The Creative Instinct

[Gil Haight]

Barrett,
This thread has been particularly interesting for me. The very idea of being impulsive seems so foreign in Physical Therapy that it is no wonder why we have been marginalized to the degree we have. Indeed an impulsive urge can get one in trouble but certainly not always. In rehab however risk it is not even a part of the equation. Maybe this is why physical therapy is not really an attractive profession.
Gil

[Jon Newman]

I think Garr Reynold's blog entry related to Brenda Ueland's book, If You Want to Write, lends itself to this thread.

[Barrett Dorko]

Gil,

Right again. I’ve noticed that the simple act of standing and/or sitting once someone is a therapy patient becomes something akin to a NASA shuttle launch.

The time invested in instruction, movement precautions, positioning, repeated instruction, postural instruction, repeating all of that, admonishing, cheerleading and one final repetition of the whole thing once again seems to stand in the way of spontaneity for some reason.

[Diane]

I thought of this thread when I read this post.

[John W]

As therapists, we privilege psychic reality over historical fact and as such, the patient is free to construct his story. Since the medium of psychotherapy is an exchange of ideas, the transmission of this "play" can involve tones of voice, expressions and hand actions. In so doing, a deep communication takes place.--S. Vollmer, MD (excerpt from Diane's link above-the bold is my emphasis)

What an added privilege we manual therapists have- our "secret weapon" so to speak: our hands- to help patients expand and expound on their stories.

This is one of those special threads that reminds me on a deep level why I choose to do what I do. And how I might become better at it.

[Barrett Dorko]

You're right John, this thread is special.

On January 1, 2007 I wrote this in the Story and Narrative thread:

In the Feb. 10 2005 issue of The New York Review of Books there is an essay about a new collection of Sherlock Holmes stories. The author speaks of Conan Doyle being trained by a physician named Joe Bell, a legendary diagnostician in London. Not only were his observational skills and interpretive abilities acute, he attended to the patient's story in an unusual way:

"To succeed as a narrative diagnostician...you needed the feeling for story, both for the 'history' to be inferred from the signs and symptoms and for the way that story could be reconstructed, in therapeutic terms, for the good of the patient. Bell treated his patients, in part, by telling them their own stories, as if threading a coherent narrative were itself a kind of therapy."

Here I can see that the author had a wonderful understanding for the difference between narrative and story; how both contained therapeutic elements but that the narrative finally constructed by the therapist reduced the confusion and irrelevance stories commonly contain. I think it’s important to remember how important the patient’s story is to them. In fact, in German there’s a word for this; Lebensluge. It means “the lie that makes life bearable.”

So, I’d conclude that an effective diagnostician turns the patient’s story into narrative and then repeats it back to them in a fashion that satisfies the needs of everyone involved – not always an easy thing to do – and the therapist needs to do this at the proper moment and at the proper pace as well.

As I speak in this fashion, retelling the patient's story in a manner that will alter the context and augment the therapy I handle them in a certain way, and that's no small thing.

[Barrett Dorko]

Seated with two friends my age on New Year's Eve, I listened to them speak of how much fun they'd had recently building doll houses and model cars. Given the chance I brought up the points in Brown's book about play's importance and both agreed that their life-long passion for creative crafting kept them sane in jobs that rarely offered any such opportunity.

I build nothing but working with my hands on inanimate objects has long been something that fascinates me. Sleights with cards and coins, juggling a variety of objects and now playing the harmonica each day are all examples of play that maintain my interest in living. Bringing an empty page to life with some writing that informs, endures and questions the dogma that surrounds therapy is my favorite form of play, and I'm sure it's much the same as ideomotion when done without a primary concern for its cultural correctness. Perhaps what I've said for years about the rejection of this active movement by those around us and, by extension, the educational community, is directly related to the dearth of jugglers, magicians, harmonica players and writers around us.

[Diane]

Barrett, I thought you might like to watch this. I thought it was quite good.

[smikolic]

Great thread.

I have recently encountered a pt who's mother urged her to read a book about creativity and how it decreases pain (have to look up the name again....), and she said she started to make jewelry for people for Christmas to help w/her therapeutic progression, and that she finds it both distracting and releasing (both beneficial to her for her pain).

The interesting thing about said patient, is that she was a hairstylist, though a manager at the time....don't know how much her creativity was welcomed/stifled in her role as manager...but it would be interesting to find out, especially in light of this thread, as she has no evidence of any "reason" for her pain and is most frustrated w/the lack of attention from her other providers for that fact.......

Funny thing too...she was mentioning that she had not had her hair done in a while (but was in too much pain/too busy to get it done), and I asked her what she liked to do with it, said I loved the idea (she told me she likes very funky colors/styles), and next visit she comes in with an awesome style and a t-shirt w/a funny phrase on it that I commented on. I was all about noticing/pointing out/encouraging her creative process without realizing the effect it might have had. I tended to agree with her assessment that allowing her creative processess to flow would likely assist other creative (vs. destructive) processes to resume, but I am just beginning to understand the connections.

Anyway, she is doing much better now (pain centralized and almost resolved). And prior to her re-awakening (?) of her creative processes, we were doing SC...wonder if it brought out her creativity again? Good to see how it all comes together either way, as I was tempted to disregard her creative impulses (not purposely, just didn't know it was as meaningful as it apears after reading this thread) as only slightly impactful on her pain.....

I wonder how we, as providers, can educate our patients to be more "creative" except through SC/ideomotion. The funny thing about SC is that the pt thinks the provider is moving them, so they don't really realize (consciously) that they are doing the moving (which is the point as far as I understood...).

So, how can we encourage creativity and keep it non-conscious? I am asking as a poet, and a person who has many friend tell me they could "never" write like that..or at all. And for me, no one encouraged me to do it, and I don't consciously seek to write, phrases and associations just come, and when they do, I am desperate to get them down before they rattle my head apart. At times it would be nice if I could consciously subdue them, or bring them out impromptu as well....just don't work like that for me!

Steph

[Gil Haight]

I have not noticed any correlation between being a “creative person”, ie. poet, musician, artist, etc. (believe me when I say I am none of the above) and the ability to maneuver in an unique, spontaneous and corrective way. Perhaps the very idea of what it means to be creative is what needs to be explored. Our societies’ insistence that only certain individuals are “really” creative is likely the fundamental problem.
It seems the most significant point in all of this is about the “urge” and not about talent.

Gil

[Barrett Dorko]

Gil,

I think you’re right. I also think that creativity and imagination are intimately linked. That was discussed at length here and I feel that helping people in pain is vitally dependent upon their educability. Perhaps there’s a line crossed in the midst of dementia that makes it nearly impossible to help them in the usual ways discussed here.

So, we need imagination, creativity and movement. Perhaps most importantly our patients need a therapist present who understands these things from several different angles and on several different levels.

Oh, and I need your email address in order to send you that stuff we discussed on the phone last week.

[smikolic]

Found a quote from that thread (thanks Barrett for the link), regarding pain, imagination and movement, and I think it clearly (in my mind) states how SC might help us access the imagination/creativity necessary to move out of the habit of not healing:

From Diane in post #10:

I think we get a little closer to the idea of pain here, by considering the relationship to it that core might have, that extended might have. There might be conflicting "images" of the same "pain," one that is nonconscious or core generated, and another that is conscious or extended generated.

Movement: Where awareness goes, image-making will immediately follow.
If one can shine a mental flashlight in on the relationship between core and extended consciousness in someone's brain, however briefly, and create a moment wherein that individual becomes aware of the possibility of differentiation between these two main modes of operation, a new relationship between the two, a new image, immediately springs into being, a movement image in this instance. A new image that is mutual to both core and extended, logically could go a long way toward decreasing a pain state based on an incongruency between the two, clashing images that bother the organism and will be trumped eternally by core mechanisms operating to maintain survival.

Also seems to be a great explaination of where words might come from in poetry. Think the images, if powerful enough for conscious representation, are describable in words, and the associative and aware (?) mind is able to pattern them into some configuration known commonly as poetry. Perhaps poetry is simply making the image visible to the public mind...also a personal expression, just the way that the movements patients undertake w/SC make their options/expressions visible to the public mind of the therapist and the pt.

I think one way to encourage more creativity/imagination in patients is through less cuing for the exact movements (as part of HEP, for example in Feldenkrais movement patterns) and to attend more to what the movement chosen feels like, etc. Also attempting to educate the pt on the importance of explorations of movement and responsiveness to pain is a good tactic. I am finding that pts seem to tap their own inner resources/creative instincts when they are given the gift of conscious/non-conscious exploration of movement and given the "permission" to continue to explore, and maybe that is enough?

As far as the urge to be creative, I wonder if the urge is there underlying in the fact that they have pain in the first place (at least neurogenic-type pain). Also the fact that they move w/SC demonstrates that urge underlying as well perhaps. Is it enough to know the urge is there, the act of moving is creative if it's the right kind, and the pt's "creative/imaginative" processes, once tapped and encouraged, remain open and expressable/expressive once the process begins?

I think it is correct to say that society tends not to recognize creativity as much as "talent," or to encourage the creative act. We do that with SC and our cues/instructions to pts. From there, I wonder if it is individual to the pt how creative/imaginative they allow themselves to be or are motivated to become, and we need to learn how to better assess for the individual expression and speak/teach to that? Any ideas?

Steph

[Barrett Dorko]

In post #4 of this amazing thread begun by Cory in June 2006 he wrote:

When you exclude consciousness (or better stated, prior to consciousness), the choice of action is based upon past experience and how the body responded to those decisions. The action chosen will be the one that will bring about the body response best suited to the task at hand, based on previous experience with similar situations.

In the next post I said:

Is there any indication from Damasio as to when this previously learned ideal reaction might have been learned? I couldn't find any, and if there isn't, wouldn't earliest childhood be the most fertile ground for such learning? Ideomotion as manifest in adults seems to be a return to this.

In light of recently posted ideas here I might now say that play leads to the learning manifest as ideomotive or corrective movement later in life. It follows that play is related to creative activity, and that’s connected to healthy albeit largely countercultural movement when performed by adults. If the therapist can in some manner create a context in their presence that promotes play, well, pain relief is more likely to follow.

I think. I'm almost sure.

[John W]

My wife has been converting some old VHS home video of our kids to DVD. It's mesmerizing to watch them frolic about at play when they were between about 3 and 6 years old- before they had much rational concern about what they were doing. Their movements were so spontaneous and whimsical.

After watching them flit, twirl and kick about, I can understand why patients might feel a little self-conscious about engaging in such behavior- and why a therapist might question his professional "gravitas" trying to evoke such instinctive movement.

It seems so much more serious to restore an arthrokinematic glide than to evoke a playful, ideomotive response.

[smikolic]

It seems so much more serious to restore an arthrokinematic glide than to evoke a playful, ideomotive response.

Yep. Also satisfies the need to have "control" over healing "your" patient, and the ability to say, exactly, what the therapist is "doing" to/for their patient.

Also, yaaaawn...

[Diane]

Originally Posted by John W

It seems so much more serious to restore an arthrokinematic glide than to evoke a playful, ideomotive response.

And it seems so much more measurable for those interested in measuring in order to appear more sciencey. So much more a noun than a verb.

[Barrett Dorko]

I especially like John's point. My brother Kevin once told me that he objects to being referred to as "childish" though "child-like" is perfectly acceptable.

Over the years I've developed a demeanor that gives the appearance of thoughtful and experienced professionalism. I'm certain that this permits much more playfulness (and by that I don't mean raucous behavior) than if I were to appear as my colleagues commonly do.

My behavior and speech have a purpose, and it is to advance the progress of the patient toward the various goals we have agreed upon and still feel are realistic. Unlike the therapist handling others as if they were some sort of combination lock they were trying to defeat - posing and posturing with self-importance and some imagined magical skill - I offhandedly enter their peripersonal space, allow them to enter mine and then attend to what's happening. It is not at all unlike the communion of play that Donaldson speaks of so well.

In short, it helps to wear a tie while teaching and playing with others. After all, it worked well for Fred Rogers.

[smikolic]

Great imagery Barrett!!! Excellent examples of how to professionally and seriously "play" and just what attention and direction/purpose is in this environment....and the link between provider/pt interpersonal connectiveness.....mutual bond and learning.....wow....great stuff....so complete, so consice, so right on and not missing an ounce of expressiveness.......you are my idol for writing for sure......

Awe.....memories..... That song won't come out of my head too easily though....darn it....gotta love the shoe thing though!

I don't think I'm gonna let my gray show or start wearing a tie though.....

Steph

[EricM]

Good post today from Jonah Lehrer with insights into childhood creativity and the adulthood decline of that ability.

As the brain develops, the prefrontal cortex expands in density and volume. As a result, we're able to exhibit impulse control and focused attention. The unfortunate side-effect of this cortical growth is an increased ability to repress errant thoughts. While many of these thoughts deserve to be suppressed, it turns out that we also censor the imagination. We're so scared of saying the wrong thing that we end up saying nothing at all. One interesting line of evidence in support of this speculative theory is that jazz musicians engaged in improvisation selectively "de-activate" their dorsolateral prefrontal cortex. In other words, they inhibit their inhibitory brain areas, which allows them to create without worrying about what they're creating.

[Diane]

Yeah. They do drugs some.

[BB]

From the "correlation, not causation" angle it would also seem possible that the inhibitory changes seen in the brain are a result of plasticity brought about by a reduction in use of creativity brought about by the social contructs of what it is to become an adult.

[Diane]

This picture might be interesting in this thread. It depicts circuitry that the brain can use (taking advantage of the fact that there are ten times more descending fibers from cortex to thalamus) to downregulate or otherwise shape incoming/upgoing perceptual input, raw info from thalamic processing of visual, auditory and somatosensory input.

People are somewhat prone to messing up this downregulation/focus in themselves, with common "NMDA receptor antagonists" also known as "dissociative anesthetics." These were what were used to delineate the pathways described in the paper.

[Barrett Dorko]

I second Cory's comment.

I'd like to think that the regular discipline of writing keeps my brain plastic.

[Diane]

The aging brain: Why getting older just might be awesome, from CNN.

"...younger people are more likely to connect with others from their own place of need. A 22-year-old may have an idea, and that idea may be quite brilliant and useful, but more than likely it's all tied up in how that young person feels.
"Because of their greater capacity to empathize, older people can have a better sense of the things that may charge up another person's brain and get them excited."
Older people are also highly capable when it comes to the "define" aspect of human-centered design -- that is, the unpacking and synthesizing of empathy findings into compelling needs and insights.
An aging brain can better tease out patterns and see the big picture, Small says.
Whereas younger people may have better short-term and get-to-the-point-quickly memory, older folks have had a greater variety of experiences and are better able to build a wider image out of a lot of different parts of memory. They can make more connections because they have more things that have happened to them."