A line from Jurassic Park

[Barrett Dorko]

There’s an exchange in Jurassic Park I’ve always liked:

John Hammond: All major theme parks have had delays. When they opened Disneyland in 1956, nothing worked!

Dr. Ian Malcolm: But, John. If the Pirates of the Caribbean breaks down, the pirates don't eat the tourists.


I struggle to understand how it is that the professions dealing with patients in pain every day haven’t yet learned that this phenomenon can be understood, despite its complexity. Efforts to simplify it for teaching purposes have been proposed. I certainly use them. Methods of management are legion, though I’ll admit that most don’t begin with understanding and plausibility where they should.

I have spoken to many thousands of therapists. A typical exchange follows:

Them: Why is it that this still hurts even though there’s nothing wrong and the patient has attended every treatment?

Me: Melzack explains that.

Them: Who?

Me: You never heard of him?

Them: No, I haven’t. What difference does that make? My patients do fine.

Now. Please return to the Jurassic Park exchange and see how it matches this.

If you dealt with chimpanzees all day, trying to understand and alter their behavior, would it make any sense that you’d never heard of Jane Goodall?

[CDano]

If you dealt with chimpanzees all day, trying to understand and alter their behavior, would it make any sense that you’d never heard of Jane Goodall?

Maybe if you'd only dealt with engineering drawings of chimpanzees?

[Barrett Dorko]

I've been asked on Facebook if Melzack has been left out of the PT cirriculum.

Who knows about this?

[btolley]

I currently have a 2nd year PT student who has heard the term neuromatrix in a lecture. I also recently was able to look through an neurolgy textbook antoher PT had used at school from about 5 years ago and there as a paragraph or two about Wall/Melzack. It discussed the gate control therapy as well as the neuromatrix theory. Parts of the passages were highlighted, so she at least read the words.

So it seem there is some passing mention of this informantion.

Brian Tolley, PT

[Barrett Dorko]

My point is this: People in pain need for us to understand this NOW.

Do I think patients in pain suffer needlessly because of the willful ignorance pursured by their therapist? YES

Jurassic Park was not Disneyland.

[Barrett Dorko]

Anybody who understands gravity at all knows that it follows certain rules. Heck, both of my grandsons test these repeatedly from their highchairs. Neither knows Newton’s name, but I’m sure they’ll learn it. Newton discovered these rules and explained them. He didn’t invent them.

Similarly, Melzack invented nothing, he explained things; things therapists see and hear every day, should they choose to.

[AdamB]

To many it is "just" symptoms - not the center of the problem...

[Barrett Dorko]

That's why I wrote the aphorism:

When the primary complaint is of pain, the treatment of pain should be primary.

And man, that has gone nowhere.

[AdamB]

When I think back and try to remember how my paradigm changed from mesoderm to ectoderm (still struggling with mesoderm-ish reasoning at times though - so hard to let go) I would always like to say that it was Butler and Gifford that changed my views, but the first real nail in the coffin was from you, Barrett.

I can't remember in what thread of course, but you wrote someting like "when you ask a therapist what he/she is doing when they lay their hands on the patient they say [this] and [this]. I would say that first my nervous system interferes with that other persons nervous system. I then place my hands on their cutaneous receptors and [so on]". Something along that line - I can't remember. But that way of looking at the patient and the view of manual care COMPLETELY changed my mind in an instant. It was only two or three lines. I guess I had been going down the path for some time, but those lines changed my paradigm for good.

The thing is - I think you have to be open, be a seeker, to let someone push you in another direction. I don't know why I was seeking, but I have always been insecure about my practice - always a feeling of not knowing exactly what I was doing, why I was doing it and what I could expect from doing it.

What has driven my (insecure) practice (not necessarily forward all the time) has always been the word/question WHY.

Probably not an answer to anything in this thread, just felt it belonged here...

[Barrett Dorko]

Adam,

I recall writing about how different the response would be from someone traditionally focused on the mesoderm than my own. I don't remember where I wrote that though.

There's something in the sololiqui delivered by John Hammond about the "flea circus" that began his career that keeps coming to me today. Perhaps it's his obvious delight in the fantasy it represented. When he did something "real" there were consequences he hadn't anticipated.

I'm working on it. Maybe another "nail" will emerge.

[AdamB]

I guess you can't fix a million year old primal response with needles, cracks to the bones, biofeedback or cyclic sound pressures or in Hammonds case: electric fences...

[Bas Asselbergs]

Ian Malcolm chuckled at John Hammond and remarked on chaos theory and the complex ways nature "finds a way" - and why that would screw his plans.
Hammond simplified the challenge, that was his mistake.

[Barrett Dorko]

I suppose that's it: Living creatures and their instincts weren't something Hammond understood. He thought that somehow his money would solve the problem, thus his repetitive line, "We spared no expense."

Disney, on the other hand, did as much with robots as he could.

[byronselorme]

Originally Posted by AdamB

The thing is - I think you have to be open, be a seeker, to let someone push you in another direction. I don't know why I was seeking, but I have always been insecure about my practice - always a feeling of not knowing exactly what I was doing, why I was doing it and what I could expect from doing it.

What has driven my (insecure) practice (not necessarily forward all the time) has always been the word/question WHY.

Hey Adam,
I think someone has to have some strange combination of security and insecurity to do what you did. Secure enough to take a turn that so many are afraid or unwilling to. I am still trying to figure out what the insecure part is because everytime I think of it the answer leads back to secure at its root.

I think it is truly awesome that there are a few people like you out there and your post sure was inspiring in that regard!