Doing the splits I

[Barrett Dorko]

There are several places where my approach to manual care splits into two related but distinct entities; ectodermalism and mesodermalism, defect and defense, biomechanics and neurobiology, cause and origin, mechanical and reflexive effect.

You could take each of these and assign them to either tradition or the revolution in thinking we are now witnessing. You probably know which I would favor.

I will write about each but today it is the last of these (mechanical and reflexive effect) that I want to address.

When you arrive at the front door of someone’s home you usually have two options; you can knock or you can ring the bell. Both may be done in a manner that implies something about your urgency, but they are distinct from one another in a couple of ways.

The bell is deeper in the house and might be much easier for the occupants to hear. Though both the knocking and ringing are novel sounds, the bell might be more so and less threatening at the same time.

What if the button for the bell is some distance from the door? Wouldn’t it have the same effect? Which action is easier for you to do? Which is harder to understand?

Is the skin similar to a door with a bell? How? What mechanisms would explain the distant sensation and effect of gently “ringing the bell”?

[zimney3pt]

Thanks for a great metaphor. I would also add to it (so as to remind myself during treatment).

I don't need to push the bell 10 times hurriedly and then knock insistently also and look to see if anything is moving to respond to me before repeating the whole cycle over and over. This only makes the person inside angry due to my impatience as they are probably attending to a few things before they can answer the door. As they should, they did not expect me to come to the door and they need time to prepare before letting me in.

I need to constantly remind myself to push the doorbell once and wait patiently for a response, it will come.

[Luckbox]

I also like the metaphor. One of my professors used to say; 'if you want to find out what's going on in your neighbors house, look in as many windows as possible.'

The neurological examination is my tool to 'look' into as many windows as I need.

I might not want to knock or ring.

[Barrett Dorko]

I was thinking in terms of treatment intervention but exam and treatment often flow together. As long as "looking in the window" tends not to threaten the patient in pain I'm all for it.

What mechanism might we use for this effect: The therapist "rings the doorbell" in the periphery and the patient feels a new sensation nearer the center.

Antidromal flow?

[nari]

I think the type of doorbell sound is relevant; its volume and cadence.

If the occupant is absorbed in something or half-asleep it could be startling or annoying. like some ringtones on mobiles. I know of one doorbell which quietly plays 'The Loveliest Night of the Year'. Corny, but it gently alerts the occupant of the house to attend.

Nari

[Barrett Dorko]

It's a good point Nari - the occupant says what the doorbell will sound like. They can hardly say anything about what knocking can sound like.

[Barrett Dorko]

Mike Reoch has placed an interesting post on my Facebook page. In relation to this approach he wrote a modified version of a Kafka poem you can find here.

You don't even need to leave your room, just sit at your table and wait.
Don't even wait, just listen.
Be quiet, be still, be solitary.
The world will fully offer itself up to you, to be unmasked, it has no choice.
It will roll in ecstasy at your feet.

Mike wrote:

You don't need to enter the house, just sit at the stoop and whistle.
Don't even whistle, just hum.
Be present, be careful, don't threaten.
The door will open up to you, curtains pulled, it has no choice.
It will swing with ease at your feet.

[vancouverRMT]

Barrett,
Thanks for introducing me to Kafka many many posts ago. I have this poem placed on a small desk in a 6 x 9 frame. It helps to hold a stack of pain pamphlets. I always read the quote while treating but was yet to realize it could apply to myself as a therapist. Now I do.

Anyone feel free to change my version to what makes sense to you. I'm not sure I am fully happy with my draft.

[christophb]

I can't think doorbell without thinking of the Simpsons episode "Maximum Homerdrive" when Marge installs a custom doorbell that gets stuck playing the Carpenters "Close to You"

I'm sure there is some metaphor for central sensitization in there somewhere. There is a bad recording of the ending of this episode on youtube which demonstrates nicely an ectoderm (Senor Ding Dong... happy Cinco de Mayo) vs. mesoderm (Chief Wiggum) approach.

I found some other Simpsons related doorbell clips that nicely (I think) reference some of the variety of behaviors that can happen with a reflexive response to a particular stimulus.

Homer needed at the door.
Marge responding to a horn as she would a doorbell