Buckeye and Me

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

No matter where we are, the shadow that trots behind us is definitely four-footed.
Clarissa Pinkola Estes

My hands have been emptied of patients for nearly a month now. I find that I miss especially those moments when change in the right direction is perfectly obvious to me, even before the patient knows it. This is impossible to measure in any meaningful way. I think that’s what I like most about it.

As I always have, I go to a small restaurant each morning very early and write. It’s after that that things have truly changed. There’s a fine facility near my home full of exercise paraphernalia and I decided to take advantage of that. I’ve grown stronger in every way, but I’m not sure what that means. Physical fitness is overrated, I think, and I have difficulty finding any real meaning in it.

This search for meaning on those days when I’m not treating patients or teaching doesn’t surprise me. I knew it was coming and as very little’s come to me. I’ve sorted through a large pile of paper and reorganized my library and written what I consider a major statement (http://www.somasimple.com/forums/showthread.php?t=3407) about my work but still feel largely unfulfilled – like my hands.

I understand that every animal instinctively looks for recognizable patterns around them. This instinct is so powerful that when these aren’t actually present we imagine that they are anyway. This accounts for a great deal of superstition and senseless therapy, in my opinion, and I’m not immune by any means. I try to balance this tendency with a regular return to the intricacies of science. In that realm belief is kept to an absolute minimum, if it's present at all. Careful observation reveals that the universe is attracted to symmetry, as are people, but that doesn’t make the expected and predicted answer to our problems the right ones. Surprise rules, especially in the clinic when dealing with neurogenic pain.

Years ago I wrote an essay titled Running With Buckeye (http://www.barrettdorko.com/articles/running_with_buckeye.htm) for the special section in the physical therapy association interested in treating animals. In part it said, “I run Buckeye on a long retractable leash that I can manipulate to control her closely or let her move with a great deal of freedom. For a few hundred yards at a time I can loosen the lead while she almost floats along beside me. If a dog can emote, it seems to me that Buckeye is perfectly joyful at this time. But at any moment this lovely picture can change. This begins with a sudden stopping or veering by the four footed member of the team. Without warning, Buckeye is overwhelmed by a scent, and her instinct to follow it takes immediate precedence.”

Now that she’s in her eighth year, and I in my 56th, the two of us don’t run as we once did and being leashed or unleashed doesn’t alter our behavior much. Despite that, our instincts remain present and we can choose to act upon them given the time and strength necessary. We’re both looking for patterns, for sense in our surroundings, and, for me anyway, some meaning in life as it unfolds in unexpected ways. I love what Keith Devlin (http://en.wikipedia.org/wiki/Keith_Devlin) says about what a scientist does, “A scientist finds as many perspectives as he can on things in the universe that we can’t see with the naked eye.” I know there’s more to manual care and the teaching of it I’ve yet to discover, and that’s what I intend to do.

These days I can sit and nap and dream about that for a while as Buckeye gazes out the window behind us. Sometimes she turns and looks at me, no doubt wondering what I’m doing at home so much.

She doesn’t seem to mind.

[Diane]

That must be Buckeye, curled around Barrett's head. Such a peaceful sight. :thumbs_up

[nari]

I have a penchant for beagles - used to have two of them until they gave up around 14 years of age. Fabulous dogs.

Re the Keith Devlin quote; it reminds me of the sentence that Antoine de St Exupery wrote many decades ago: What is essential is invisible to the eye. Bernard knows it well.

Intangibility in clinical practice can't be measured. Maybe that is what PTs and others are missing in their efforts to change people's health status; that sense of knowing what to leave well alone and what to elicit.

Barrett, if anyone can find a way to improve manual therapy, I reckon you can. With Buckeye's assistance, of course.

Nari

[Barrett Dorko]

Nari,

Yes, the intagible in practice.

My mind keeps returning to “unmeasurable” things in therapy for some reason. That moment, for instance, when you see something small in a patient that assures you that failure is just around the corner. You sense this stuff unconsciously, as you do most everything else, but it cuts through to your consciousness like the sudden, unexpected ringing of a bell. How this happens with remarkable speed is covered in Malcolm Gladwell’s Blink – The Power of Thinking Without Thinking ( http://www.amazon.com/Blink-Power-Thinking-Without/dp/0316010669/ref=pd_bbs_sr_1/104-7213658-3536738?ie=UTF8&s=books&qid=1174826429&sr=1-1). There’s also plenty of evidence that we can be exactly wrong in our conclusions when doing this.

I think that this is the territory of clinical veterans like myself. I’m trying to come up with ways of speaking about this without sounding any crazier than I already do.

In an interview in New Scientist the great Douglas Hofstadter ( http://en.wikipedia.org/wiki/Douglas_Hofstadter) said this (I’m paraphrasing): Think of a smile. It’s a pattern we recognize in others over many decades, yet there are no atoms that compose it and it doesn’t have any mass or dimension. A smile persists for a while and then vanishes. Where is your smile when it’s not on your face? It’s a potential. Once more, it’s a pattern – like a whirlpool or a tornado.”

I dream about what he says here and wonder what might be taught about a person’s way of expressing themselves authentically that is similar. My difficulty describing ideomotion concisely and my student’s similar concerns when they write their notes has everything to do with Hofstadter’s question i.e. Where is it when it’s not there? In the end, we’re trying to describe instinctive behavior to a profession that has little or no interest or appreciation of it.

Think I’m onto something here?

[Diane]

Definitely.

Patterns are what the brain needs to understand the world, all the way from physicists to weather forecasters to detectives to microbiologists to economic forecasters to evolutionists to parents to PTs.

Patterns are what chiropractic calls "subluxations". Patterns are what the orthopaedic PTs think they can draw "scientific" conclusions from.

They don't get that they can't do "science" that way. They can only knock against the pattern based on wider information and try to destroy it. If they can, it was never real. If they can't, then it's "real". At the moment they don't want to know ANY information that might knock their patterns. Instead they'd rather pretend that what they're doing is called "science" and ignore any information that suggests they have too many confounding variables. Makes me want to call them all "boneheads" and rip out my hair some days, other days I think, well, that's just where we're at right now, for now.

[Barrett Dorko]

I cannot recall who said it, but the quote goes like this:

Theories may be right or wrong but models have an additional option; they can be right but irrelevant.

The model constructed so carefully by the physical therapy community over the past few decades is in many ways accurate insofar as muscle function, connective tissue response and their consequent forces go. This model has, after all, also formed the basis of spectacularly successful orthopedic surgery. But for the abnormal neurodynamic the model is irrelevant. Let me say it again, the orthopedic model, though accurate, is irrelevant for many painful problems.

If I’m right, it would explain a whole lot, and perhaps it is the sort of abductive reasoning (http://www.barrettdorko.com/articles/discovery_and_abduction.htm) needed to discover the origins of this huge rift between those who provide orthopedic care for neurologic problems and those here who have decided that it would be wise to do otherwise.

There’s another long thread here in my head, and watching Buckeye’s instinctive movement, I think, has led me toward it.

[nari]

Definitely, (as Diane has said) re patterns, but in many ways the patterns of the brain's daily duties are intangible to many PTs, and therefore not kosher.

Methods get results, but I figured out they were built on the wrong premise, that premise being an external one, not internal.
The patient was never really taken into account, only the manifestations of the body; so a heck of a lot of patients, including of course the persistent pain patients, got short-sheeted.
To make up for that, the patient was classed as having psychological problems of some kind; and shunted off around the medicalised merry-go-round.

I'm saying 'was'...after reading Gary S's thread on physical therapy, it should be 'is'.

I now watch the actions or nonactions of my cats; and it is enlightening. Dogs aim to please, but cats want to be pleased, so when my cat scratches on the screen door, I know he wants to chase a string with me.
He remains the master at all times. His erratic movements are his own making; his complex patterns of action in the trees or on the lawn have nothing to do with anything but him. If I intervene in any way, it all stops, immediately.
With patients, if we intervene as masters, instinctive movement ceases.
When they are non-active, ie sleeping, they ignore us if we wake them.
Unless they have a need for a feed.

Barrett, do write up something on Buckeye's instinctive movement. People are too far gone - animals may teach us a lot.

Nari

[Barrett Dorko]

I’m anxiously awaiting the delivery of Hofstadter’s new book (not yet released), I Am a Strange Loop ( http://www.amazon.com/Am-Strange-Loop-Douglas-Hofstadter/dp/0465030785/ref=pd_bbs_sr_1/104-7213658-3536738?ie=UTF8&s=books&qid=1174958525&sr=8-1). In there he’ll speak more of the significance of a smile.

I’m reminded that smiles come in two basic forms; Duchenne’s, which includes an instinctive use of the obicularis oriculi, and the non-Duchenne, a fake smile that never reaches the eyes. The second isn’t a consequence of instinct but of culturally created design.

In the early 90s I wrote this in The Piano Lesson ( http://www.barrettdorko.com/articles/piano.htm), “It is when I start to note unconsciously motivated movement seemingly unrelated to disability and wonder aloud what it may signify that I invite the derision of some of my colleagues. The unique, artful expressions of the body that make us human cannot be measured or easily interpreted. No graph can contain them, no normative values can be assigned to them. And my failing as a serious researcher probably lies in the fact that I cannot ignore them.”

I realize now that I was speaking of ideomotion without yet knowing the word. I allowed the concept in though, knowing I’d never clearly measure it and that investigating it would marginalize me. Now I see that I was writing about my mother’s way of smiling as the Alzheimer’s deepened.

Hofstadter will help me understand more about this, and, more than likely, I’ll move even further from traditional practice.

[Jon Newman]

Check out the March 26 podcast (http://www.newscientist.com/podcast.ns) at The New Scientist.

[Barrett Dorko]

Jon,

No wonder I tell my classes you're "The Linkmaster," which sounds so much better than "an ordinary schlub therapist" which is how I refer to many of the other valuable contributors here. From me, this is another kind of compliment.

I've downloaded the podcast and will listen as I head home in a few hours.

[Jon Newman]

Hi Barrett,

Thanks for that, it's much better than some things I've been called recently. To be honest, I do one of the schlubiest PT jobs around town.