself outfitting yourself in yoga pants and learning a lot of polysyllabic words in a foreign language, or learning mantras and about mandalas, or learning strange non-existent non-anatomical body systems. To go it alone is preferable in my opinion, but may still require some outside support from a patient observer/coach from time to time. Most people won't bother doing any of this stuff until such time as they are unfortunate enough to sustain a pain episode, at which time it will suddenly be the only way out of the cage.

No matter what, anxiety will be a feature. If you are exploring by yourself, you will learn that deep breathing will take care of a lot of the anxiety, and will smooth out the process. You have to make yourself keep going back, though, until the behaviour becomes pleasurable enough to motivate you by itself. You could think of it as getting to know your inner zoo, all the creatures your antigravitysuit evolved through on its way to becoming human. You have to be careful not to spook any of them. Or yourself.
If you use one of the cultural adaptations, you have to adapt yourself to them. Which is fine, I suppose, until/unless cognitive dissonance interferes. Which it may well do, sooner or later, Which is why I personally choose/recommend the go-it-alone method.

If pain has driven you into the corner of your own existence and has forced you to become interoceptive just to get through the day, I feel for you - I really do. Deep breathing will still help, plus it will be of use to find yourself a caring human primate social groomer who vows not to create more suffering for you to have to endure, but will stand by you as you find your way out of the gloomy forest of being lost inside your own physicality with a suddenly heavy humanantigravitysuit that doesn't work right, and a nervous system that no longer feels like "you", but instead feels like a bunch of alien creatures biting at you.

Tuesday, November 15, 2011

Our fellow vertebrate creatures

Saw this earlier tonight: Fin massage relieves stress in surgeonfish
Another piece supporting the idea that social grooming provides stress relief, in vertebrates, from fish to humans. (Still not sure about reptiles.)

Further to a manual therapy theme, George Takei, who played Sulu on Star Trek, and who posts plenty of whimsey on Facebook, posted this picture.  I do not know the original source.

It has manual therapy logo possibility. Rabbits are vertebrates. Humans are vertebrates. Vertebrates evolved social grooming. Manual therapy is human primate social grooming. I like the possibilities.

Saturday, November 05, 2011

Just because these links are so good

Check out Hyperbole and a Half (Allie Brosh's) blogpost on depression. 

Looking on the bright side, eventually everything changes, even old incredibly self-flattering and self-reinforcing institutions. Maybe it's true that there is a season for everything, that everything eventually crumbles, and that in and of itself, hey, that's not so bad.

More about empathy:

Sunday, October 30, 2011

Empathy comes in different flavours

Empathy and Evolution, a blogpost spotted today. It discusses various flavours of empathy, its expression during development and outward into the social sphere.

The sorting into various flavours interested me most.
Psychologists distinguish two main components of empathy: cognitive empathy (knowing another person’s thoughts and beliefs) and affective empathy (knowing another person’s feelings and emotions).
The degree of empathy we have for others can be found on a spectrum. At lower ends, empathy only requires that we are aware of other people’s thoughts and feelings. But at higher ends of the spectrum, empathy may include actually experiencing one’s situation as if it was our own.
Some experts on empathy, such as emotion researcher Paul Ekman, say that these higher levels of empathy lead to a third kind of empathy: compassionate empathy, where we are so attuned to the thoughts and feelings of others that we are driven to alleviate their pain and suffering through kindness and charity.

 My bold. What if one has off the chart extreme empathy in one flavour, and not much in another? I feel other peoples' pain all the time. I've had to build strong boundaries in myself, around my insular cortex, in order to do what I have to do in life, which is to treat it in other people.

When I say, "have to", I don't mean that someone held a gun to my head and forced me into this line of work; rather, I mean, I was driven into it for completely self-contained reasons, chief among them to learn as much as I could about pain in order to be ready for when and if I ever needed to combat it in myself. (A situation in which I eventually found myself, and successfully won, so it all paid off.)

This coming week, I'll fly to Winnipeg to attend a workshop by Michael Sullivan, on progressive goal attainment. This involves careful attention to the "cognitive empathy" side of the scale, learning the thoughts and beliefs of another, helping them separate those from their feelings and emotions. It's for sure outside manual therapy kinds of "helping", but I think I'm ready to learn more about it and weave it in. Some might wonder what took me so long. To that, all I'd be able to answer would be, "better late than never" and, "I'm a late bloomer".

Monday, October 10, 2011


Crude graph made in photoshop.
Happy-ness has more chance to develop/exist if red and blue lines are deliberately kept separated.

I'm pretty sure "happiness" isn't a feeling, or a mood or even solely a personality trait; I think it might just be a measure of the gap one can create between something called "stress" and something else called "capacity to regulate stress response".  So, happiness is an achievement, perhaps, for anyone prone to depression. Here's the reasoning, broken into sections:

Stress is not a fixed thing. It's a relationship one's nervous system has with existence.
Some stress is necessary or the brain will just sit there and do nothing - it won't learn. It won't remain flexible and adaptive.
Too much stress will make it adapt badly. It will impair the brain sooner or later.
Stress is described as an upside-down "U" function - an optimal amount helps one navigate life, if not with pleasure, at least with a sense of success rather than defeat. (I've read and learned much from all the articles in  Nature Reviews Neuroscience: Focus on Stress [2009])

One can manipulate, if not stress itself, stress-ors.. mostly by avoiding them or reducing them or eliminating them. What might be some stressors easily eliminated? Oh, most TV shows, smoking, drinking alcohol, etc.
Likewise, hanging around people who belittle you in any other way, or do not enhance your mental or physical life, is counterproductive, best avoided I find, at least for me.

E.g., I find boredom very stressful.

Freedom from the stress of boredom
If left to myself, I'm not bored. I can find things to do and read and think about. I can watch my brain machinate its way through perceived conundrums. I can plan (although I don't really like to be attached to plans, because plans have to fight a lot of external resistance and get changed as a result, much of the time) and organize (something else I'm not all that attached to) and learn (something I never get tired of) and think (about anything, everything) and write (about anything, everything). Or just breathe and not have to do anything with my brain. Unencumbered.

Social stress, boredom
I find it immensely stressful to be around people I consider boring, and I find most 'socializing for the sake of socializing', boring, so I am mostly a solitary hermit. I've never married or had children, because I find routine (outside my own easily changeable personal routines) extremely boring; the very thought of harnessing myself into a small group of other human primates forever dependent on my personal involvement with them, freaked me out completely as a young woman, so I just never went there or did that.
Now as I look back on life from the ripe old age of 60, I appreciate the instinct that kept me unattached, and the way I chose to combat and navigate but not give into competing instincts, such as wanting to belong somewhere or find 'lasting romance': I did live with someone for three years (ran a simulation of what marriage might be like); nice man, satisfying relationship in most of the important ways (from the perspective of a 22-year-old healthy female), but in the end found it boring and therefore stressful.
Having to continuously adapt to other peoples' needs and wants in exchange for 'belonging' to a domestic arrangement was something I knew intrinsically that I'd never ever be able to pull off successfully. It never looked like it would be a good bargain. I had instinctive fear of the avalanche of expectation that surrounds ordinary social domesticity. My nervous system's threat detectors have been allergic to social norms, and have therefore sounded pretty much continuously, all my life.

It's Thanksgiving here in Canada; it seems appropriate to include the fact that every day of my life I'm grateful that since I had to come into existence in the first place, with such strong personal proclivities in the second place, it was into a culture and era that permitted me, a woman, to retain control of my own physicality, in particular that physicality residing below the waist (...and enjoy it too, when/if I wanted..).
Most important has been social autonomy. I was born at a time when I learned I had the right to bodily autonomy, enjoyment of physicality, to wear whatever was/is comfortable, sensible shoes, no make-up. Or, on the other hand, the right to dress like a female caricature if I felt like it. Which I did sometimes, mostly in order to escape notice, to blend in, feel more invisible and be able to 'compete' successfully. Not that I ever won any prizes for looks, or captured any trophies of any other kind (a vision comes to mind of a marriage partner mounted like a deer head over the mantle, but more likely a spouse would be sitting on the couch, quite alive, watching sports no doubt..)
In most cultures on the planet, girls are groomed from birth to adapt to the fact that they are destined to become someone else's reproductive livestock, uteruses with arms and legs, that their humanantigravitysuits are not strictly their own - that instead, they do not have any right to enjoy ownership of their bodies, specifically from the waist down, ever, and usually not the space between their ears/above their eyes, either.
My family gently hinted at this, but never did I feel coerced toward enacting such a role. My life was mine to live however I chose - my body, all of it, was mine to do with as I wished, and the culture of the 1960's and 70's that surrounded me as an emerging biological woman made it real.
For this freedom, which I realize now is a true happiness, I'll be forever grateful to my mother. I think my dad probably had more restrictive, more male-biased, protestant-tent-religion-based, traditional views on the matter, but my mother, a lapsed catholic who never displayed any ambition beyond keeping a home and raising a family, somehow still managed to keep enough space open for me to run away through, out to 'freedom from family'. She has probably never really reflected on why she did that. I certainly have disappointed her in almost every way imaginable from an interpersonal or social point of view; I'm pretty sure she likely expected her oldest daughter to heave to eventually and contribute my share to the planet's overpopulation problem; but I never did - instead I took total advantage of the opening out into the brave new feminist-hardfought-and-won world of female autonomy, and sailed away.
On the other hand, it may have been that she just didn't care; I think the fact her first-born happened to be female, not male, disappointed her, and so it didn't really matter to her what I turned out like, as long as I didn't do anything too egregious like end up an unwed mother or in jail. Still, I remain grateful that she wasn't as overbearing as she could have been.
I did not copy her life, only half her genome. During all the years she spent on care and feeding and cajoling and 'training' (as she called it), and encouraging me at schoolwork, I also absorbed years of watching her be content with cooking/baking/cleaning/laundry/hanging clothes out on a clothesline/enjoying herself in the evening by knitting/crocheting/sewing/doing petit point/etc., reading "ladies'" lifestyle magazines (the only reading material that ever made its way into our family home, beside my dad's Commonwealth newspapers), and.. found it utterly boring. I repaid her maternal investment by not reenacting her existence.
Some judgey little part of myself, some mirror neuron biological part, no doubt, feels (weirdly to me) bereft, and despises me for what it considers selfish ingratitude, based on my having not replicated family life. But the rest of me forgives myself and moves along, knowing full well it would never have had a chance to surface at all, had things not gone the way they did. Plus, I spared all my unborn children the fate of having a mother who would have found child-rearing utterly boring and probably intolerable. I spared them the chore of existence itself. I spared them having to put up with someone as capricious and depressive as I, from being their mother. I saved myself (and them) a lot of stress. Furthermore, I made a colossal forward payment on my own carbon footprint by not replicating any more people.

Learning how to increase this has also been found to help to widen the proposed happy-gap.
It's something I'm finally getting around to, now that I know how crappy (opposite of happy) life can feel when this capacity diminishes. The single biggest ingredient of maintaining this capacity is regular exercise, so I'm led to believe.
Now, I haven't been exercising on a regular basis long enough to find out how I and me and myself will adapt to it - for now, it's still a stressor and therefore has not widened any discernible gap. But  I do have faith it can, and will, based on a bunch of stuff I read about the endless benefits of exercise on physiology and brain health, and that it's never too late.
For the moment, I'm content that I finally discovered a place in which I can exercise with minimal psychosocial stress from exercise itself. I mean, there's still the issue of having to be in the same room as a bunch of other women, and having to put up with music I don't enjoy (this is Weyburn; country music about neon signs and green tractors etc. is mixed up with Katy Perry and Lady Gaga; on the plus side, it's a women's gym, so I have not noticed any loud head-banger music).  In spite of minor distractions (music which I could avoid if I wanted by using an iPod or something) it feels like this is some sort of turning point for me, that someday soon I could actually enjoy exercise (i.e., not find it boring, or nociceptive), and instead of going through life just reducing stress at one end, I could increase the happy-gap from the other end too.

Saturday, October 01, 2011

Fixing up my own humanantigravitysuit

After two years and two winters of bracing winter air and sun,  I have been feeling much better, ready to resume the overhaul on my own physicality I started 4 years ago. I lost a bunch of weight, then plateaued out for the last couple years, seemingly unable to overcome the inertia that would be involved in increasing daily aerobic exercise. The diet has been fairly good, weight maintained, but no more coming off. But I think I found the solution. Very conveniently located, a few blocks from where I live, a place for women like me opened up just a year ago, a nice clean, fresh-smelling place, a franchise called Inches A-Weigh. So, I joined last month, and so far, it's perfect.

The deal is, you pay a bunch of money, go into a program of cognitive behavioural therapy around food choice, follow a restricted calorie plan, be strictly accountable, hand in your food diary and be "counselled",  regularly weighed (twice/week) and measured (every two weeks) for several months, eat their protein snacks (included), and work out on their equipment for 20 minutes, at least 3x/week, or as often/long as you want. There are elliptical machines, treadmills, and stationary bikes, all good quality and smoothly operating. There are TVs in front of the bank of machines, with DVDs of movies with subtitles looping all day long. No mirrors. None. Except in the bathroom over the sink.

OK, no big whup so far.. but there is another thing they offer, which I instantly became addicted to - along the other wall are a bank of beds that move you around, bend you, shake you, pummel the body. They feel fantastic. You do plenty of "exercise" on them, i.e., keep the abs tight, keep certain muscles contracted, arms overhead, etc. Sort of Pilates Lite. For the first several weeks that's the program. Then they increase the stuff you do on the beds, make it more complicated, adding heavy balls and light hand weights.

What I like is the feeling of being tossed around, 6 minutes per bed, 7 beds, a total of about 45 minutes. After that I feel good enough physically that putting out a 30-minute effort on the cardio equipment is no longer a daunting prospect. I think all the jiggling likely stimulates endogenous opioid systems or something.

What I know for sure is this: exercise never ever ever felt good to me before. I have a nervous system that always has found exercise painful, daunting, boring, an exercise in futility, incapable of dredging up the will power after a couple weeks, no intrinsic motivation to do any regularly, ever. In other words, exercise has never ever been a source of joy or pleasure or intrinsic motivation, the way it seems to be for people who seem to be comprised only of large bungee cords, and whose surface layer does not feel heavy or sensitive to them. So, the under-exercised corner of life was the one I found I had painted myself into, trapped by paint that refused to dry. 

I think I (and many many others, mainly female) have more "feeling" (interoception) than bungee cord people do. I think the beds must anesthetize me/my interoception or something. Then, sure, I can go on some cardio thingy and spend a half hour keeping my heart rate up - I have even started liking the elliptical; never in my life before have I managed more than a couple minutes on one of those things. But one day, I found I had Achilles tendons that could recoil all by themselves! Nice thing to finally be able to feel, at my advanced middle age. I've been going every day. Moi! Maybe by spring I'll be thinner-looking and have a much more fit CV system.

Sunday, September 04, 2011

About treatment boundaries

Yesterday, I commented about treatment boundaries in this post. I want to elaborate. I want to explain how explaining pain to a patient can be woven straight into the constructing a safe psychological, social, therapeutic container to work within, while utilizing physical contact.

Guys, especially, seem very reluctant to take on gentle manual therapy. They are concerned they could be misinterpreted. (Maybe this is why they seem to head off in large droves toward ortho and other structural, manipulative technical approaches and away from physiological change approaches - they don't want their physical contact to be misunderstood.)
I say, then, make the situation be completely transparent. Ask for and get permission every step of the way. 

Let's say you had a patient with some kind of pain problem. Let's make you a guy, and the patient female. Let's make her a tough case: anxious, known drug user/abuser. Chances are, you are scared of using gentle manual therapy. You worry that she might cling, rapidly become dependent.

You can avoid any danger of creating dependency by setting a simple but firm treatment boundary: Something like:

"We could try to help the part of the brain that is making the pain figure out a way to stop. I'd like to try some hands-on work, if that would be OK with you. (Pause and wait for an indication the patient is interested.)

"It may help, although I wouldn't know for sure, without us trying it first - it helps most people in a pretty straightforward way; what I am sure about is that if it we do a few sessions and it hasn't helped yet (changed the pain significantly right away, so that it is less severe, less bothersome, less frequent, stays away for longer periods of time, one of those things or some combination of those things) then it wouldn't be worth pursuing further. 
"I'm saying, it's something we could try, and see what happens, and if it doesn't help, we haven't really lost anything by trying. So, what do you think? Would you be interested in seeing if it could help your brain to stop giving you this foot (or back, or leg, or arm) pain?" (Pause and wait for an indication the patient is interested)
The next set of treatment boundaries involves explaining the patient's nervous system and how it mounts a pain presentation. This does a number of things:
1. It explains pain to the cognitive part of the patient's brain, which will give her the idea that you consider her worthy of learning it and capable of understanding it (respect).

2. It creates a conceptualization that "she" is something apart from the rest of her own brain, that you would ask for her cooperation in helping you, so that together, you (plural) can detach from the pain, watch the nervous system (with minimal input from you) solve the "problem" which is something in the rest of the nervous system (recruitment of patient's cooperation, mostly her dorsolateral prefrontal cortex).

3. It also gives her non-conscious brain time to mount reward expectation mechanisms and dopamine (if she has any of her own left), all that anticipation stuff. This wouldn't be a bad place to reassure her that you aren't going to hurt her with your handling, that you want her to tell you if anything you do, any grip, feels uncomfortable to her, because you aren't in there and can't feel her nervous system the way she can, and you certainly can't feel her pain experience, only its manifestations. So you are relying on her to help. You don't think it's prudent to have her nervous system, which is a learning machine, learning to have to deal with more pain, associated with you - your job, as you see it, is to help it learn how to feel less pain.(You are assigning her a job, a role, and indicating that she has locus of control over your handling, are giving her veto control over it, and therefore over all your physical contact with her.)
The third set of treatment boundaries involves explaining the actual physical contact, what position you would like her to lie down in, what you are going to touch, how you are going to land, then what you're going to do once you've landed, what she can expect, what you'd like her to pay attention to, to breath, etc. Then before you actually touch her, ask her permission one more time.

These are little things, mostly good manners, but they add up into setting a treatment relationship/contract that is OK for either of you to walk away from at any time. It's egalitarian and fair. It should not give her any opening to become a cling-on.  It permits the dance between nervous systems to develop to the point of helping the patient get out of the way such that his or her nervous system can resolve its problem, can fix itself, all the while, as you provide it with clear, boundaried messages and feedback, both verbal and kinesthetic, and ask for the same from the patient.

You have the right to end the (manual) treatment relationship if you sense it's not helping, and she knows from what you've said, that she has to carry a lot of responsibility for any success, and her nervous system carries the rest; if she doesn't get this, then I'd recommend stop manually treating her and move to other management methods.

Saturday, September 03, 2011

What we don't even know that we don't know


LINK ->>>  What Do We Know For Sure, Really? (For therapists)

The blog post is by Alice Sanvito, at, a thoughtful massage therapist, interviewed lately by Will Stewart (who calls himself thrill96) on his blog-radio show:  Russian Massage and Neuroscience: Interview w/ Alice Sanvito.

Alice is somebody who isn't afraid to change, who isn't afraid to think about things a bit differently, who isn't afraid of the unknown or of uncertainty. It's a rare quality in a manual therapist - most want to convey the impression that they are experts. Much of the time, I imagine, a patient can feel a level of expertise through their own somatosensory afferent system. If the attitude and the handling don't match, I think it's better that the handling be "expert" rather than the claim.

What constitutes "expert" handling? Well, every nervous system is different. Every pain problem is as unique as the person's fingerprints. So, rather than claiming some sort of "expertise" in some technique or other, i.e., a set of cookbook approaches learned at a class, it's way better to stay humble, let treatment be at the pace of the nervous system with which one's own is interacting, let treatment be more about exploring than performing, watch for settling, watch for deepening of breathing, watch for long periods of silence, encourage the same without being dominating. One lets processes occur until they stop. These are easy to feel through sensitive aware handling - warming, softening, sense of lengthening, pulsing, etc. All these indicate nervous system corrections. Let the patient become fascinated with feeling their own body's life. Let them describe what they can sense. Much of it will be a surprise to them. Give them room to enjoy new afferent experiencing, the feelings that arise when nervous systems self-correct in response to the most minimal and non-invasive input you can manage. 

How does one become "expert" at handling another's nervous system? One learns manners, and boundaries, remembering to "ask permission", not just verbally but also kinesthetically. One maintains these throughout the entire therapeutic encounter. One adapts, matches oneself to the patient. Something as simple as learning to separate one's own breathing from one's own contact with the patient can buffer a lot of unintentional "noise" from a nervous system that is sensitive. This means, literally being aware of your own breath and controlling it, or resting elbows somehow so that breathing motion doesn't travel all the way down your arms to the patient's body. Little things like that. 

Thank you, Alice Sanvito, for being a fellow traveler in the world of deepening into whatever it is we do. I don't think we can, or ever will, know anything for sure, because manual therapy is a verb, in the moment, not a noun, ever, in spite of how many conceptualizations are dreamed up to try to package it or analyze it or measure it scientifically. One thing is for sure, though: we cannot "touch" (directly) anything but the nervous system, as represented in the skin. All the rest is stuff we make up, an "as if" story.

Thursday, September 01, 2011

Understanding Pain and what to do about it in less than 5 minutes.

GREAT little video on YouTube - Understanding Pain and What to do about it in less than 5 minutes. on Facebook posted by Sandy Hilton, PT and Noigroup.

"We now know that pain is 100% produced by the brain!"

Unfortunately I can't embed it, can't find the code anywhere. So click on the link to see it on YouTube - well worth the minor effort. ---> LINK

Thursday, August 18, 2011

Dunbar on social grooming in primates and humans


This is a (free access, download 9-page pdf) paper by RIM Dunbar of primatologist fame. Along with Robert Sapolsky I've learned more about human nervous systems from him than I ever knew from studying PT.

Studying PT is being trained in how to use a toy pail and shovel. A lot of effort goes into explaining what shovels do and what pails are for, and how to scoop and dump, but almost no emphasis is placed on the vision of the huge expanse of beach one has been set loose to tackle, or what kind of castle to build, or the nature of sand itself, or how long one can expect to have to dig, or how easy it is for the sand castles to be washed back out to sea. 

Once out on the beach, one generally heads over to where other castles are already under construction, and gets a job helping. Sometimes PTs head off to a secluded part of the beach and figure out how to make their own castle. Some PTs go into the business of making and selling ever more attractive pails and shovels, pointing out the inadequacies of the ones that exist. Many never ever get that building castles is futile altogether. 

Long ago I threw away the pail and shovel, walked down the beach to the water, went into it, and figured out how to swim. I took all the time needed to learn properties of water, learn to float, swim, with and without goggles, learn to avoid sharks and other predators, and how to stay warm even as water sucks at my core temperature. It's been a very engaging life; even if it doesn't look like it has amounted to much from the outside, on the inside I'm very contented and feel fulfilled, all that. I love being a human primate social groomer, swimming around in other peoples' nervous systems, most of the time, most days.


Tuesday, August 16, 2011

Killing Pain Part VI

Almost back to normal. I can now sleep comfortably on all sides.

I am including a picture of a slide I made for a presentation in June - it contains a very intriguing cylindrical 3-D image of how convoluted a nerve (which just happens to be musculocutaneous) is, inside its tunnel. They really do look like roots.

It's important to bear in mind these are comprised of neurons, each one of which, if its soma were the size of a tennis ball the axon would be a half mile long and the size of a garden hose, according to Jack Nolte, a neuroanatomist. Well, OK, he was talking about a motor neuron, from the spine to the big toe, but you can see the proportion. Maybe in the arm we'd be talking a quarter-mile long. That would still be a pretty long garden hose.

One can imagine that unrelenting stress on a noodle-y system like that would affect its vascular supply adversely. Eventually. One can think of adaptation, I think, as a bunch of nested buckets. The mechanical stress would be like a slow drip into the center smallest bucket; after a time it would overflow and the next bucket would start to fill. It might take a long time, but eventually, the last and largest bucket would fill and spill - then the system would mount an alarm strong enough to get one's attention. I think that's how it went down in my case.

I managed to find somebody to help me empty out the buckets again. Whew.

Killing Pain Part V
Killing Pain Part IV
Killing Pain Part III
Killing Pain Part II
Killing Pain
Somasimple discussion thread about this post series.  
Scientific American: Anger Gives You a Creative Boost
This article is about interpersonal confrontation, however, I see no difference, from the perspective of the "I"-illusion, whether the perceived "foe" is external or internal.

Sunday, August 14, 2011

Killing Pain Part V

This is the latest entry regarding my recent adventure on the other side of the mirror, being an acute pain patient with something that I would have instantly recognized in another person as "frozen shoulder".

I hate pain so much that I refuse to put up with it. That's really all there is to say.

I wanted to drop in here to say that I'm doing stuff today which 3 days ago would have been unthinkable:

1. Sleeping on that right shoulder*, my back, my front when I want, all comfortably, without waking up in pain.
2. Using my arm for anything, almost everything. E.g., did a couple loads of laundry, including sheets, made the bed
3. Used the iron (!) no problem
4. Lift heavy objects down out of the microwave.
5. Even carrying a cup of coffee.
6. Still can't get my arm behind my back for those annoying bra clips. Oh well. No pain. I'll get the range back after the neural tunnel syndrome is better and the CNS stops guarding it with movement restriction. Hey, I can actively abduct and elevate the arm, almost fully, and easily.. It feels weird, like I have the shoulder of a diving suit glued on and am painlessly restricted by it. But Kirsten will attend to that sensory delusion, no prob.
7. Personal hygiene behaviour no longer a problem. 

I think there was likely vascular involvement. Coderre talks about mini-compartment syndrome in cases of CRPS. My presentation didn't manage to get that bad, but when one thinks about the complicated twists in the brachial plexus, how the vascular and neural bundles are intertwined, I can see how they could bother each other a lot, just mechanically. I suspect that acute "frozen shoulder" has nothing whatsoever to do with any "capsule" or "joint" issue, whatsoever - that would amount to conceptual hallucination, endlessly perpetrated/sold/taught by who knows who for who knows what reason.

*still can't sleep on the unaffected side - it's still too uncomfortable. Something happens to the nerves in my arm - some sort of adverse tension, so I know they need another go with Kirsten.

Killing Pain
Killing Pain Part II
Killing Pain Part III
Killing Pain Part IV
Killing Pain Part VI 
Somasimple discussion thread about this post series.  
Scientific American: Anger Gives You a Creative Boost

Saturday, August 13, 2011

Killing Pain Part IV

In Killing Pain Part III,  I added visual study notes to do with afferent pathways. In this post I'll add visual study notes on descending modulation pathways, made from Ossipov's diagram, found in his chapter in his book chapter, Ossipov MH; Pain Pathways: Descending Modulation. Ed. Larry R Squire; Encyclopedia of Neuroscience 2009 Elsevier Ltd. It's a book I could read for the next hundred years, along with Ramachandran's Encyclopedia of the Human Brain, all four volumes. At the rate I learn, it would take another thousand years to absorb it, probably. Oh well. I don't have that long, so I tear along as best I can visually taking things apart and putting them back together.

(I think what happened with me had something to do with neural inhibition.*)

The first image is straight out of the book. It's nice, but I couldn't follow it as well as I wanted.
The other three are my own deconstructive line diagrams.

Click to embiggen.

Killing Pain

Killing Pain Part II

Killing Pain Part III

Killing Pain Part V 

Killing Pain Part VI

*I was pleased to see the Scholarpedia article on Neural Inhibition was written by Dr. Gyorgy Buzsaki, Rutgers University, whose book, Rhythms of the Brain, I read and absolutely loved a few years ago. I blogged about it in Brain Oscillations: Ten part series.

Somasimple discussion thread about this post series.  

Scientific American: Anger Gives You a Creative Boost