Memes and (Un)Natural Selection

[Nick]

I have to first give credit here to Jon for introducing me to the www.gapingvoid.com. Love those cartoons! Anyway, I read something this evening that made me think of the issue of stickiness. How to make neurophysiology more viral in the world of physical therapy and beyond. No doubt something to do with joint popping would help, but there is some more food for thought here that I found interesting (from Hugh McLeod talking about WoM marketing for a movie ):

"The blogosphere doesn't get us sales, but it makes us much smarter salesmen.

So where the blogosphere could be useful to Hallam Foe is, to help you better understand which parts of your story are inherently viral, and which are not. Allowing you have what I call a "Smarter Conversation". And align your marketing accordingly.

What I wish to use the blogosphere for, is to understand two basic questions:

1. Who is talking about the movie.
2. What are they saying about the movie.


And I want to know the answer to this question before the film is in general release.

As any Cluetrain maven will tell you, when it comes to Word Of Mouth, you don't control the conversation. The only way you can have any control of the conversation is if you improve the conversation.

i.e. Control the conversation by improving the conversation.

i.e. Find ways to make it easier for people to talk about your movie."


So, besides people on SomaSimple (who are my "exceptional minds" for "Smarter Conversations"), who is talking about pain and how can we improve the conversation?

Nick

[EricM]

Nick, you make my head spin whenever you write on here, tonight is no different. Maybe coincidentally, I have finally been plowing through Blackmore’s ‘The Meme Machine’ over the last few weeks. She writes about altruism in the service of memes; “if people are altruistic they become popular, because they are popular they are copied, and because they are copied their memes spread more widely than the memes of not-so-altruistic people, including the altruism memes themselves.”
The ways of being altruistic include; “generosity, kindness, caring behaviour and so on anything that makes it more likely that others will want to spend time with those people, and emulate them, and so will pick up their memes.” For this kind of memetic altruism to be successful two things must be true; “people are capable of imitation, and second that they more often imitate altruists.”
Blackmore also writes that “a meme that gets into a meme-fountain will do better than one that only gets into meme-sinks.” Who out there is most likely to become a meme-fountain?
I haven’t directly answered your question regarding who is talking about pain, but perhaps by being altruistic (not that anyone here isn’t mind you!) we are more likely to engage them, whoever they might be, in a smarter conversation.

My last thought for now, also from Blackmore, is that whenever a new meme comes into someone’s life, it is far more likely to be accepted and acted on if the receiver can avoid cognitive dissonance – the unpleasant consequence of holding two incompatible views. Our conversations are much more likely to be continued if we remember this fact. How to do this though, I don’t know…

eric

[Jon Newman]

When I went to the American Pain Society meeting there were almost no PTs talking about pain. Psychologists/psychiatrists, pharmacologists, anesthesiologists, a wide variety of MDs, dentists, social workers, and neuroscientists--At least at the lectures I attended.

[Diane]

Jon, Nick said above, "The only way you can have any control of the conversation is if you improve the conversation."

About the pain meeting, and in general Nick, if PTs were talking the same language it would help. Everyone else is talking Ectodermalese while PT is still talking Mesodermalese. We can't "improve the conversation" until our profession understands the language and learns to speak it fluently. Forget ever trying to control the conversation. We'll be lucky to be politely listened to (with the rare exception such as Moseley), if things don't change soon. In fact if things don't change soon we'll be joining chiros as some weird sort of living museum piece.

[nari]

Eric,

Pleased to know you are delving through Blackmore. Although she has a number of critics (Dawkins is one, even though he happily wrote a nice positive preface or intro - can't remember which), her hypotheses make some sense out of the confusion of meme theory. I don't see that it collides with Dawkins' self-ish genes. They're still self-ish.

Cognitive dissonance is to be expected when memes collide with a new one; and if anyone can work out how this can be done without bloodshed, they should publish immediately. :) Preferably in Nature or at least Discover...

Nari

[Barrett Dorko]

Since I'm on the front lines of this conversation with regularity I can relate entirely with Nick's original post.

What I feel again and again is, well, alone. Try as I might, I can't talk about the neurobiologic revolution without bringing up authors and information that therapists are completely - and I mean completely - unfamiliar with. Frieda Apostol, a reader but noncontributor to this BB, was at my course in Erie where she had driven from Ontario. She can confirm that she was the ONLY one who had ever heard of Patrick Wall or David Butler.

In anticipation of this (and I know it's coming) I do a little thing about "walking into the middle of a movie" at the beginning of every class. It's cute, people can relate, it puts them at ease - it doesn't help them understand me at all.

As far as I can tell, my two and a half year effort to spread this meme has been a dismal failure.

I think you all know what this work needs - a celebrity spokeperson.

[Chancellor Mobley]

Thankfuly I was exposed to your effort, Barrett. Your altruism, Bernard's for hosting and the rest here who frequenly post has been stunning and influential. Thank you.

Chance

[Barrett Dorko]

Chance,

I appreciate this. But you are but one of thousands exposed similarly. What I said and demonstrated resonated with you, a Rolfer, a mesodermalist. How is that possible when it seems nearly impossible to drag PTs into this? Is it that "neighborhood" thing I spoke of in the latest edition of "The News..."?

[Nick]

Eric,

Sorry for the head spinning. And I'm not entirely sure about the altruism thing. MFR has become a pretty powerful meme. For us, somehow, this issue seems to be related to the tangibility of the mesoderm.

Barrett,

You should change your outcome measure. For instance, by your efforts you've completely changed my practice. Not sure if I'm ready to thank you for that or not.:teeth: :secret:

Here's more from Hugh McLeod on Smarter Conversations:

"How to have smarter conversations.

Somewhere along the the line I decided that embracing "Smarter Conversations" was preferable to prematurely consigning my career to the dustbin of history. I just wrote down some random thoughts:

1. Understand why what you're offering to do for other people is interesting, important, meaningful etc then start telling people about it.

Think about this one. Hard. If you don't know, then how will other people know? Exactly. They won't.

2. Live like you know the difference between remarkable and unremarkable, like it matters to you.

The more "remarkable" matters to you, the more likely that it will appear in the product you're selling. The more likely other people will notice it.

3. Seek out the exceptional minds.

This is my basic mantra. It's a good one to have. Not everybody gets it. Their loss.

4. Start a blog.

Blogs are funny things. Say something smart, people pay attention. Say something dumb, you're ignored. We big media folk just can't seem to get our heads around that concept, for some reason. Regular blogging can help train you to better discern between smart and dumb. Makes it easier to extend this to the rest of one's business.

5. Ruthlessly avoid working for companies that "don't get it".

Yeah, you may have to turn down a few gigs, and that can really hurt when the rent is due. Still, anything that's easy to get isn't worth having.

6. Ruthlessly avoid working for companies that think they know better than you.

Luckily, if you get the whole "smarter conversations" thing, their "Yes, Buts" will just seem rather empty. Making them easier to "toss out like old furniture".

7. Be nice.

Smarter conversations are fuelled by goodwill. Lose it and die.

8. Be honest.

Again, smarter conversations are fuelled by goodwill etc.

9. Karma is key.

But you already know that. Or you're stupid. No middle ground on this one, sorry.

10. Listen.

Tongues are dumber than brains, brains are dumber than ears etc."

[Chancellor Mobley]

Barrett,

Now, I do not consider myself a 'mesodermalist'. I do my best to provide competant manual care through touch, movement and education. It is what you said that resonated with me and it did so because it made sense. As for the PTs, it may be the "neighborhood" thing you spoke of or it could be the name Physical therapy. Does the name not denote mesodermal therapy? It could be that people don't want to be lonely. Again, thanks for the exposure.

Chance

[Barrett Dorko]

Chance,

How would you go about talking to your fellow Structural Integrationists? I was personally "Rolfed" through twelve sessions in the early 80s by a man named Austin McElroy, a student of Ida herself. Austin on several occasions spoke of his concern that his handling or pressure did not often resemble what he'd been taught and I never found his pressure heavy or painful. He followed me around, not as much as I follow my patients today, but a bit.

Wouldn't the Feldenkrais Guild members be even easier to communicate with? I've had about 20 in my classes the past few months. From them I get nodding heads followed by, well, zip.

Many massage therapists attend my courses. Nothing.

In the skeptical scientific community these days the term "philosophy of ignorance" is gaining some momentum. It is distinct from the "philosophy of discovery" which is used to describe the scientific method. Briefly, the former describes this attitude: If I encounter something I can't understand, for whatever reason, I will choose some supernatural and essentially unknowable process to explain its obvious presence. The latter, of course, seeks to do whatever it can to discover an explanation.

Can anyone else see the former attitude growing in physical therapy? Other types of therapy?

How do we sell our meme to them?

[Chancellor Mobley]

Barrett,

I am going about it slowly for I am just now getting getting comfortable in this movie as you like to say. Robert Schleip, a rolfer and feldenkrais practitioner is talking to the Structural Integration community rather well about the neurobiological meme. I do remember you telling me about your rolfing experience. I do agree with you that the "philosophy of ingorance" is alive and well with in our culture. Superstion has been around a long time. Perhaps selling this meme to 'them' requieres gentleness, compassion and patience.

Chance

[Barrett Dorko]

Perhaps selling this meme to 'them' requieres gentleness, compassion and patience.



Oh. That explains it. In that case, I have no hope of being The One (reference The Matrix).

Again, we need that celebrity spokesperson. NOTHING in this culture gets sold without some of that.

[Bas]

Barrett, I think Eric's post gave a good quote from Blackmore about altruism. This applies to you in my mind. In Europe, the "drawing room socialism" - socialism from well-to-do people - became a rapidly spreading meme. Caring, giving of self, concern fo others above self. It spread. Very rapidly and very seductive.
You have NOTHING like that.

As Nick's posts indicate (thanks for the headache, Nick), some "memes" are made - "selling" an idea/concept/movie takes a whole culture of attitudes and communication "constructs".

Yep, you don't have a chance in hell. Even if you could convince Al Gore to take on neurophysiology - it wouldn't get made into a movie. It's just not sexy.
Hey, maybe that's it - we have a famous Canadian girl who could sell anything. Even her home movies. :-)

The new big meme in PT seems to EBM - mainly because it stays away from any deep model, but focuses on prediction and outcomes. This is much easier to "adapt" to, than to re-evaluate the whole foundation of most practices.

Alas, this new meme seems to have effectively re-closed many minds to anything further.

[Barrett Dorko]

But the EBM folks don't strike me as altruistic as described by Blackmore. If anything, they've been the opposite to those of us interested in EXPLANATIONS (Forgive the shouting. I always lose it when I think of that).

Might it be that the most powerful thing about the most popular therapy memes are their simplicity and lack of thoughfulness? Is this what led to the demise of Bobath's method and the endurance of Kendall?

Stan Paris' thinking is quite simplistic as well, in my opinion. No wonder his lasting influence.

Can we make our meme "simple" without gutting it?

Where have you gone Joe Dimaggio? (A fabulously successful spokesperson, Pamela Anderson notwithstanding)

[Chancellor Mobley]

Barrett,

I may be reaching here, but are you not asking those in your profession to become comfortable with uncertainty. I know for myself that that can be a tall order. Bas is probably right about Al Gore not taking up the neurophysiology banner but if you can get on Opra Winfrey's show..... In Peter McWilliam's book LIFE 102: WHAT TO DO WHEN YOUR GURU SUES YOU he tells an interesting and entertaining story about how he got his book on Opra's show and how one can be led to believe the most bizare of things that surely relates to meme propagation.

[Bas]

"Might it be that the most powerful thing about the most popular therapy memes are their simplicity and lack of thoughfulness? Is this what led to the demise of Bobath's method and the endurance of Kendall?"

Yes. This is exactly why they are popular. Even the most convoluted MFR, CST or XYZ theories, have a common thread: it's learning a technique by rote. Learning a skill. That is the meme. The meme "we" would like to see spreading out, requires a fundamental shift (I won't say "paradigm-shift" - John Barnes ruined that one for me) in how we approach a human with pain.
This fundamental shift requires much more than just learning something new - it requires examination of many aspects of our practice and of our education. And THAT is hard for most, I am afraid....

[nari]

All very true.

Unless it is written down in black and white as the 'thing to do' without requiring any lateral thought - it is not on.

Criticism of gurus with or without the right socks or hair is just not on, either.

Yet those following the meme would strongly deny that last sentence...;)


Nari

[EricM]

Back to Nick's original question.

Who is talking about pain and how can we improve the conversation?

The general public talks about pain quite alot I think.

eric

[nari]

Who is talking about pain?

Certainly it is uppermost in the minds of those who experience pain. There are some PTs who are focusing on pain management/resolution; nurses talk about pain a lot but only from a relaxation/medication focus; doctors are a heterogenous group when they discuss pain and probably only anaesthetists take it seriously enough to delve into the physiology....
...how can we change the conversation?
I think most of us have been trying to deflect the conversation away from pain being seen as a symptom of the condition, towards directly dealing with pain.
Perhaps, each in his/her own way, we can do more in terms of inservicing other PTs; even interns; developing simple literature that is quite intelligible to the lower common denominator (the Okie from Fenokee or the Ocker from Oodnadatta) so it makes sense to them. People need time to think thoughts that are relevant to their need state; rather than a bunch of exercises which they perceive will make them strong and therefore painless.

If feasible, this message needs to reach our associations. Their focus is heavy on education, but heavier on the hands-on palpation and mobipulation. So they would be more receptive to education than a perceived wild clinical swing away from the expectations of what a PT does. That's a very hard call, however.

I think we are on our own here, and cannot expect much support from anyone but the public. Patients can relay well by word of mouth, but the risk there is the information becomes Chinese whispers; thus:
..there is this wonderful PT who does nothing but touch the neck and the pain goes away.

Not good for the model we are attempting to present..

Nari

[EricM]

I don't see anything horribly wrong with 'Chinese whispers' Nari. The 'touches neck' whisper is no different than the 'ultrasound' whisper. If the meme is strong enough it will propagate through whatever means it has at its disposal. If the science behind the 'touches neck' whisper is solid and accompanied by whispers of 'that PT also does a whole lot of talking about pain and explains why ultrasound isn't appropriate etc etc,' no harm is done.

I think PT's are just as much a part of the general public as anyone else, just as susceptible to the nonsense that gets distributed through lay media and referral systems. Why not take advantage of that? I don't see much point anymore in going after the professional associations and educational institutions. It is quite clear to me now that their definition of what constitutes PT is rather skewed for reasons that have been discussed at length on this forum. How else could they accept and promote some of the nonsense they do? They reflect in their actions the beliefs and more powerful memes present in our culture. We can't expect them to behave any differently when we come along. I think we have to address the culture they reflect. Unless of course some enlightened person (probably an altruist with meme-fountain type qualities of course) was able to move up through their ranks and exert some dictatorial style leadership. Not very likely though.

eric

[nari]

Eric,

However...

if those "touch" whispers are not accompanied by spontaneous info on pain ed and the US bit?
Anyway, are you implying we can change the conversation by translating (sort of) into the collective their culture?

I haven't found that helpful at all; any hints? :) The only people I have found who take any serious note of what I have spruiked about at times are the patients and the nurses.

Nari

[Luke Rickards]

The only people I have found who take any serious note of what I have spruiked about at times are the patients and the nurses.I'm with you here Nari.

I should add though, I think it can happen quite easily when you are exposed young. About a third of my class became obsessed with pain science after third year with Nic Lucas. I know four others who I taught Simple Contact use it in practice (though not as much as I do).

Perhaps we can add; a few enlightened academics - to, one celebrity spokes person, and a pinch of altruism.

Luke

[Barrett Dorko]

In The Tipping Point Malcolm Gladwell’s formula for the spreading of a meme, includes the participation of a connector, a maven, and a salesman.

According to the Wikipedia entry:

Connectors - Those with wide social circles. They are the "hubs" of the human social network and responsible for the small world phenomenon.

Mavens -Knowledgeable people. While most consumers wouldn't know if a product were priced above the market rate by, say, 10 percent, mavens would. Bloggers who detect false claims in the media could also be considered mavens.

Salesmen - Charismatic people with powerful negotiation skills. They exert "soft" influence rather than forceful power. Their source of influence may be the tendency of others, subconsciously, to imitate them rather than techniques of conscious persuasion.

Writing about our profession’s view of methods and theories in my review (http://www.somasimple.com/forums/showthread.php?t=1352) of the book I said “…techniques are not nearly so important as our perception of them. And that perception might be seriously flawed. It is colored by the current conventions of our culture and the misguided beliefs of a few people with an inordinate amount of influence.” The Mesodermalists are those people in PT, and the “myofascial” folks spewed out by Barnes make matters worse with their screwball theories and inappropriate practices. They have made anything non-traditional distasteful.

Can we find the connectors, mavens and salespeople we need?

[Diane]

All we have is us. We'll have to learn to do those jobs/roles. We are already connected. Most of us are already mavens of one kind or another. Probably Barrett, you're the best salesman. Somasimple is a sort of crucible in which this little community is doing some kind of self-organizing. It will be interesting to see where it goes over a couple more years.

[EricM]

Nari, I'm not sure we are on the same page quite, yet! You said the only ones who take you seriously are patients and nurses. This is exactly the culture I mean. I'm thinking, among other things, about articles that could be written for them (patients, nurses ie the public) in local newspapers, junky health brochures that are found for free at supermarkets, maybe even a few magazines. People believe what is written in those things. This just might improve a few of their conversations, and if the right mavens, salesmen and connectors take notice, voila we reach tipping point, within the general public, rather than just the PT subset of the population. I think Barrett has proven dramatically that going after those in the profession isn't working; or has it just not worked yet?!

This is just an idea in the end, thanks for letting me try to express it even if it is a bit muddled.

eric

ps. Barrett I'm not suggesting in any way that your work hasn't been important nor that it shouldn't be continued.;)

I tune in here everyday to read from someof the best authors I know. I am suggesting that some of this talent be turned towards writing educational material for a different audience, through a different media, even if it is distasteful for the author to do so.
I'm gonna get it now. :p

[Barrett Dorko]

Eric,

I appreciate your comments and I don't disagree. I love to agree with Diane, but in this case I must. My failures in sales, and they are huge, have to do with a number of things, not the least of which is my inability to close. I am the Fausto Carmona of the manual therapy world.

(For those of you who don't follow Cleveland Indians baseball as I do, Carmona was promoted to the role of "closer" a month ago. The rest of the story is too painful for me to describe. Let's just say he now pitches for Buffalo in the minors)

I also think we need to consider a new presentation of the product. I'm working on a new thread with that in mind. It should be ready by tomorrow.

[EricM]

A new presentation of the product may represent the (un)natural selection Nick is referring to.

[Bas]

Silly idea, but I have to spew it:
Is there not a way to entice ANY MSc or PhD PT to explore the issue in a final thesis/paper? If we all look at our circle, is there not a student we (any of us) who we can lure into this? It would provide a scientific paper, with oodles of references, specifically exploring ideomotor and dermal neurophysiology. Keep your eyes open for that one student.....

Any PhD or master's paper, will be a "funnel" reference (with it's own whole bag of ref goodies) with clout - and it brings the concepts in front of a thesis committee of academics.

It CAN be done: I had a whole lot of resistance writing my final paper about the value/function of PT in anorexia nervosa cases. Yet, when the paper was discussed, it got graded "with honours"..... We HAVE to find that one student.

[Barrett Dorko]

Bas,

I know Luke's research is progressing and Jason Silvernail has indicated to me that he will be exploring these themes as he heads toward his DPT.

[Diane]

Barrett, when I said I thought you probably were the best salesman, I didn't add, but probably should have added, ...of a sorry lot. Sales-wise that is.
There, is that more agreeable?

[Luke Rickards]

Jon, are you still heading towards a PhD?

Luke

[Jon Newman]

Hi Luke,

I'm taking Calculus and American Government this fall. Depending on how that goes it is a good possibility. We'll see if anyone else thinks so too.

[Barrett Dorko]

Diane,

I get you. Anyway, if I were a really good salesman I don't think I could stand myself.

What we need is Ron Popeil (http://en.wikipedia.org/wiki/Ron_Popeil), the subject of the original "Pitchman" column I wrote a few years ago, archived in "The News...".

Anybody volunteering for the positions of maven or connector?