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Barrett's Forums This discussion is devoted to the latest advances in neuroscience and the clinical phenomena it explains.

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Old 10-05-2008, 01:31 PM   #1
Barrett Dorko
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Default Therapy and The Discontinuous Mind

While reading some of Richard Dawkins work recently I came across a description of thinking that I feel may help us understand how and why the application of neuroscience to manual care has been such a hard sell. He calls it the discontinuous mind.

Dawkins gives several examples of this that I find both humorous and disturbing. He suggests that the issue of whether a five foot nine inch woman is tall or not might generate in the discontinuous mind an entire legal investigation into the nature of “tallness” and a further prolonged and expensive discussion regarding the qualitative and quantitative value of various heights among humans that also takes into account their gender and unique culture. Conversely, Dawkins would simply say, “She’s five foot nine. Doesn’t that tell you what you need to know?”

While the preceding can be played for laughs, a very real example of discontinuous thinking regarding racial identity took place in the apartheid regime in South Africa – and that wasn’t very long ago. This, to me, is where the consequences of the discontinuous mind become disturbing.

I looked hard for a single phrase from Dawkins that might sum up his definition of discontinuity but couldn’t find one. As an evolutionary biologist he focuses on how this sort of thinking has led many to conclude that animals must clearly belong to a specific species and that humans are somehow “special” and thus distinct from our evolutionary predecessors - despite that fact that there is no evidence that these things are necessary or true - he hasn’t stated very simply what he means. Instead, he speaks of the outcome of this thinking, which is okay, I guess.

So, I’m going to try one out here and build a thread with this as its foundation:

The discontinuous mind represents a gap in our perception and therefore our reasoning. It leads to our presumption that things begin at a given time and in a measurable way. These things lead to the presence of other things that we may be able to sense with sufficient ease, measure again and alter predictably. In short, it encourages ignorance of the deep model of existence and functioning. The discontinuous mind finds it easy to dismiss evidence that does not conform to its current model and to only emphasize that which does. It is the antithesis of scientific thought.

More soon.
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Old 10-05-2008, 03:54 PM   #2
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[QUOTE=Barrett Dorko;52519]

1 a very real example of discontinuous thinking regarding racial identity took place in the apartheid regime in South Africa – and that wasn’t very long ago. This, to me, is where the consequences of the discontinuous mind become disturbing.

2 The discontinuous mind finds it easy to dismiss evidence that does not conform to its current model and to only emphasize that which does. It is the antithesis of scientific thought.
[/B]QUOTE]

1 This discontinuous thinking is still going on a lot in our world.

2 would you agree that discontinuous thinking regarding manual care is partly caused by the way of "pt" education. It's easy to believe a logical (scientific?) rationale : A causes B therefore if we treat A then B is solved. Without regarding a possible relevance of lets say C (Nervous Sys.). and maybe even a factor D (yet unknown, i.e. poorly understood proccesses in the brain such as consiousness)
I agree it's easy to think along "one line" (straightforward), in this way thinking is not draining much energy.

Ps The Selfish Gene : great book
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Old 10-05-2008, 06:17 PM   #3
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Barrett, what book are you reading in?
Is he referring to the "discontinuous mind" as how the brain works, or is he using it as a metaphor for how "society" thinks?
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Old 10-05-2008, 09:01 PM   #4
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Never mind, I found a link.
Now I know..
"We admit that we are like apes, but we seldom realize that we are apes."

I'd venture to say that the discontinuous mind is one which favors "idealism", sees life narrowly through human eyes only, as a group of discrete nouns which can be arbitrarily moved around, categorized, placed in some preferred order (E.g., "God" at the top, male humans directly beneath, everything else in descending order);...

...over "progressive-ism", seeing life as a verb, as biological movement progressing through time of all kinds - cyclical, evolutionary, planetary time, with all living superficially discrete conglomerations of matter having an equal right to exist. I.e., humans not special but rather "speci-AL", just another "specie".
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

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Old 10-05-2008, 09:51 PM   #5
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Fred Watson is an Aussie astronomer who has written a book called Why is Uranus upside-down?
He is fond of saying I don't know, but.... and embraces the uncertainty principle wholeheartedly,as any good scientist does. Yet he actually knows a vast amount about the cosmos, just as Dawkins does about biology.
Both to me demonstrate that valuable attribute of the scientist: it's OK to be uncertain about the validity of sequential events, but it is not OK to draw one's own conclusions from such information and sell it off as honest knowledge, without being challenged.

Dawkins certainly gets challenged. Traditional manual therapy teachers have not been challenged enough.

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Old 11-05-2008, 04:37 PM   #6
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Great comments as usual. Let's take another stab at getting more of the readers involved:

When a thread lands in my head like this I usually list the ideas it generates in bold letters in the file, returning to them as things progress. Today I want to bring that list here. Perhaps it will help others see where the discontinuous mind plays a role in our difficulty in seeing how various aspects of therapy and disability are simply shadings of what are essentially the same phenomena.

  • Passive, extremely gentle mobilization (eg Maitland’s Grade I, Feldenkrais’ functional integration, strain-counterstrain, Bobath’s handling, Reiki, acupuncture) and Simple Contact

  • The distinction between so-called “neurologic” problems and “orthopedic” problems that remain painful

  • The distinction between threat and danger

  • The distinction between neuroanatomy and neuroscience

  • The distinction between skill and knowledge

  • Evolutionary processes, the kluge of the brain and the discontinuous mind
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Old 11-05-2008, 07:57 PM   #7
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I'd like to take a stab at skill and knowledge. I taught a classmate how to do Simple Contact. We were working with another classmate who has had serious neck injuries. The therapist was able to elicit authentic motion immediately. I had previous worked with the same student patient and it felt awkward and forced.

I know the difference in the experiences was due to a) The student therapist I taught is a walking authentic. He has no cultural inhibitions, he is happy, and he is unencumbered by the why's of how it works just that it does. They were both surprised when the patient said she was warming and moving easier.

b)I was afraid of being laughed at (because I label myself a smarty pants). So to show students SC is a risk for me. I an encumbered by the culture of my school. I have deep resentment for the fact that the why's are not being taught well or at all. [What I want: Neurology as it applies to the whole organism not just sensory-motor. Neurology of pain. Anatomy that places nerves in and with the structures that they contribute to, not just another inert tissue like fat to be damaged by bad treatment techniques]. I don't know when I will feel authentic, perhaps after I finish school.

As Barrett experiences the silence after his classes, I know my fellow students struggle with what they are learning now. I do too. None will come here. I'm here to try to grasp concepts well beyond my current knowledge so I can fill in the gap. I ask questions, stumble and learn. You have to want more. I think that is why there is silence. They don't see the value for the why's or the more. Education interfering with learning.

My classmate is a great person and he will be an amazing RMT, and our patient is doing well. I continue to expand my knowledge and hope that I will apply it skillfully one day.

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Old 11-05-2008, 09:39 PM   #8
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Karen,

Thanks for joining in. Of 36 students here in Cleveland you’re “it.”

I see the skill and knowledge thing in this way with that portion of my brain/mind that isn’t discontinuous (at the moment anyway).

Knowledge and understanding, while not the same thing, are certainly related. When handling another in pain understanding should precede whatever skills the therapist might attempt to employ, and, in fact, it is understanding that ultimately determines what the manual therapist doesn’t do, attempt to do or imagine that they are doing. It should also dictate what they think or imagine happened after they let go.

Skill then, is a consequence of knowledge. And when a therapist makes some technique “work” without any real understanding it’s much like winning the lottery; it’s exciting and the initial thrill is intoxicating but nothing good eventually comes from that. They’ve done studies.

So, those practicing manually and seeking to develop skills should understand first and practice later. One rises from the next and the order, according to me, is set in stone.
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Old 13-05-2008, 01:38 PM   #9
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Okay, let’s try that first one: Passive, extremely gentle mobilization (eg Maitland’s Grade I, Feldenkrais’ functional integration, strain-counterstrain, Bobath’s handling, Reiki, acupuncture) and Simple Contact

After demonstrating for a while I am always asked about one or more of the techniques mentioned and I can understand why. To me, the continuity seen in these techniques may be traced as follows:

Maitland’s “don’t bend the fly’s knees” grade one mobilization is pure “skin-deep” technique. I recall my old boss Stan Paris often speaking of its inability to actually affect the joints and therefore its uselessness. Little did he know.

I watched Feldenkrais himself passively encourage the muscular contraction he discovered manually. Not bad, but more coercive than I’ve become. He seemed not to know that the patient had an actual instinct for correction and only treated what he saw as an invitation to help it along with passive manipulation. He was close but not quite there.

Strain – counterstrain theory (from Jones) has been totally disproved but at least the method is painless and gentle. It’s passive movement though and thus not likely to catalyze instinctive expression.

Bobath, I think, came closest – mainly because of her understanding of painful function as neurologic and not orthopedic in nature. See This is Why for more of my thinking about this.

Reiki and acupuncture are both quite clearly skin deep in approach. However both possess bankrupt theories and neither promote movement as did Feldenkrais, Bobath, Maitland and Jones.

See the continuity here?
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Old 13-05-2008, 09:57 PM   #10
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I would add to #1 on the list:

DNM;
and the art of walking with patients with one hand on them somewhere. Not guiding, just keeping contact, briefly. I remember the times I did this with stroke and TBI patients and have just thought about it now. A butterfly touch, more in anticipation of my preventing a crash to the floor than anything else. Hmmm...

Maitland's Grade1: We used to be told in the 1970s that Grade 1s must be so light the joint can only just be felt. What surprises me is that GM thought of doing such light contact in the first place, given the theory was purely joint-based. What was he thinking of?

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Old 14-05-2008, 12:06 AM   #11
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My thoughts on the skill and knowledge/understanding issue:

Personally the more I read and learn the more questions I seem to have. While I do feel my understanding is increasing it doesn't immediately transfer into increasing skill. Some older skills become less important, and new skills need to be perfected... I guess I have a problem with dissonance.

I find myself a bit envious of those who have no trouble developing and applying their apparently wonderful "clinical skills" without needing the time and bother of developing their understanding (deep model).
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Old 14-05-2008, 12:51 AM   #12
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I wanted to take a stab at distinguishing between "threat and danger" but then I thought maybe it should really be "discomfort/unease and danger", with threat somewhere in the middle. Then it got worse, because I was not sure what sphere of existence to discuss; physical, emotional, spiritual, intellectual etc. Not to mention how different folks/cultures/generations prioritize these qualities in their minds and whether it is a conscience choice- or simply something they are not even aware of. It finally hit me that some of the fairly lengthy debates on EIM/SOMA that can vary in mid stream from scholary presentations to school yard fights are probably due to difficulty between those participating in recognizing where their responses fit on this continuim, much less how others percieve it. That is why I prefer face to face over phone, and phone over writing, as you get so much more information/feedback to work with. As therapists we get to go one better with the addition of touch. It has been "threatening" to me to try and participate in these forums when I barely have time to read them/maintain my lurker status, but I also find it more dangerous to consider never trying. Just my 2 cents, yen, grains of sand.
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Old 14-05-2008, 01:27 AM   #13
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Nari,

Yes, Diane’s dermoneuromodulation is certainly the closest method to Simple Contact that I know of. In fact, I think most people would have difficulty distinguishing between the two. I know that Diane’s knowledge of neuroanatomy and internal processes of many sorts far exceeds my own however. On the other hand, Ohio State recently signed some really fine football talent – so I got that going for me.

The reason I didn’t mention it initially is because nobody at my courses knows of Diane until I speak of her.

The “threat and danger” idea was the result of my reading of Nick Matheson’s latest blog entry. Let’s have a few read it and move forward from there.
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Old 14-05-2008, 04:36 AM   #14
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Barrett,

I realised that this is what you would say to a class, but could not resist adding DNM for those who haven't been to your classes.

jlsmithivan,

Your post struck a chord (or two) with me because I think what you stated is a very common difficulty with lurkers/posters/would-be posters. I doubt there would be the same situation in a face-to-face encounter; body language makes such a difference in responses.

Threat and danger I see as different, with grey areas of overlap.
One way I've looked at it is this: the brain may perceive a threat whether there is danger to life and limb or not. If a person in some degree of pain receives news and reacts negatively, it is not a danger to him or her. However the brain perceives a threat and increases pain, usually. Negative thoughts are powerful things.

I've known some very astute and competent clinicians over the years. Their knowledge seemed endless and their handling accurate and mostly useful to the patient. Understanding, however seemed to ride in third best, as if it didn't matter much. It has been stated over the last few years by quite a few writers that EBP does not include understanding. If it did, then knowledge and understanding would transfer much more easily into skillful clinical practice. It took a class with Barrett to clarify that.

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Old 14-05-2008, 01:26 PM   #15
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I'm reminded of the often heard phrase from screenwriters wanting to make a character sincerely sinister: "That's not a threat, it's a promise."

I see danger as something more immediate and close by. Danger might be avoided, though not always, and threats are warnings. They overlap, as Nari says.

Nick speaks of Moseley's assertion that pain is output by the brain when it concludes that tissue is in danger and action is required. Without both criteria present there will be no output of pain, I guess.

My question: Where does the continuum of danger <=> threat fit in here clinically? What can we do with a patient to alter this? How can we be with them?

I've a few ideas, and it occurs to me that the therapist with the discontinuous mind will commonly miss this issue entirely and always wonder why they struggle.
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Old 15-05-2008, 01:32 AM   #16
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Barrett. From a clinical perspective isn't the danger <=>threat idea the biggest hurdle we have to deal with in patient care, and as many of you have often pointed out - our relationship and careful handling of the patient becomes the key to preparing them for for the possibility of change via new understanding-or better yet, a way for us to be with them. On another note, is it possible that thinking we can actually define what is a threat versus danger for one person is actually another form of discontinuity? I keep thinking of those chronic pain people who get stressed simply from the possiblity of something which to me is more of a threat than a danger, yet they have worse pain and they really aren't taking any action
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Old 15-05-2008, 03:38 AM   #17
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I've listened to a couple of neuroscience podcasts recently discussing the hypothesis that the brain evolved as an organ of perception and action. It somehow made the "pain as output" explanation make more sense to me.

I think threat is something that might be dangerous, involving many more possibilities than something that actually is dangerous.

Reassurance seems to be an important therapeutic approach.
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Old 16-05-2008, 07:15 AM   #18
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Discontinuous: adj.
    1. Marked by breaks or interruptions; intermittent: discontinuous applause.
    2. Consisting of distinct or unconnected elements, such as the physical features of a landscape.
    3. Being without sequential order or coherent form.
Interestingly I see a landscape as continuous albeit with discernable features.

Diane said "We admit that we are like apes, but we seldom realize that we are apes." Sometimes I catch myself thinking; "Damn, I'm just a hairless monkey driving a car. Now that's a circus trick!" (I know we are apes not monkeys).

Discontinuous? Shadings that in one mind make a landscape fractal bits and in another a whole...

Threat > Danger, shadings in a continuous spectrum of which both can elicit pain. Ignoring the treat ignores the whole danger.

For me Simple Contact is the big picture. I must fill in the continuum with knowledge from neuroanatomy, neuroscience and other disciplines so that I may develope my skills that will empower patients to manage and reduce their pain. The trick is avoiding discontinuity of thoughtful logic and reasoning.


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Old 16-05-2008, 01:15 PM   #19
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Quote:
Evolutionary processes, the kluge of the brain and the discontinuous mind
from Wikipedia
  • Kludge, an ad hoc engineering solution, inelegant in principle but possibly elegantly pragmatic
    • Kluge: The haphazard construction of the human mind, a 2008 book by Gary Marcus
hmmmm "...inelegant...but...pragmatic..."

from Amazon's blurb about the book
"...Throughout, he shows how only evolution -- haphazard and undirected -- could have produced the minds we humans have, while making a brilliant case for the power and usefulness of imperfection." (emphasis mine)

Now there's a concept I can relate to.
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