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Old 16-04-2007, 02:10 PM   #1
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Default Therapy's Strange Loop

I’ve struggled a bit to find a way of beginning this thread. I anticipate its being a long and surprising one. Long because the subject is so large and surprising because I haven’t yet read most of the materials I intend to use. I’m sure there are some I’m not yet aware of.

Let’s start with this: Deep in his newest book, I Am A Strange Loop, Douglas Hofstadter uses a dialogue between two fictional characters, one a doubter regarding his basic premise (more on that later) and one a believer. They are discussing the way in which humans perceive things. I’ll paraphrase it here.

Believer - We humans are beings whose fate it is to be able to perceive abstractions, and to be driven to do so. We spend our lives sorting the world into an ever-growing hierarchy of patterns. Being macroscopic, we can’t see way down to the level where physical causality happens, so in compensation, we find all sorts of marvelously efficient shorthand ways of describing what goes on. Fortunately, despite the chaos, the world is filled with regularities that can be counted on most of the time.

But there’s this to consider: The one who perceives has to constantly deal with its own viewpoint, a viewpoint that may be skewed by its own “soul,” which is yet another shorthand term for our “central essence,” which is something else we fabricate a story about.

Okay, I know that this is a rather heavy subject, but I hope to lighten it with specific examples from my own clinical experience and look forward to seeing some of yours.

There’s no hurry. I’m not going to be far from the computer no matter where else I might be. In my second post I will explain a bit more what it is I hope to talk about here.

All I have to do now is figure that out.
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Old 17-04-2007, 04:36 AM   #2
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Hofstadter is all about self-reference. He especially likes Drawing Hands by M. C. Escher. Prior to this he was best known for a book written in ’79 titled Godel, Escher, Bach: an Eternal Golden Braid. Believe me, this book is a cult classic and it got rave reviews. I’ve had a copy for years but can’t say that I ever read it through or understood it well. Maybe that will change with the writing of this thread.

Hofstadter contends that if we carefully examine the small brain events that wend themselves toward the symbol-making that eventually forms the story we make up about our life that we will discover something about consciousness.

Okay, I get that. How it relates to therapy remains to be seen.
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Old 18-04-2007, 12:04 AM   #3
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i didnt have much luck understanding godel escher and bach when i tried to read it in my early twenties.maybe it wasnt luck but too many spliffs
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Old 18-04-2007, 12:22 AM   #4
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It was too deep for me I'm afraid. Had some nice pictures though, of growth curves etc., as I recall.
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Old 24-04-2007, 09:10 PM   #5
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Default Hofstadter's Meteor Metaphor

Everything I do is some kind of modified borrowing from others who have been close to me either actually or virtually, and the virtual influences are among the most profound…We are all curious collages that grow by (fusing) with other people’s habits and ideas and styles…as if they were meteorites that came soaring out of the blue, collided with us, and then stuck.

Hofstadter, I Am Strange Loop, pgs. 250-251

I’m still picking out phrases from this book and letting them swim in my head for a while, hoping to find a way into Hofstadter’s basic premise and then out again so that I might post here.

This quote struck me as especially appropriate for someone like me. After all, I mainly behave as one of those “meteorites” that flies through a town and catches the gaze of a few therapists. I glance off most with no appreciable effect, mine not being as “sticky” as the memes carried by McKenzie or Paris or Sahrmann or a few others. Hofstadter takes pains to explain this:

Although my meteorite metaphor may make it sound like we are victims of random bombardment, I don’t mean to suggest that we willingly absorb just any old mannerism we see – we are very selective, usually borrowing traits that we admire or covet – but even our style of selectivity is itself influenced over the years by what we have turned into…

I’m beginning to suspect that my difficulty getting other therapists to be less aggressive and threatening; to become manually accepting and non-judgmental, has everything to do with what they’ve become before they arrive in class. This isn’t news to me, but through Hofstadter’s writing I’m more appreciative of how change in others may or may not occur – and that includes our attempts to change our patients.

Perhaps a therapist's previous contacts - the meteorites that have flown near to them - make seeing and understanding and handling others as I do nearly impossible in some instances. I think that this situation is preserved by the silence of their former teachers. There's certainly plenty of that going on.
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Old 25-04-2007, 06:40 PM   #6
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There’s a passage on page 264 that I found very interesting. Here Hofstadter is discussing viewpoints and the manner in which we “routinely transport ourselves into virtual worlds.”

He says, “The mere act of reading a novel while relaxing in an armchair is an example par excellence of this phenomenon.”

I’ll paraphrase here: Though what we look at in the book is just a myriad of black smudges arranged neatly in lines on a set of white rectangles, we “see” the scene described. (And should I use the quotation marks around see?) We are so impressed with this we lose sight of the room we actually occupy. In fact, we become unaware of the black smudges we are depending upon to bring us the images we “see” while reading.

“Black curlicues on a white background, when suitably arranged, transport us in milliseconds to arbitrarily distant, long-gone, or even never-existent venues.”

I can’t read this without thinking about how a patient’s words can do the same thing to us and ours to them, and then what we write in a chart may take yet another therapist to a place that isn’t real and/or never could be real.

It’s far more convenient to simply ignore this way of “seeing” when we read another’s description of something, and, of course, that’s what we commonly do.

Knowing this, how can we come closer to the “truth” behind a patient’s condition as they are passed about in the system?

Worth thinking about if you’ve the time, and better yet if you’ve the courage and inclination.

I think Hofstadter writes of this with a tremendous amount of courage, and, of course, he pays a price.
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Old 25-04-2007, 11:22 PM   #7
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Which way of seeing is beneficial to the patient?

Two different therapists sitting in a room listening to the same patient may be transported to two different places. I’m sure much has to do with the therapist’s education, understanding, and training (context?). I can just imagine one PT “seeing” joint while I “see” neural tissue even though we hear the same story. We also may write the same things down on paper, but the meaning I give the words may direct a method of care quite different.

Douglas Hofstadter states in the preface of “I Am A Strange Loop” (referring to “Gödel, Escher, Bach”),

“And, yet despite the books popularity, it always troubled me that the fundamental message of GEB seemed to go largely unnoticed.”

Do our patients ever walk away thinking that?

There is also much to patient’s stories that can’t be written down but are still important, non-verbal communication comes to mind. Then there are also the things we write down that just don’t matter. I think I will forever struggle with trying to see more accurately. However, understanding a bit more neuroscience helped to put it into a hopefully more appropriate context allowing me to appreciate the right words and “visualize” the right image.


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Old 25-04-2007, 11:25 PM   #8
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I should also add that perhaps in reading Barrett's post, I didn't "see" the proper meaning. It's scary and sometimes I feel that with patients.

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Old 26-04-2007, 01:10 AM   #9
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There is an awful lot that goes on between therapist and patient that is never revealed; taking over from someone else's patient brings this home sharply. All we have is a page or many pages of what was done. If it is all purely objective, it is a matter of starting all over again, in most cases.
Mostly, it is attempting to erase any unreality caused intentionally or unintentionally by the other encounters.

Each encounter is, or should be, unique; if we move away from assembly-line, recipe based treatment, it either annoys the patient or enchants. What is lost, however, is the previous rapport the patient had with the therapist.

Chris is right; each of us sees a patient in quite different ways, especially if we listen properly to the patient's narrative.

Linking the presenting symptoms to the patient's being and their connecting with our presentation is a huge challenge.
Pulling techniques or methods out of a box is easy in comparison, which is why a lot of PTs do just that. In a way, it is much safer, though unlikely to be as effective.

As a supervisor of junior PTs and students (for what seemed ages) I would occasionally cringe at the way patients were spoken to and answered. Then again, I had to stop and ask myself: Why am I reacting like this?

I think that comes first in an attempt to understand a PT/pt encounter.

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Old 26-04-2007, 06:36 PM   #10
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Default The Smile of Ideomotion

Now we’re getting somewhere. I find Hofstadter’s observations every bit as interesting as his explanations, and, of course, the former typically precedes the latter. (Notice how that last phrase is true in two ways and how it is oddly self-referential – another strange loop)

I can’t find this in the book, but I wrote somewhere here on Soma Simple an addition to a thread that included his comments about a smile. He spoke of this in an interview recently.

Hofstadter points out that anyone’s smile is unique and immediately recognized by their friends, even after an absence of many years. Despite its individualized and distinct nature, a smile can’t be measured in any meaningful way. Within each of us it is a potential within the brain and manifest as muscular activity emergent when the context is appropriate.

Is ideomotion similar? I am convinced it is. I’m convinced that I can get another to express this unique thing within them as easily as I can get them to smile. Of course, my ability to do that will vary with my experience and knowledge. But any standup comedian will tell you that this improves with increased exposure to the situation and a variety of audiences. The comedian also grows increasingly aware of what’s funny.

We’re the “comedian” and our patients are the “audience.” How do we have to be with them? What is it we can do to promote the “smile” of ideomotion?
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Old 26-04-2007, 07:15 PM   #11
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I remember reading in "Phantoms in the Brain" V.S. Ramachandran speculating about the nature of a smile and laughter. His idea was that a smile was in response to a perceived threat understood as no longer threatening. This was just speculation of course and I'm sure there is more to it. But not being perceived as a threat is big.

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Old 27-04-2007, 12:31 AM   #12
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We can easily see anger or frustration or pleasure in the written word, but I have never seen a smile in a text, unless it is specifically stated as occurring. We simply have to imagine that particular text suggests smiling.

So if ideomotion is a smile (and those who are experiencing it usually have a bit of a grin), connecting with a PT's spoken words can be difficult. A smile is a change in the muscle function of the face, and a forced smile is an entirely different but similar explanation. Perhaps this could be a sort of analogy: a PT requesting someone to move in a certain way, produces a forced smile; eliciting ideomotion is like a spontaneous smile.
I've painted myself into a corner again, so will think some more about this...

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Old 27-04-2007, 01:14 AM   #13
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About smiles, I've read that they also function as submission gestures... I will go along with the metaphor, but only for smiles of the spontaneous sort that indicate delight and no other kind.
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Old 27-04-2007, 01:30 AM   #14
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I remember another piece from Ramachandran's "Phantoms in the Brain". There are apparently 2 different pathways of a smile (one authentic/unconscious, one forced/conscious). The example he used was of a patient with a facial droop, when commanded to smile produced some contorted expression. When a loved one walked through the door the person would produce a full smile. So like Nari said, ideomotion is a spontaneous smile.

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Old 27-04-2007, 01:39 AM   #15
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It’s true, smiles are of different sorts. There’s a pretty good description of the “Duchenne” smile here and some interesting comments in addition here.

In the second link there’s this comment: “In Duchenne smile, the facial muscles involved in are difficult to control voluntarily. Therefore, it's difficult to fake a Duchenne smile unless you smile from within.

The Pan American smile is a perfunctory smile. It is nothing but a courtesy smile as in the case of a flight attendant responding to a patron. It's an expression of courtesy and politeness rather than inner joy. Alas, the Pan Am airline is dead but the smile will live forever.”

There’s a direct correlation here to the authentic, corrective movement seen in ideomotion and the approximation of that when people try to correct via a conscious motivation. I know I can tell one from the other immediately but it would be hard to say how it is I know that. This ability is intuitive on my part, secondary to prolonged observation.
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Old 27-04-2007, 08:47 AM   #16
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It may be intuitive, but isn't that dependent on what intuition is based on; what 'feeds' it from hour to hour and I suspect that particular tucker is observation?...

Short of getting into deep water with fabrication, consciousness and intuition, I wonder if the 'central essence' of someone, anyone, defines the ability to manage threat; whether it is to stay alive or relax in a chair for an hour. When we encounter another person, there is a threat value which can disappear in a second or hang around for a while. Chris mentioned Ramachandran's version of why a smile occurs, and I figured that threat is the most crucial aspect of living. Threats can be real or totally irrational in someone else's view, but that does not matter much.
A therapist can smile, converse and empathise with a patient and still feel threatened - (I really don't know what to do with this person) - but take the therapist into a pub for three hours and chances are the smile and conversation will be quite different. Far from suggesting we should become boozers when treating, I wonder if our awareness of our own forests of threats could be increased.

We may not like it, but it would be beneficial for our patients' wellbeing.

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Old 27-04-2007, 11:39 AM   #17
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Nari,

These are all perfectly relevant points, and I think they have more to do with practice than most realize or would like to admit.

Many of the therapists I encounter are literally scared to speak about their work and won't offer an opinion about what they've been doing for years if they can avoid it. Today's class in Hartford is quite large (60) and last week's in Lexington set a record for small (4). Today's crowd will provide cover for many and they'll be glad to hide in the midst of it. Maybe these same therapists would prefer treating others in a generic manner because it is far less likely to expose them. Unique behavior is, after all, both counter-cultural and courageous. Threat will always grow when we step out of the herd.

But Cory's words about an absence of threat in successful manual care gleaned from modern neuroscience are something I emphasize these days and the classes seem to "get" this readily. It explains so much even while it makes them seriously question their usual manner of handling. Perhaps they begin to sense that if they simply stopped threatening their patients with uncalled-for coercion they would find the patient's reaction less threatening in return. Action followed by equal and opposite reaction comes to mind.

Maybe we should keep this in mind: When therapeutic practice threatens the patient the patient will begin to threaten the therapist. In such an environment, very little pain relief is likely to occur.

There's also this from Hofstadter. He recounts on page 56 his first experience with a video camera in a store. He asks the salesperson if he can point it at the television screen that depicts the image the camera is seeing. This would result in an endless series of camera-in-screen-in-camara-in-screen images that essentially "close the loop" that Hofstadter is striving to describe. The salesperson said in a panic, "No! You'll break the camera!"

Think about that one.
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Old 27-04-2007, 12:27 PM   #18
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Barrett,

This almost inherent need for therapists not to talk about their work surprises me; it seems as though they are afraid they are substandard.
I have always found PTs in an audience such as a course won't shut up about how they practise. It is normal to me, (although I prefer to listen mostly). Whoever is taking the class or course usually invites comments and criticisms, but she/he gets them, invited or not.

This is something of a loaded question, but why are many of your audiences so afraid of themselves? Don't try to answer that, it is rhetorical; and all of us would like to know the reasons, I'm sure.

A very long time ago there was a thread about rabbit holes, either here or on NOI; can't remember. The camera-screen-camera-screen image reminds me of the rabbit hole, somehow; endless digging in the same spot, deeper and deeper in the same hole and all that could be seen were the same striations of earth layers. Whereas from the top ground it could be seen that there are many holes, all connected and functional. Yet, the salesman was seeing only one aspect and anything else was a threat. Probably to his job....or so he thought.

I know when I hear the words: "OK, lie down/sit up for me" I cringe. To me, that is a threat because the patient is in no position but to obey.

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Old 17-05-2007, 01:14 PM   #19
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I have borrowed a copy of Hofstadter's Godel. Escher, Bach.

After two hours on the section Brains and Thoughts, I am not really any the wiser. (But I did like the Jabberwocky in French and German) As I like Escher's strange loops and hierarchies, I'm trying that next...
Don't like my chances much. I need Jon to sort out the horrific maths.

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Old 17-05-2007, 07:28 PM   #20
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Hi Nari,

Maths are easy to sort as far as I'm concerned. They can all go to the same place.

Better to ask Bernard or Luke.
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Old 03-06-2007, 02:47 PM   #21
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Default The seduction of symmetry

I think this fits here.

I listened this morning to the first few minutes of the latest podcast of Studio 360. Today’s subject was symmetry. I found especially interesting the discussion regarding the art of M. C. Escher, a man whose work has remained fascinating for millions across several decades and will never disappear from college dorm room walls entirely.

Escher’s obsession was symmetry, and we are drawn to his depictions of its many forms for a very simple reason; it is a deeply embedded part of us. But we know as well that a diversion from symmetry’s predictability also attracts our attention, and that finding a balance between symmetry’s perfection and unexpected eccentricity in an object or a song or another person is something we might find compelling as well.

I looked for the word “symmetry” in the index of Hofstadter’s book, expecting to see a long entry. I found nothing. Once I got over my shock it occurred to me that Hofstadter perhaps understands that all self-reference (his primary subject) is a kind of symmetry. In short, we look for ourselves in the things around us. Seeing this, we find comfort and safety. Therapists obsessed with “posture” as a means of solving painful problems might be just a little more obsessed than those of us who don’t. Ramachandran has demonstrated how certain images draw our attention and, if they are considered art, our money. This is discussed in detail in the thread Altering the Ideal. See especially post #4.

Perhaps the mirror neurons in the therapist insistent that symmetrical postures are essential for health are driving their practice. Mine might be as well, but I learned early on not to trust my eyesight because it was terrible and not corrected until I was 8.

Instead, I turned to what I felt and this has altered my career massively.
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Old 05-06-2007, 02:00 PM   #22
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Default The Source of My Dis-ease

I just read through this thread and found it both remarkably illuminating and confusing. Some of the comments are amazing and seem brand new to me – despite the fact that I wrote them. This is both a source of pride and uneasiness.

See where I’m going with this?

A life like mine full of solitude and long, quiet moments might produce a kind of therapy unfamiliar to my colleagues and certainly to the patients who attend care expecting what they’ve always gotten before. After all, they ordinarily receive therapy from others who are very like them - on the surface at least – and everyone’s expectations are met without conflict.

But in my presence and especially when my hands land upon them there is a “strangeness” that might be difficult to articulate but is felt quite profoundly. In fact, I often tell my classes that a stranger’s touch is far more likely to produce a large reflexive effect than your spouse’s would. I say, “This is why I remain a stranger to my patients. I’m friendly to be sure, but not familiar. It enhances my manual effect.” I’m convinced that my patients didn’t receive therapy – they revealed it.

Yet, if Simple Contact successfully enhances another’s awareness and expression of ideomotion (and almost without exception it does) there is a sense of familiarity and reminiscence that is undeniably, well, strange. This novel stimulation will not threaten the patient as long as the therapist understands its purpose. This lack of understanding is my major problem with myofascial release and the craniosacral therapies.

Teaching what it is I’ve come to understand and defend is what my life is about these days since I no longer see patients. When I find myself uneasy it is because I lack those moments of self-reflection that can only be had with another in my hands.

Today, I don’t know that this will ever change for me.
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Old 13-06-2007, 02:04 PM   #23
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Default Consciousness Is Not a Power Moonroof

I read something in I Am Strange Loop today after looking in the index for the word “magic” that I feel fits here. I plan on duplicating this entry in the Therapy’s Strange Loop thread.

The passage begins under the heading "Consciousness Is Not a Power Moonroof” and concerns the fact that this thing we experience as consciousness is a result of our brain power, not an “add on” that we can purchase separately once the thing that contains it is in our possession. In other words, it’s not a moonroof on a car. As Hofstadter puts it: Consciousness is not an add-on option…it is an inevitable emergent consequence of the fact that the system has a sufficiently sufficient repertoire of categories. The strange loop of selfhood will automatically arise in any sufficiently sophisticated system, and once you’ve got self, you’ve got consciousness – NOTHING ELSE IS NEEDED. (emphasis mine)

This is where magic comes in. As Arthur Clark so powerfully states, “Any sufficiently advanced technology is indistinguishable from magic.” As Hofstadter goes on to point out in a variety of ways, a belief in something that something over and above physical law is necessary to explain that which can’t be explained according to our current knowledge is fraught with all sorts of difficulty, not the least of which are the illogical conclusions we must eventually draw.

Understanding this, the manual magician simply doesn’t go there. Instead, a therapist of this sort will prepare explanations that do not require belief and are in compliance with what is known presently. Of course, therapists and patients don’t necessarily want this, anxious to be deceived as they tend to be.

We must give it to them anyway.

This post also appears in the Manual Magic thread.
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Old 24-11-2011, 11:45 PM   #24
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Check out RadioLab's Loops for more insight about loops. Don't let the first segment turn you off.
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