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Old 08-08-2007, 06:58 PM   #1
Barrett Dorko
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Default The Power of Dissonance

I am on record at that conference believing what I had read, and proposing my work was similarly effective.
I was wrong and am perfectly willing to admit it.
It will happen again.


From page 9 of my book, Shallow Dive

The discomfort I sense in my students as I lead them toward what is a new way of thinking about pain and its management is something that troubles me and, I’m certain, keeps many from incorporating Simple Contact and ideomotion into their care.

Of course, I can only resolve this issue by first of all understanding it, and it’s clear that I haven’t done an especially good job of that over the years. But an interview I listened to recently that led me to purchase yet another book has me feeling a little more hopeful about all of this, and that leads me to introducing this thread today.

The interview was with Carol Tavris, a social psychologist and writer who appeared on the Point of Inquiry podcast this past week. She’s recently co-authored with Elliot Aronson a book titled Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts.

The problem I encounter is “cognitive dissonance,” defined in the book as “a state of tension that occurs whenever a person holds two cognitions (ideas, attitudes, beliefs opinions) that are psychologically inconsistent.”

I’m pretty sure that when I say to my classes that “there is no known correlation between pain and posture,” and then add to that “no correlation between strength and pain, strength and posture and appearance and pain,” that the sense of dissonance and the mental “tension” (read anguish) all this produces commonly grows beyond their tolerance.

What this book does is point out how all of that is remarkably common and that we will all deal with that dissonance in predictable ways, though these ways of reacting might be decidedly counterintuitive when we don’t look at all of this objectively.

I put a quote from my book at the top of this thread that, I’m glad to say, indicates that while I am by no means immune to the trap of self-justification that dissonance theory predicts I will fall into (more about that later), I have at least in one instance quite publicly moved all the way through this situation into an admission most of us avoid at all costs – I admitted that I had been wrong.

For me at least, this is a good starting point, and I’ve never been so grateful for having written something before, and I did it in 1994.

Much more to come.
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Old 08-08-2007, 10:09 PM   #2
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Hi Barrett,

I recognize that passage from a chapter intro, I believe, in your book.

I'm really looking forward to this thread. I think we all have much to learn on this. I know I do.
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Old 09-08-2007, 02:31 AM   #3
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As I said, I cannot help but speak of things that will lead to cognitive dissonance (CD) among those who choose to attend my workshops, and, after a day like today, I’m beginning to appreciate how difficult that can be for those who show up completely unprepared for change.

This sort of thing isn’t unusual by any means, but that’s another thread entirely.

In any case, Tavris and Aronson make it clear that we will seek immediately to reduce the psychological tension created by CD by making a choice, and that we will almost always choose the idea in which we have invested the most time, money and emotion. Even at this point, early in the process, the brain will automatically begin to marshal what resources it can to distort the evidence before it in a fashion that justifies the choice made.

There are several ways that this is done and my plan at the moment is look at one at a time. The first: Justification by claiming successful clinical outcome.

Though I do a whole bit about how outcomes are just one aspect of our clinical experience and expertise, and the most difficult to meaningfully measure at that, almost without exception therapists who are presented with an alternative theory (or, perhaps, their first rational theory of dysfunction and therapeutic method) will retreat immediately to a narrative that might be called the “I get good results doing what I do already” storyline. I think everyone reading this knows what that sounds like.

Embracing the results you claim you have, or wish you had, or remember hearing about from favored patients or truly believe you must be having given the amount of time you’ve devoted to doing something endlessly is, well, pretty easy to do, and I’m certainly not surprised to hear this from therapists battling with the new idea I’ve placed in opposition to their reasoning and method.

The problem, of course, is that what they claim to have in the way of success is something they have never really measured in a way acceptable to any serious investigator. Their defense is shaky at best, and, in the end, not really worth a thing as an argument against changing methods of care now that the deep model dictates we should.
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Old 09-08-2007, 11:11 AM   #4
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Default The counterintuitive response

Suppose we make a choice among several possible behaviors and then are shown that this choice is neither rational nor has it led to any great deal of success. What might you expect in the way of response to new information?

This is where the counterintuitive nature of what is called dissonance theory kicks in.

Let’s back up a bit. Tavris and Aronson make it clear that dissonance motivates us, but that more often than not it doesn’t motivate us to change but rather to find ways of justifying our previous choices. The brain’s goal is to reduce the discomfort it feels when it senses conflict between old decisions and new information. This goal commonly takes precedence over the lofty aspirations of learning many claim to have. We will instinctively seek comfort and survival over the uncertainty that intellectual change may offer, and unless we realize that, methods of self-justification will rule our thoughts.

Here’s another I commonly encounter: Justification by claiming that all new knowledge is too difficult to assimilate.

Student/therapist: “I understand what you’re saying and I agree with it, but something keeps me from remembering any part of it for more than five seconds.”

I hear this several times a day, and yesterday a lot more than that. Usually, the information I provide about the origins of pain and the significance of knowing how they are manifest in the patient is treated in this way. I’ve yet to hear anybody disagree with me, it’s just that they can’t remember this simple but essential thing for any length of time.

As justifications go, this one isn’t all that bad. After all, the study of memetics explains it quite clearly. Consider this from the Wikipedia entry for “meme”: "Memeticists argue that the memes most beneficial to their hosts will not necessarily survive; rather, those memes that replicate the most effectively spread best, which allows for the possibility that successful memes may prove detrimental to their hosts."

“Hanging onto old ideas even if you know they’re wrong is common,” I say. “After all, they’ve served you well in the past. But today we have new information that should supplant what you were taught was true in the past, and a scientist would tend to accept the new, let go of the old and modify their theory and practice accordingly.”

The problem with this little speech is that I’m talking to therapists, and they aren’t necessarily scientists.
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Old 10-08-2007, 01:38 PM   #5
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Default Killing the Messenger

Perhaps the easiest and most commonly used method of distorting evidence is what I’ll call Justification by Negative Personal Association, which is another way of saying “kill the messenger.”

Anybody reading my work over the years knows that I’ve encountered this a lot, but I know other workshop instructors who are unfamiliar with this. Though common, I find this to be the one justification I can actually influence with a bit of power. If I’m kind and patient and display an authentic interest in the thoughts and questions of my colleagues they find it difficult to use this justification to dismiss the evidence I present and usually retreat to one of the methods mentioned earlier. Being this way isn’t difficult for me, mainly because I am that way.

This is tricky though. I’m convinced that a scientist, in effect, draws a line in the sand. We say, “Beyond this both my credulity and interest disappears.” For me that line is drawn at the point where physical possibility and biologic plausibility are no longer part of the therapist’s theory (if they have one) and I make this clear. The person I’m speaking to begins to make a choice at this point, and I know that they might just conclude that I am “close minded” and not worth listening to. I had a woman call me “rude” (rather loudly) a while ago because I said that her description of “the healing crisis” made no sense to me. I said this gently and sincerely and, as it happened, to her alone. Ah well.

How does an instructor avoid this? It’s easy – they never draw a line.
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Old 10-08-2007, 01:52 PM   #6
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This is a great thread, Barrett. My own experience with cognitive dissonance related to treatment paradigm after taking your course was that, although it would have been more comfortable and safe to ignore it all, it wouldn't go away. Like a mosquito. Or a little brother. So I basically had no choice but to "go there." Or find a new profession. Like library science. I've always thought it would be cool to be a librarian.

:teeth:

by the way, i dropped my last name from my username due to an uncomfortable incident with internet identity (not from this site). deicded to get a little more private.

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Old 11-08-2007, 03:18 PM   #7
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Default Edison and Tesla

Glad so many are enjoying the thread. Tell your colleagues about it when they disagree with your sudden change in theory and method. That's why I'm writing it.

Thomas Edison and Tesla were mentioned as potential laureates to share the Nobel Prize of 1915 in a press dispatch, leading to one of several Nobel Prize controversies. Some sources have claimed that due to their animosity toward each other neither was given the award, despite their enormous scientific contributions, and that each sought to minimize the other one's achievements and right to win the award, that both refused to ever accept the award if the other received it first, and that both rejected any possibility of sharing it.

From the Wikipedia entry for Nikalo Tesla

Yesterday while teaching I mentioned the Manual Magic thread and began thinking about a small portion of it that included some information about Nikola Tesla. He played a part in the movie The Prestige. This post came to me then.

Edison and Tesla had one primary disagreement during the early part of the twentieth century, and due to their enormously influential presence it managed to threaten the existence of most of the technological advances of the age. Other than that it was just a minor tiff.

They fought The War of Currents, pitting Tesla’s alternating current against Edison’s direct current for use in a system of general power distribution. Ultimately, Tesla won because his idea and methodology was far superior. His personal eccentricities bordering on the bizarre probably didn’t help his case, and there’s a lesson there for all of us. Well, not me of course.

I bring this up in the thread because it is yet another wonderful example of dissonance theory and how even the greatest minds cannot escape our genetically acquired tendency toward self justification when an idea we’ve devoted time, money and emotional resources to is suddenly placed alongside another that opposes it.

“Edison carried out a campaign to discourage the use of alternating current, including spreading information on fatal AC accidents, killing animals, and lobbying against the use of AC in state legislatures. Edison directed his technicians to preside over AC driven executions of animals, primarily stray cats and dogs, but also unwanted cattle and horses. Acting on these directives, there were demonstration to the press that alternating current was more dangerous than his system of direct current. Edison's series of animal executions peaked with the electrocution of Topsy the Elephant. He also tried to popularize the term for being electrocuted as being "Westinghoused" (Westinghouse was Tesla’s sponsor).”

From “Edison’s publicity campaign” here.

And to think – Edison was an Ohio boy.

I think it’s clear that these men engaged in the very sort of thinking we might expect given what we now know of memetics and dissonance theory. Interestingly, I have also read of Edison finally admitting that he had been wrong. This took a while but the evidence eventually overwhelmed him and he did what we all must eventually do if we are to progress in science - he said he was wrong.

Of course, Edison was from Ohio.
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Old 11-08-2007, 06:23 PM   #8
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Default Wondering

Another instructor who contracts with Cross Country Education attended one of my classes this week. I had had some previous dealing with her a few years ago when invited to debate the merits of “alternative medicine” in a national Magazine (Advance for Physical Therapists). She took the pro and I the con.

This is a pleasant and friendly woman, an academic and clinician, and a strong proponent of her brand of “myofascial release” and, if our debate was any indicator, a big fan of “energetic” medicine. We met civilly and with evident good will and spoke briefly of our mutual experience as teachers with this company. Quite kindly she invited me to lunch though I declined. I don’t eat lunch while teaching – I stay in the room.

I heard not a single objection from this therapist to anything I said. She bought a copy of my book and I signed it for her, she took a copy of a monograph I’ve written titled Manual Magic with her to lunch and returned it without comment. She left early and quietly as I continued to teach.

I can’t help but wonder what she must think but if she doesn’t come here as I had invited her to do I guess I always will wonder. The only clue I have is my observation of the way she casually tossed Manual Magic back on the front table after lunch. To me, the impact was a little loud – but I’m perfectly willing to admit that my own instincts toward dissonance reduction inflated that way beyond its reality. Maybe. I’m almost sure.

Perhaps.


(This post also appears on this thread)
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Old 12-08-2007, 02:36 PM   #9
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Default Dissonance and Memory

“I have done that,” says my memory. “I cannot have done that,” says my pride, and remains inexorable. Eventually – memory yields.

Frederick Nietzsche

After my first year of teaching for Cross Country I found that I was beginning to make another visit to the same city, commonly to the same hotel. The first time this happened was in Norfolk Virginia.

True story: After the first hour’s lecture a young woman in the second row said suddenly, “I remember you now. I came to this course last year and we were across the hall. I didn’t realize this was the same thing.” She began to smile. “Oh yea, I never read any of that stuff you recommended. Hehehehehe.”

I recall being fascinated by the look of horror on her coworker’s face as he sat beside her. All I could do is shake my head and think, “Great story.”

I discovered this past week while in New York that exactly one student in the combined workshops had been here to Soma Simple before class. It was Erica, who doesn’t really count because she was here and contributing before she got the course brochure that “strongly encouraged” people to do so. So, no one actually prepared for the course in any meaningful way whatsoever. Believe me, this is common.

Tavris and Aronson write a great deal about memory and its place in dissonance theory. They say, “Confabulation, distortion and plain forgetting are the foot soldiers of memory, and they are summoned to the front lines when the totalitarian ego wants to protect us from the pain and embarrassment of actions that we took that are dissonant with our core images.”

I would add to that, “We also conveniently forget actions we didn’t take.”

On the whole, the therapists in my classes are completely and utterly unprepared for anything I have to say, and now I’m beginning to see this in a new light. It occurs to me that our brains might be up to something even more effective than simple forgetting – they just arrange it so that we don’t have any dissonant knowledge to forget. All this requires are simple acts of omission; books and articles not read, an avoidance of conversations with other clinicians that might lead toward change and absolutely no preparation for a workshop that people claim they want to attend in order to help their patients. I know that their strongest defense when I point this out will be “I’m too busy.”

We know that ideomotion designed to relieve pain will occur before the nervous system is sufficiently compromised to actually perceive pain. Quite brilliantly, the unconscious is anticipatory and drives our behavior accordingly. Perhaps we are hardwired not to learn as well. Dissonance theory would predict this, I think, I’m almost sure.

See where I’m going with this? I’ve lived an ordinary life and never found that I didn’t have time to learn more about what my career entailed. I wanted to know what was happening beneath my hands and still do.

Often, what other therapists want to know remains a mystery to me. The real problem is that they can’t tell me though they’re sure that they once could.

They’ve forgotten what it was.
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Old 13-08-2007, 02:28 PM   #10
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Default A little review

I want to review a little here.

1) Cognitive Dissonance occurs when we hold two ideas that are psychologically inconsistent.

2) This makes us uncomfortable, and in an effort to return to a state of comfort(which is closely related to survival, see this thread) we make a choice between the new knowledge and our old idea.

3) Meme theory indicates that your choice will not necessarily be the one that helps you or makes sense – it will be the one that is strongest within you for a variety of reasons including comfort, familiarity and peer-pressure.

4) In order to justify your choice you will then engage in evidence distortion and/or kill the messenger, neither of which is likely to advance your knowledge base or alter your methods of care.

5) All of this process is driven by instinct and NO ONE is immune to it.

I suppose that you’re wondering what might be done to combat this, and that’s the subject of my next post.

Stay tuned.
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Old 13-08-2007, 03:08 PM   #11
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Barrett,
Very thought provoking thread. Interestingly enough, I never received a brochure for the course-I linked to it through this web site.
As I prepare to go into work today, I am thinking about certain patients with whom I will employ simple contact. (and how I will explain this to them as they are used to the ompt manual paradigm of jt. mobs, manip, stm and an occasional Butler-esque neural "mob" thrown in. )
The power to change a patients perception of what good PT is and make a difference in the way they feel and move is indeed a gift. To impart new found knowledge to your colleagues and patients is, I believe, essential for one's growth as a therapist and the profession.
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Old 13-08-2007, 05:43 PM   #12
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Default Some mail today

Erica,

Thanks for the post.

Before I get to the methods that might be used to combat our instinctive response to cognitive dissonance I want to write a bit about the difference between being the one who gets the dissonance and the one who provides it. I think you know which role is mine, mostly. I’m reminded of a line by J.R. Ewing, the classic villain in the TV series Dallas: “I don’t get ulcers, I give ‘em.” He smiled as he said this, of course.

This morning I got the latest brochure from John Barnes’ Myofascial Release organization. It is precisely the same as all the ones I’ve seen in the past with one notable exception; on the front cover Barnes is no longer standing in the clouds as he has for years – in the background today there are trees. Perhaps this is in response to a portion of the discussion here where the appropriateness of this was questioned. Maybe with this new picture Barnes is saying, “No, I’m not dead.” Well, at least that’s my interpretation.

What interests me most about the brochure is the way in which the message of a new theory and technique is delivered. An entirely different vision of dysfunction and management is offered with prose that is supremely confident and liberally salted with unsubstantiated claims of success and properties of connective tissue it doesn’t possess. (Anybody who wants to argue about this should read the above referenced thread first)

Clearly, one method those on my side of the equation will use to diminish opposition is this sort of manipulative phraseology that preys upon the desire many bodyworkers have to become superheroes. The distinction between a superhero and a manual magician is clear however and is discussed here.

Bottom line: one way of reducing cognitive dissonance among your students is to prey upon both their ignorance and desire. There are countless examples of this sent out in the mail each day.

Here’s the irony. Many people attempting to break the laws of physics (or nature, if you would prefer) are eventually broken by the same laws.

But sometimes it takes a while for them to realize this.
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Old 13-08-2007, 10:45 PM   #13
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I find it useful to think about the examples of CD which have occurred over the years.
The strongest example came from David Butler's first course way back in 1990; as he talked, energetically about what was then very new pain physiology, I could feel and hear the resistance around me. Especially when he mentioned 'ultrabul****', there were looks of dismay and head shaking as the threat to comfortable kingdoms grew. These PTs had no dissonance; they were certain he was up the creek.

But some others felt he wouldn't lecture around the country if there wasn't some logic in it; they thought about reading, and maybe trying a few things out...

Out of that class of about 30, probably none used neurodynamics in their clinical work, or if they did, never talked about it. Generally, they were satisfied with their results and accepted their failures.

I think one has to be dissatisfied with the status quo to begin with. From there, the level of CD could be inversely proportional to the level of dissatisfaction. Of course these same folk may be more vulnerable to the power-seeking gurus, too.....

Of course adolescents and twenty-somethings are in a state of CD most of the time!

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Old 13-08-2007, 11:07 PM   #14
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Nari,

That same year I read Butler's first text and was thrilled with the insights regarding dysfunction and pain. I went on to add even more dissonance with the addition of ideomotion to self-correction of the abnormal neurodynamic, but, as yet, this seems to be something the NOI people can't assimilate.

Heck, they won't even discuss it.

Now I understand.
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Old 14-08-2007, 01:44 AM   #15
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Default Finally, the answer begins

To understand that we are structurally no different than the rest of the cosmos is to let ourselves expand into infinity.

Chet Raymo in Skeptics and True Believers

Last Wednesday on Long Island, a therapist who had run the gamut of self-justification available to her; after she could no longer deny that the person in her hands was moving correctively as I had predicted and could see that this was easily the most reasonable way of manually approaching many of the patients she had waiting back at the clinic she said:

“It seems too easy.”

I know, I know.

Now that I think about it, this may have been her final shot at what she considers normalcy, and I can’t really blame her for taking it.

If anyone reading this expects a simple, rapid method for reducing the methods of justification that retard learning to show up next, they’re probably going to be disappointed.

As Chet Raymo reminds us in the quote above, once we realize how we are all pretty much the same in a variety of ways we have to take responsibility for being as good as the best of us, and for many, this is more than they bargained for.

From page 222 of Mistakes Were Made…

The need to reduce dissonance is a universal mental mechanism, but that doesn’t mean that we are doomed to be controlled by it. Human beings may not be eager to change, but we have the ability to change, and the fact that many of our self-protective delusions and blind spots are built into the way the brain works is no justification for not trying…An appreciation of how dissonance works gives us some ways of overriding our wiring.

Tomorrow, solutions.
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Old 14-08-2007, 02:13 PM   #16
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Default An answer, finally

If you don’t know that your instincts are leading you, you’ll assume that your actions are reasoned and appropriate. I’m guessing that a lot of people “fall in love” this way. Sometimes there’s a price to pay before too long.

Tavris and Aronson put it this way:

The ultimate correction for the tunnel vision that afflicts all of us mortals is more light. Because most of us are not self-correcting and because our blind spots keep us from knowing that we need to be, external procedures must be in place to correct the errors that human beings will inevitably make and to reduce the chances of future ones.

I imagine that for many reading this the procedures of scientific experimentation come to mind. Another “external procedure” in the clinic would be the accepting presence and touch of a therapist who understands the deep model of neurologic function and doesn’t care what the patient “looks” like. Maybe a student of mine.

Tavris and Aronson again:

Once we understand how and when we need to reduce dissonance, we can become more vigilant about the process and often nip it in the bud. By looking at our actions critically and dispassionately, as if we were observing someone else, we stand a chance of breaking out of the cycle of action followed by self-justification, followed by more committed action.

Think about that.

A bit more soon.
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Old 14-08-2007, 07:50 PM   #17
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In my original post here I said: “Maybe I should promise a little more and expect a little less.”

Now that I think of it, my expectations have a duality I’ve not begun to reconcile. That is, my expectations are both high and remarkably low. I always supposed that I belonged to a profession that followed the evidence only to find that it didn’t, and then I watched the concept of evidence itself mutated into a narrow view of “outcome only” evidence that many now refer to as “evidence based practice.” This has been awful to witness.

There’s a passage in a thread titled “Tenar’s Revelation” that comes to mind here: “Tenar did not feel joy…She put her head down in her arms and cried. She cried for the waste of her years in bondage to a useless evil. She wept in pain because she was free.

What she had begun to learn was the weight of liberty. Freedom is a heavy load, a great and strange burden…It is not easy. It is not a gift given but a choice made.”
(This is from one of Ursula K. Le Guin’s fantasies)

It is followed by this:

We must not believe the many, who say that only free people ought to be educated, but we should rather believe the philosophers who say that only the educated are free.

Epictetus
Greek Stoic philosopher and former slave

For those who choose to remain the same despite the introduction of dissonant ideas, and these ideas make more sense if examined, there is this to consider:

Education leads toward freedom, but “freedom is a heavy load, a great and strange burden…It is not easy.”

No wonder so many choose less education rather than more.
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Old 15-08-2007, 01:51 PM   #18
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Default The true meaning of silence

More from Tavris and Aronson:

Becoming aware that we are in a state of dissonance can help us make sharper, smarter, conscious choices instead of letting automatic self-protective mechanisms resolve our discomfort in our favor…The goal is to become aware of the two dissonant cognitions that are causing distress and find a way to resolve them constructively, or, when we can’t, learn to live with them.

There is something distinctive in this passage that made me stop reading for a while. I began to think of those times in my own life where I concluded that “living with it” is the choice I occasionally make when faced with dissonance. I notice that this decision requires that I remain silent though I want to speak. I also notice that the silence itself is troublesome because as Tomas More says in A Man for All Seasons, “Quin tace con secere,” which is Latin for “Silence gives consent.”

Of course, I don’t want those with whom I disagree to think that I’ve given in to their point of view, but there are mitigating factors, first and foremost, friendship. As Israeli Prime Minister said of Ronald Reagan, “When a friend makes a mistake the friend remains a friend, and the mistake remains a mistake.”

I have a number of friends in the therapeutic communities that practice in a fashion I consider, well, misguided. (Notice I didn’t say absurd. These are my friends after all) We don’t discuss the treatment of patients and we certainly don’t discuss theory.

My silence is my gift for my friend. And, in the end, it is another way of dealing with dissonance that is both thoughtful and, ultimately, useful.
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Old 15-08-2007, 11:30 PM   #19
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Default Popper's Paradox and The Final Answer

Karl Popper told us how to deal with dissonance. He pointed out that scientific ideas are scientific in nature only if they can be falsified and that the real work of scientists is not to look for evidence that their theories are correct, but to look as hard as they can for evidence that their theories are false and that the closest a scientist can ever come to proving that his or her theory is true is failing to find evidence that the theory is false.

He used this argument to demonstrate that many things are not sciences because they cannot be falsified. He said, “Whenever a theory appears to you as the only possible one, take this as a sign that you have neither understood the theory nor the problem which it was intended to solve.”

(Thanks to The Writer’s Almanac for parts of this)

That part about not looking for confirmation of your theory meshes with Tavris and Aronson’s most powerful point regarding how to deal with dissonance. I’ll quote it below, but let me say this:

Once we have invested our time, money and passion, being confronted with contradicting evidence is humbling, and most people will avoid such a situation, Karl Popper notwithstanding. So we shouldn’t be surprised that seeking disconfirming information and/or avoiding people whom we know may carry it around in their heads. I’m pretty sure that’s why most therapists I personally invite to this site either never show up or don’t remain.

There’s also this. Time and again when ideas are being deconstructed here, the proponents of the discredited theories retreat rapidly to a charge of personal attack and/or a defense against charges never made. We hear, “You guys say we don’t get good results,” for instance. This isn’t said, but it is expected to be said, and no personal attacks are permitted on Soma Simple.

Tavris and Aronson on page 228:

Understanding how the mind yearns for consonance, and rejects information that questions our beliefs, decisions or preferences teaches us to be open to the possibility of error. It also helps us let go of the need to be right.

It’s that last line – let go of the need to be right – that encapsulates the attitude I need to adopt. I’m convinced it will help all of us who try to do a better job of treating patients.
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Old 16-08-2007, 01:10 AM   #20
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Quote:
..let go of the need to be right
Could this be quoted to the marketers of EBM??

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Old 16-08-2007, 01:39 PM   #21
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Nari,

The marketers of EBM are Mesodermalists, so I wrote this at breakfast this morning.

We counteract a deep feeling of insecurity by making of our existence a fixed routine. We hereby acquire the illusion that we have tamed the unpredictable.

Eric Hoffer in The True Believer

I have the distinct impression that therapists who struggle with the complex nature of chronic pain in their patients would feel a whole lot better if they simply relinquished their need for control. I’m not suggesting that this will be easy, but I’m convinced that a thorough understanding of modern neuroscience as it relates to this problem will lead them to conclude that controlling the patient’s behavior and sensation is a lost cause.

Of course, therapists with a mesodermal bias are unlikely to concede that the body is as unpredictable as Ectodermalists claim that it is. In my mind it comes down to geometry – the nervous system is fractal and the mesoderm is not. (I’ve written about this here)

The Mesodermalist who perpetually chooses that tissue to blame, those tests to do and those protocols to follow reduces dissonance via routine. Maybe it’s that simple to explain why we cannot make a dent in their logic or practice.

Maybe they need to hear this from Richard Powers in Gold Bug Variations:

Science is not about control. It is about cultivating a perpetual condition of wonder in the face of something that forever grows one step richer and subtler than our latest theory about it. It is about reverence, not mastery.

I have concluded that it comes down to being thoughtful rather than right. I seek the former much more than the latter.

Now I just have to work on acting that way.
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Old 16-08-2007, 10:46 PM   #22
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We have mentioned the control factor in various posts for some years and you are right to conclude that this is part of the problem/s with traditional therapy.

I don't think we intentionally set out to control; it is part of the meme that PTs know more than patients about the body's mesoderm and therefore patients need to be compliant with what we ask them to do, or they won't improve. That thought reduces dissonance.

Broken down to its elements, we expect compliance and obedience in order to solve a problem the patients know more about in the first place. The problem is pain, and we don't know their pain, they do. But accepting that fact is enhancing dissonance.

Oddly enough, we nurture the very meme that creates dependency, although we may aim to lessen dependency. It's a part of the social structure: my doctor, my PT, my chiro, my hairdresser, my trainer, my pharmacist...

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Old 17-08-2007, 01:45 AM   #23
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Nari, these are all social groomers of one kind or another - dependency on them enhances troop cohesion, which we now know as the 'economy'. Another thing it might do is elevate self-esteem in a very occult way - i.e., if "I" have all these people/ "my" people, who I've hired to "groom" me, "I" can feel, just for a little while, that I'm "worthy" of the attention. We are still primates.
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Old 17-08-2007, 02:05 AM   #24
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In the private sector, I'd agree with you, Diane; it's all tied up with the economy and goodwill and whatever; but in the public sector I see it differently.
Those PTs are paid a salary, regardless of how many patients they see, and total freedom to treat as they see fit. I have seen many PTs change in attitude when they move from public to private where they indeed become social groomers and more bequeathed to doctors.

I think a PT who chooses to stay clear of the private world already has good self-esteem and, although still trapped in a routine assessment system, remains more open-minded in clinical reasoning. There are quite a few who would answer the question: What do you practise? Kaltenborn, Maitland, Bobath, Mulligan, Carr and Shepherd....? with:
I practise according to me.

They are all mesodermalists, but they are thoughtful, too.

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Old 17-08-2007, 02:33 AM   #25
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I agree with you Nari,
Quote:
PT who chooses to stay clear of the private world already has good self-esteem
I wasn't referring to a PT self-esteem, rather that of the individual who has his or her "own" PT etc etc.
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Old 17-08-2007, 02:33 AM   #26
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Nari,

I'm glad you mentioned that to be a Mesodermalist does not mean that you aren't thoughtful. Too often I imply something else, but now at least I have dissonance theory to blame for my bad behavior.
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Old 17-08-2007, 04:09 AM   #27
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Diane, yes, on re-reading, you did mean it was the individual who 'has' a PT. Although I could argue (nicely) that patients can preen and prop a PT's self-esteem.

Barrett,

Some mesodermalists are worse than others with their tenacity towards tissues; which could imply they are not thoughtful at all. Does that help with the dissonance factor?

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Old 17-08-2007, 04:21 AM   #28
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Not sure whether this should go here or in Manual Magic, I suppose it could go anywhere. I was browsing Mind Tweaks and read a series of 4 articles about 'The Secret,' a new show I don't think I've seen yet, and sensed a connection between what I was reading and some of physiotherapy's pains.

1. The Secret: A Rant Against Self-Help Pseudo-Science
2. Why The Secret Seems To Work: The Serial Debunking Begins!
3. 10 Rational Reasons The Secret *Seems* To Work
4. Hit and Miss: The Brain's Bias

I particularly enjoyed the fourth article describing confirmation bias.
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Old 17-08-2007, 12:35 PM   #29
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Good link, Eric. The confirmation bias section is very relevant, I think.

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Old 17-08-2007, 07:13 PM   #30
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Default some thoughts

Barrett,

I appreciate your comments and pose some questions:

"my expectations have a duality I’ve not begun to reconcile. That is, my expectations are both high and remarkably low."

Wouldn't you suppose most of your classess come with this same duality towards you? I propose you teach to the part of the class that expects much..., Ultimately I believe it to be most productive to not have any expectations at all.(Do what you do, simply because you love doing it, no attachment to outcome) Can one be dissappointed without first having an expectation??

Secondly,

The biggest lesson I have learned in my marriage is to choose Love over being right. When you say thoughtfulness, I believe this implies love, and approaching our patients with "this" vs. any personal attachment, attachment to outcome, or "being right" mentality serves us all better, but most importantly the patient.

Excellent Thread!!
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Old 18-08-2007, 03:13 AM   #31
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I think there is a difference between the need to be right and being right. Getting things right is usually preceded by getting things wrong and as noted in an earlier post by Barrett (Edison and Tesla), the need to be right (perhaps expressed as a bias) can only slow the march toward knowledge.

I also think there is a difference between things being right and achieving a desirable outcome. I think this is where the thoughtfulness mentioned by Barrett would come to bear.

My dissonance is resonating.
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Old 18-08-2007, 11:30 AM   #32
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Good (last) point, Jon.
A desirable outcome is often serendipitous. It can appear when we have done something which may not be wrong, but isn't right according to the rules. This has happened to me a number of times, leaving me thinking: What the hell did I do, anyway?

Perhaps those who 'need to be right' are far more conscious of the ogre of unpredictability and that is scary for them. Physiotherapy has evolved with more and more complicated techniques that promise predictability and when that fails, the therapists 'know' it's their fault.

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Old 18-08-2007, 02:16 PM   #33
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Default Back to Asimoz's Insight

Last night I realized how similar this thread was to one titled Asimov’s Insight from a few months ago. There’s some discussion there about the need to be right as well.

At that time I hadn’t heard of Tavris and Aronson but can see that their book was just waiting to be discovered. I have to wonder if those who stick to traditional methods in therapy would be as anxious to embrace its theme. As I push these ideas into my classes the next few weeks I guess we’ll find out.

Nari’s comment about our reaction to an unpredicted outcome triggered my remembering what Asimov said:

The most exciting phrase to hear in science, the one that heralds new discoveries, is not 'Eureka!' (I found it!) but 'That's funny ...'

In short, some clinicians don’t respond with any defense against change as dissonance theory predicts – they’re drawn toward it.

Today I would conclude that it isn’t the routine finding that draws a scientist’s interest but the unexpected one, and this fascination with the unexpected trumps the instinctive response to reject its reality.
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Old 19-08-2007, 05:00 PM   #34
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I agree with Nari and Barrett here as well. Having those moments of "wow, it actually worked" does not help my cognitive dissonance however. Because of the complexity of the organism we deal with (humans), we can't control and can rarely predict the outcome of our handling. However, we can choose to do no harm, which is our highest priority.
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Old 19-08-2007, 10:13 PM   #35
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I’ve been thinking about what’s been said here recently about expectation.

Jason states: “Ultimately I believe it to be most productive to not have any expectations at all.” I know this sounds good, and is probably consonant with the Buddhist or Zen philosophies that many find very comforting and insightful. But I don’t think for a minute that this attitude can be realistically maintained in the circumstances of workshop instruction.

Though I am troubled by any therapist who espouses “belief” in the care they provide and usually ask for understanding instead, I’m aware that I am required to believe many things if I am to get through the day. Things like where I believe I left the keys to the car. This saves me all kinds of time when I’m trying to drive to the airport. To save time looking I can’t help but maintain a certain expectation, but this isn’t quite the same as believing in the way the body functions or what my care accomplishes. (see Why We Believe for more on this)

I suspect quite strongly that my students have been repeatedly exposed to certain remarkably common clinical phenomena, though they’ve quite commonly missed all of this or misinterpreted it. They’re all therapists, educated and licensed and paid for seeing patients who depend upon them, yet there’s little or no evidence that they’ve read any neuroscience beyond the meager amount offered in school. Their “beliefs” regarding dysfunction and effective care cannot be defended beyond the perfunctory, “Well, it seems to work.”

To enter a workshop as an instructor with no expectation would require that I somehow become robotic and, ultimately, behave as if nobody knew anything, which is in my experience a major mistake.

I also wanted to say this today: Something I find lacking in Tavris and Aronson’s description of dissonance theory is a response to cognitive dissonance I find is easily the most common and the most difficult to do anything with on my part. It is simple silence. Non-action. No argument. No apparent defense of current behavior. No follow-up. No comment. Silence combined with non-expression.

Nothing.

What are we supposed to do about that?
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Old 19-08-2007, 11:01 PM   #36
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Barrett

You ain't no Red Queen when it comes to believing impossible things, especially before breakfast?

Have you ever had a class or two which exceeded your expectations? Did the class start out as usual and metamorphose into something quite unexpected? If so, what might have been different about a) your expectations and b) theirs?

A couple of years ago I went to a talk given by a local PT who is highly ranked as an educator and clinician. It was about the technicalities behind the use of ultrasound. The audience as a whole was interested, attentive, asked questions, agreed, disagreed.
I was so bored by his topic and his mechanical and formalised presentation I have no idea what his conclusions were, if any. I think he had no expectations at all; he simply spewed out information. I was extremely silent for the 80 minutes.
This does not solve any problems with walls of silence, but my silence was entirely due to his lack of expectations from us.
That cannot be said of your presentations.

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Old 19-08-2007, 11:19 PM   #37
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I hope you have an answer coming, meanwhile I'll offer a quick opinion. This may sound flippant but I mean it seriously. Maybe your workshop is just too short. In spite of all that you offer here, and that much is unequalled, there is no follow-up, no exam to pass to ensure concepts have been learned, no next day, no next course, no next level. There is no time to respond, confront, accept and learn how to think and behave differently.
Imagine if it was drawn out over, days, weeks, dare I suggest it, even months. Classes that could go into nauseating detail, throw in some homework, exams, maybe even a private discussion forum where participation was mandatory, maybe then the silence would be broken. It would have to be, or you'd fail.
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Old 19-08-2007, 11:29 PM   #38
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Thanks Nari.

I work hard to engage everybody I can from the beginning. This is one of the reasons I often use popular culture as a teacher and metaphor. The other reason is because I like that stuff. It’s interesting to watch some therapists come alive with this while a few will act as if it’s beneath them. I tell them, “You ignore the culture at your peril” and usually they begin to see this.

I regularly see classes change, but almost without exception for the better. That’s my job, as far as I can see.

What I don’t see is any evidence that this change commonly endures. And that’s yet another reason to examine the power of the culture.

It’s a funny thing, the only time I regularly sense boredom is a few minutes into my presentation of web sites they will find helpful. In response I often hurry this.
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Old 19-08-2007, 11:38 PM   #39
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Eric,

I agree. It might be that no amount of time will take the mesodermalists or energists from the Mothership, but for others a few more hours and some testing might suffice.

But right now I'm only teaching for Cross Country Education (unless otherwise requested) and their formula is strictly "one day workshops." They know that attendance would drop dramatically if it were even two days.

I agree. That's why the room is empty five minutes after I stop speaking.
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Old 19-08-2007, 11:41 PM   #40
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Another way of looking at this is in terms of work. Confronting ones dissonance takes work. In this case a whole lot of work. I imagine it as being something like trying to change a lifetime of deeply held religious beliefs. Unless someone is genuinely dissatisfied with the status quo, they are unlikely to put forth the effort to do this work on their own. Therefore you either have to increase their sense of dissatisfaction, or force them to do the work and hope that they'll sense the reward at the end is worth hanging in for. Maybe a non-refundable tuition would do the trick.
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Old 19-08-2007, 11:45 PM   #41
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Quote:
Confronting ones dissonance takes work. In this case a whole lot of work. I imagine it as being something like trying to change a lifetime of deeply held religious beliefs.
And often mental hands must be held through the process. I'm looking at this as just another facet of HPSG.
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Old 20-08-2007, 12:01 AM   #42
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Eric, I agree that dissatisfaction must be present in the students in order to move forward and learn new things. From this, we have to assume that many are satisfied with their status quo OR they are in a state of dissonance, don't know it and are too uncertain to do anything about it.

Social grooming might be an answer. That's hard work and requires a lot of patience.....

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Old 20-08-2007, 12:45 AM   #43
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Barrett,

What about 2 different one day workshops? That would fit into Cross Country Education's formula and would provide opportunity for those who want to
Quote:
learn how to think and behave differently
As Diane said - this often needs mental hand holding...

Is that a possibility?

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Old 20-08-2007, 03:15 AM   #44
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Clare,

I'm ready to do this but it's difficult to find sponsors who can find students and venues. I'm not currently of the opinion that there's sufficient interest.

Maybe I'm wrong.

I often think back to the model of teaching and "dissonance introduction" Stan Paris demonstrated so masterfully in the 70s and 80s. I was immersed in this as an instructor and course designer and therapists flocked to them. When the operation went into a generic mode of presentation that severely curtailed intellectual growth I had to leave. That was in '79.

The courses remain very popular despite all of that, and maybe there's something to be said for Paris' formula.

A reasonable question is this: What evidence is there that Paris' many students have made a difference?
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Old 20-08-2007, 09:01 AM   #45
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I guess the question is can the what be separated from the how and maybe, in this case, the who.

I'm not sure if anyone can answer that. I'd be interested to see how another instructor would handle the same material. Sometimes the one closest to the ideas presented is the worst one to present them, sometimes they are the only one who can present them and remain true to them, and sometimes it just doesn't matter.
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Old 21-08-2007, 03:44 AM   #46
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Hi Barrett,

Maybe there isn't just CD at play but an element of Culture Shock. You do administer a heavy dose of the humanities.
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Old 21-08-2007, 12:49 PM   #47
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To follow Jon's post: in the western culture and societies, our life expectancies, health, safety and need-fullfilment have been improved dramatically over the last 100 years. Despite this improvement, people are more afraid, children are more and more shielded and protected, and risk-taking is becoming just something we do on the stockmarket. There are some strong psycho-sociological theories to explain this - but suffice it to say: there is a lack of daring, risk-taking among most of the people.
This is likely also reflected in the "learning attitude" of course participants - where is the drive? Where is the NEED to change? The only strong motivation left is the desire to grow professionally. Not a danger for life, not a need for food, not a need for shelter.....
Because once all these powerful needs are met - a moderate to severe absence of motivation for change is noted.

And apparently for many, the mental desire to grow professionally is not as strong as the urge to stay safe in the small and snug world of the "known"; in other words - no motivation to accept the cognitive challenges of the radically different....
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Old 21-08-2007, 01:06 PM   #48
Barrett Dorko
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Jon,

As it happens, Culture Shock was mentioned as a possible explanation for a murderous rampage on The Closer last night. I'm hoping that a few students in Florida this week will have seen it.

Bas,

You're absolutely right. Somehow our instinct to survive has been confused and conflated along with our desire to get along, remain safe, look good and last longer.

The only answer is thoughtfulness and communication with those older and/or wiser, I think.
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Old 21-08-2007, 07:13 PM   #49
Bas Asselbergs
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Indeed Barrett.
It can be said that in the past, how well you knew your trade/skill, could be the difference between survival and abject poverty or death. A craftsman/tradesman/farmer would pick any tidbit of knowledge, information or technique to ensure survival. This included listening to stories of elders and sages.

I am afraid that listening to elder and/or wiser ones is no longer assumed necessary by too many - an attitude fraught with great peril.
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We don't see things as they are, we see things as WE are - Anais Nin

I suppose it's easier to believe something than it is to understand it.
Cmdr. Chris Hadfield on rise of poor / pseudo science

Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

We don't need a body to feel a body. Ronald Melzack
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Old 22-08-2007, 12:12 AM   #50
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I think we have evolved over a century or less, to value our own opinions more than those of others; especially as we are mostly very well educated, and often regard young/er things as the best source of information and knowledge if we identify a need for such knowledge. Technology in particular brings its own pitfalls, at the cost of less thoughtfulness.

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