Manual Magic

[Barrett Dorko]

Manual Magic

Any sufficiently advanced technology is indistinguishable from magic.

Arthur C. Clarke

I sit alone quietly for a few moments after every workshop and ask myself the same question: What do therapists want? I learned long ago not to expect my words and demonstrations to have any significant impact upon those who just spent a day watching the changes emerge from them and the people within reach. I explain all of it and I know it’s quite impressive – but I know it makes no impression. Nothing that lasts anyway.

I listened to a podcast from Science & the City this week featuring an interview with James Kakalios, a physics professor at The University of Minnesota. He teaches a course about “the physics of superheroes” that has had me thinking about it since. Kakalios says, “The super powers themselves are impossible, but we grant each character a one time miracle exemption from the laws of nature. In other words, ‘If you could (insert super power here) then what consequences would be consistent with physics?’”

The enduring popularity of comic book heroes is probably due to this combination of the unbelievable and the merely unlikely. Somewhere in there a bit of esoteric knowledge derived from careful study would reduce the mystery, but, in my experience, many aren’t especially interested in doing the study. Some are happy just letting others know. Others prefer the mystery.

This week I’ve also watched the movie The Illusionist starring Edward Norton as a stage magician in Vienna circa 1900. Though his popularity as a performer has everything to do with his showmanship, the method behind his illusions is entirely dependent upon his skill as a craftsman. He’s the son of a cabinet maker and throughout the movie short scenes make this skill with various materials obvious. The word “craft” itself holds a certain fascination for me, and, as you’ll see, it’s loaded. In Old English “craeft” meant strength and courage, expertness and skill. Eventually, craft connoted trickery or deceitfulness. A true craftsman might possess all of this and choose which qualities he’d like to combine or emphasize.

Manual care, especially the gentler sort, can appear mysterious. The therapist seems to “do” very little and certainly doesn’t introduce enough force to alter connective tissue in any enduring way. Still, dramatic changes in sensation and range of motion may rapidly follow the application of a hand upon the skin’s surface. That such things happen isn’t in dispute; how it happens is the primary purpose of neuroscience research as it relates to touch, sensation, stimulation, perception and efferent flow. Rational explanations have grown exponentially within this realm. It takes a little reading and thinking to gather it all in, I admit.

Let’s return to the super hero for a moment. The suspension of natural law necessary to actually possess a super power is one thing, but Professor Kakalios’ lecture makes it clear that beyond the application of the power itself there are physical consequences that can be predicted and measured. Super powers are fine for a comic book, or, perhaps, a session of “energetic” therapy, but, in the clinic, the method shouldn’t require any deferment of physics as it’s been understood for several centuries. Because of this, it’s not appropriate to equate gentle manual care with super powers, unless of course you feel you can get away with it. Obviously some therapists have done this.

What do therapists want? I think they want magic. But by this I mean magic in the way that a true craftsman might present it. Though subtleties in the method may be virtually invisible to anyone witnessing gently applied touch, these alterations in pressure have a purpose and a theory with construct validity. They can be explained and defended, and, in my opinion, they should be.

More about this in Part II of Manual Magic.

[Barrett Dorko]

Manual MagicPart II

I read once that "magicians aren’t trying to fool others, but to fascinate them." But having been a member of the International Brotherhood of Magicians for a while in the 80s, it seems clear to me that most magicians haven’t gotten this memo. In fact, I came to understand that the membership card I carried in my wallet was little more than a license to lie. Magicians call these lies ‘professional secrets” and they are certainly entitled to them. I noticed long ago that every one of them was available for purchase. I own a stack of books full of these professional secrets – not that that makes me a magician.

Though a magician might hold forth with an entertaining patter, the nature of the method he uses to fool or fascinate others is withheld. If he speaks of it at all he is probably lying. His words and movement are designed to confuse, hide from view, and distract the audience. Not exactly the sort of thing that creates trust.

As this thread progresses I’d like to return to different aspects of The Illusionist from time to time because the movie is emblematic of the essence of magic, including its dance with deception; the same dance many who practice manually do so often.

Often a director makes the hands of the protagonist prominent the first time we see them and this is one of those movies. Specifically, Norton’s character, Eisenheim the Illusionist, is seated on a simple chair in the center of a stage, his hands fully spread across each knee and almost glowing against the dark cloth in the stark stage lighting. Large and seemingly strong, these hands play an integral part in the slights he does effortlessly at various times in the movie. By contrast, Eisenheim’s nemesis, the dastardly crown prince, is traveling in disguise later in the movie when the camera focuses on his hands lying limply in his lap. Anxious about his appearance he asks his companion how he looks. ”Ordinary,” is the answer.

Whether they are used to actually perform the trick, simply to gesture toward the effect or distract the audience, a magician’s hands are always busy. If you perform manual care what qualities should your hands possess?

[Diane]

If you perform manual care what qualities should your hands possess?

The exact opposite qualities to those of a magician: Still, slow, soft, warm, perceptive, receptive, kind, honest, non-threatening, boundaried.

It's ok if they are used to "take advantage" of opportunities that appear (e.g., taking up slack that appears for the first time in decades), but not suddenly, and they should communicate large amounts of thoughtfulness backing up any small amount of firmness. Fast moves are to be avoided entirely if you want the nervous system in your hands to actually learn anything new, or extinguish any former learning. The patient should be able to practically "feel" their own changing, amplified through such hands.

[Barrett Dorko]

Diane,

Actually, I would asign these qualities to a magician's hands as well. Of course, I've spent hours practicing slights (more properly, "sleights," though it seems the two words have come to mean the same thing within the proper context), learning to soften, slow down and sensitize the manipulation. I don't suppose someone who hasn't put the time in would realize this. In fact, the speed with which something is done deceptively isn't nearly as important as the angle of the observer's vision. Lying as they do, magician's would have us believe otherwise.

The obvious difference between a magician's handling and ours lies not in the skill we've acquired, but in the nature of the thing we handle - animated in our case, inanimate in the magician's. It would follow that they have a different if not more difficult job in one sense because they must make things happen via their own carefully disguised force and we don't need that; the patient already has the force necessary for movement within them.

On the other hand, while the magician merely needs to account for precision, friction and gravity, we have to constantly adjust the use of our pressure in response to the patient's movement. Bobath did this amazingly - and she appeared quite "magical."

[Diane]

OK, I accept that.. I was meaning, opposite of "distracting" or "gesturing."
I was meaning, focused and responsible. Both require a considerable amount of self-learning in the hard drive of one's own sensing and outputting brain.

I described it to a patient I saw this morning, who is a visual artist, as similar to contact improv dance, two nervous systems learning from and suggesting to one another.

[nari]

I think this is relevant when we talk about touching someone:

Last night I watched a program about an autistic woman in her 60s who has become something of a hero in the USA with her understanding of the fear of cattle going into the abattoirs. As a result of her endeavours, the practice of shuffling cattle for slaughter any old way has been radically changed, resulting in happier animals easier to manage on the way to slaughter.
She also noticed that cattle in a press which totally constrained them, for example vaccination, relaxed with the high pressure on their bodies. As she has many fears and anxieties due to her condition, she put herself into a cattle press for 20 minutes and noticed her fears resolving.
Light touch is a real aversion to her; so she has managed her condition by building her own press, where she totally constrains herself for 20-30 minutes a week.
What this means I am not sure, but I thought it was interesting. Many people do not like light touch (I am one of them) and I wonder if part of the magic of touch is recognising those folk who respond to heavy pressure, and those who do not.....?

Nari

[Barrett Dorko]

Nari,

On page 154 of Shallow Dive you'll find Temple's Gift, an essay I wrote about this woman in the early 90s.

[nari]

Thanks, Barrett..it was one of the few I hadn't read yet.

I thought she was quite remarkable, having battled through endless psychotherapy and other, as it turned out, unhelpful measures. She noticed the cattle were disturbed by some leaf rubbish on the paved path to the slaughter room, and that reminds me of my horse who startled at the merest change in the environment - a small branch on his gravel path, sometimes even just a leaf.

I too think there is a lot to be learned about contact and connecting. Maybe we 'connect' only if the context is right; regardless of what we do or enable in the external and internal environment. Temple concerned herself with animals and the environment; but she probably will never connect with people and the environment. It doesn't matter, she succeeded anyway.....


Nari

[Barrett Dorko]

Yesterday I dusted off a book by Eugene Burger titled The Performance of Close-Up Magic. As it happens, he’s being interviewed on this week’s Point of Inquiry podcast. Coincidence? I think not!

Burger’s reputation as a master of sleights and performance is unsurpassed. And when he writes about his life’s work he doesn’t stick to the usual “here’s how the trick is done” format. I’d like to paraphrase what he says in this book’s introduction, altering the terms at times to connect more closely to manual care as I have come to know it and to teaching it as well.

Burger begins by separating the “technical” from the “theatrical” but emphasizes that these two aspects of the work should not oppose each other in any way. When they blend seamlessly what you finally see is a wonderful performance. Similarly, I have always emphasized that technique (read technical) should flow from theory (read theatrical). In this way when asked to defend what they’re actually doing therapists can explain their practice by appealing to its validity and biologic plausibility. Or, at least, that’s the plan.

If either the technique or theory is lacking this will show, especially when the therapist’s method and practice are questioned. Something that I think should happen frequently. Remember Joel Achenbach’s admonition regarding the nature of science: In science if you don’t work hard enough to prove yourself wrong your friends will gleefully take up the slack.

Magicians frequently watch and critique each other, and Burger is careful to point out how this should result in subsequent performances that are unique and original rather than merely mimicked. Such “slavish imitation” he says will seriously stunt the growth of any profession committed to theory – something that’s supposed to change – and certainly the method that should flow from that.

More about this in Part III of Manual Magic – The Fidelity of the Meme

[Barrett Dorko]

Manual Magic Part III - The Fidelity of the Meme

Like any magician teaching his colleagues, I try to get my theory and method across to the therapists who watch me during those few hours we are together. I think I manage this for the most part, but, ideally, they would then take all of this and pass it along intact to our colleagues. At this I fail miserably, mostly.

Thing is, I get paid the same, much as would if I failed to help a patient feel better. Not that that’s ever happened or anything.

What I’m trying to do has a name and a growing tradition in modern evolutionary psychology; it is the creation of a meme that is replicated with fidelity. Richard Dawkins speaks of this in his original work on the subject of memes here. I especially like this brief and clear description: “a noun that conveys the idea of a unit of cultural transmission, or a unit of imitation.”

Briefly, my ideas, my memes (admittedly, very few of them actually original) are transmitted via my voice, writing and behavior to the therapists gathered around me. They take that and use what they can to imitate what I’ve done. In theory, this behavior will result in the same thing I got a few moments earlier: a warmer, softer and more comfortable person in my hands. And, in class, it does. But if memes travel from brain to brain (and they do), mine poop out after that first jump. Okay, “poop out” isn’t what Dawkins would call it. He’d call it “a lack of endurance.” I like my description better for some reason.

The fidelity of a meme refers to its tendency to remain true to its original form from one transmission to the next. A truly successful meme will appear much the same even after numerous transmissions. Classic magic tricks containing a great deal of fidelity are pretty well known despite the fact that the method has been transmitted in a variety of ways many times and the presentation of the effect ends up very different from the original. I mean, how many ways have you seen a woman sawed in half? However it might have appeared the result is always the same. Now, that’s a meme with fidelity.

So, what’s the matter with my meme?

Consider this from Dawkins: If the meme is a scientific idea, its spread will depend on how acceptable it is to the population of individual scientists; a rough measure of its survival value could be obtained by counting the number of times it is referred to in successive years in scientific journals.

More in Part IV - The Fecundity of the Meme

[Barrett Dorko]

Manual Magic Part IV - The Fecundity of the Meme

“Not a single student showed up for his second lecture, and throughout almost every lecture for the next seventeen years Newton talked to an empty room, listening merely to his own voice bouncing back at him.”

From The Last Sorcerer by Michael White

When I think of the many things I’ve chosen not to learn in my life, I can’t come up with a single strategy for ignorance more powerful than indifference. I employ this daily, and thus I don’t know all kinds of things that perhaps I should. The consequences of this cluelessness sometimes surprises me and sometimes not. Sometimes I pay dearly for it, and at other times I’m grateful not to have known. All of this is something that takes some careful introspection, and I’m pretty sure anybody reading this could say pretty much the same thing.

Fecund means “producing or capable of producing offspring; fertile; very productive or creative intellectually.” Along with fidelity and endurance it completes the triad of qualities that any successful meme is known to require. Dawkins calls it fecundity and aside from the obvious importance of a meme’s ability to generate new but deeply related ideas and behaviors, we know that the speed with which we this can happen is essential for its success as well. Think of the survival of animals in the same way and you’ll see what I mean.

The quote above from a biography of Isaac Newton describes what this man went through early in his career. More about him and his relation to therapy practice can be found here. Briefly, White describes the initial reaction to Newton’s first lecture on optics. Employing his unique knowledge and skill Isaac had personally handcrafted a new telescope that was ¼ the size of those in use yet was ten times more powerful. This is what got him the appointment to the Lucasian Chair at Oxford, the same one occupied by Steven Hawking today.

In short, people loved the device built as the end result of Newton’s knowledge, but when it came to understanding how he had come to build it as he did they were indifferent to the point of willful ignorance. Thus, this meme represented by a reflecting telescope (previously there only been refracting ones) took a while to get off the ground.

What if the therapy community were to learn of a method of care that immediately altered in the desired direction the signs and symptoms of chronic discomfort it saw in the clinic each day? Wouldn’t you expect this discovery to result in the adoption of this method – this meme?

Before you answer, I want you to think of the consequences of fecundity. If the offspring of an idea are desirable to the surrounding community then fecundity is to its advantage. If not, well, what chance is there of its survival?

Let me put it another way: If the “magical” effect of another’s hands fascinates us and compels us to investigate the deep model of its underlying reality then such a method might eventually become established along with a defendable theory.

If it scares us then something else will occur.

Do you see where I’m going with this?

[BB]

Wouldn’t you expect this discovery to result in the adoption of this method – this meme?

Before you answer, I want you to think of the consequences of fecundity. If the offspring of an idea are desirable to the surrounding community then fecundity is to its advantage. If not, well, what chance is there of its survival?

At first I was confused by the question. I thought that such a method would be desirable as it allows success in a patient population where success has been difficult in the past.

Then I realized how treating in such a way would differ from current strategies and typical clinic operation. It might be scary for the business owner who runs a clinic in this "we are paid not for the quality of our treatments, but rather the amount of treatment given" state of healthcare we are in. At least in the US.

There is an article posted on EIM from the New York Times, I believe, that is all about this topic and how a Virginia Mason hospital in Seattle is battling it. It stated that when the hospital changed its practice by focusing on quality, which did increase, it went from making $200 per patient to losing $100. Pretty scary. They found that having the LBP pt. seen by a PT first was the highest quality way to deliver their care. Turned out to be scary to some of the docs in the hospital's pain center who subsequently left.

Barrett,
Maybe you could market your course as "scary therapy for a scary profession."

[BB]

It was in the Wall Street Journal, not the new york times, and is titled "A Novel Plan Helps Hospital Wean Itself Off Pricey Tests."

Again, it is available through EIM site for free right now.

[Barrett Dorko]

Cory,

A perfect example.

True story:

Many years ago I learned of a card trick called “The Invisible Deck.” And it went like this: I hand someone and “invisible” deck of cards and ask that they go through the business of shuffling them thoroughly. Having done so, they choose a single card, memorize it, and then place it back in the deck face down while all the other cards are face up. Remember, this is all pantomimed because they are holding an “invisible deck.”

I then ask this person to tell us what card they reversed, pull a deck from my pocket and fan it out, face up. Only one card is reversed and it turns out to be theirs.

A pretty good trick, but after a while I learned to add this: I’d have the person pretend to tear a corner from the chosen card, and when I fanned the deck a few moments later they’d find that not only was this the only one face down, it was the only one torn as well.

I remember telling the magic store owner I knew that I’d begun presenting it in this way and he shook his head. “Too strong,” he said. And by then I knew that he was right.

[Diane]

A link to that article discussed by BB.