Manual Magic

[Jon Newman]

Hi Barrett,

I'll crack open my wallet, blow out the cobwebs, let the moths escape and go buy myself a copy of that. Sounds like more good reading.

From Catch-22

"Yossarian owed his good health to exercise, fresh air, teamwork and good sportsmanship; it was to get away from them all that he had first discovered the hospital.."

[nari]

......Dawkins also says: (p181)

All over the world. ceremonies are based upon an obsession with things representing other things that they slightly resemble, or resemble in one respect.

..and at the start of the chapter:

To gild refined gold, to paint the lily,
To throw a perfume on the violet,
To smooth the ice, or add another hue
Unto the rainbow, or with taper light
To seek the beauteous eye of heaven to garnish,
Is wasteful and ridiculous excess.(King John, Act lV, scene ii).

Shakespeare had it sorted out. What intrigues me is how the first quote seems to paraphrase the mesodermalist approach to dysfunction.

Nari

[Barrett Dorko]

The Fatal Heuristic

Well, Nari. You arrived at the point I’ve been preparing just ahead of me. This is great because it’s so large and complex an issue in traditional practice that I’ve been concerned about how I might present it in a coherent fashion.

Here goes: I wrote an essay about ten years ago titled The Fatal Heuristic that examined the consequences of a certain reasoning that I feel created a very negative effect on our profession, an effect that endures to this day. Let me explain.

Because you can paint it, stain it and flex it; because it is at once outstanding and commonplace – when something is manufactured in wood it lends a quiet feeling of solid normality, and so is hardly ever noticed.

Because of this, it is the ideal medium for the illusionist.

From The Prestige

There is a general tendency in human judgment to use shortcuts in order to speed the process of decision making and thus progress rapidly from one situation to the next seamlessly. For example, a crowded parking lot implies a crowded restaurant so we either leave before entering or prepare to wait. Silence from another implies consent, so we proceed as if it were so. Of course, we might be mistaken in both instances. Still, without making perfectly reasonable decisions of this sort regularly we’d be hard pressed to get through the day. Not surprisingly, magicians know this and use it to their advantage, hence the quote above in The Prestige.

Psychologists refer to this as the use of “representative heuristic.” Simply put, when things seem closely related we assume that they are, in effect, causative as well. The overarching rule is “like goes with like” and this “representativeness heuristic” is often useful and accurate – but it can also mislead us. All of this is carefully explained in "Like Goes with Like: The Role of Representativeness in Erroneous and Pseudoscientific Beliefs" (Gilovich and Savitsky Skeptical Inquirer Vol. 20 No. 2 1996).

I have the distinct sense that our profession veered from what might have been magical practice when the connection between strength and posture was erroneously made in the middle of the last century. This led to additional and equally inaccurate connections between pain and posture, strength and pain, training and pain relief, appearance and pain, health and beauty and several other combinations of the previous heuristics, all of them dubious at best.

Remember, in this thread, magic and truth are distinctly related. When a heuristic is wrong, the truthfulness of our reasoning isn’t what we’d prefer, and the magic possible in our practice disappears.

As Nari points out in post #77, “the first quote seems to paraphrase the mesodermalist approach to dysfunction.” I believe she’s right, and that the fatal heuristic developed decades ago led us to the dominance of mesodermal thinking and practice today.

It makes the magic inherent to neurologic practice very difficult to institute, no matter how much sense it makes.

[Barrett Dorko]

Let’s go back now to the quote at the beginning of this thread:

Any sufficiently advanced technology is indistinguishable from magic.

Arthur C. Clarke

The best treads weave in directions not originally intended yet welcome at the same time. Some weave in directions we’d prefer they didn’t. When that happens the fear so many have of The Internet becomes understandable.

This has grown from some ideas I’ve had regarding the connections between magical performance, craftsmanship, communicative skills and physical law. I guessed that these thoughts might lead us closer to a basic conflict between myself and few other teachers but hadn’t anticipated that it would reveal the following as it came to me this morning.

Manual care done with care and effectiveness appears gentle and mysterious. The absence of threat is evident to both those observing and those participating. This, as our friend Cory Blickenstaff has taught us, is what neuroscience insists upon. Manual care that relies upon a certain amount of luck and which carries with it a degree of danger is widely practiced but no one would refer to it as “magical” during the course of its application though they might later describe its effect in that way, hopefully.

But it is the moment of manual contact itself that I want to talk about here. It is at that moment that the “advanced technology” created by our understanding of neurobiology makes us appear magical. Not that coercive technique is actually barbaric by comparison.

Maybe it just appears so.

More soon.

[Barrett Dorko]

Years ago I wrote an essay titled Magical Thinking that’s proven very popular. I can’t help but think that many people go there and begin reading in anticipation that it will justify their tendency to practice in some “alternative” fashion. It doesn’t.

Instead I say, “My clinic in the real world doesn’t work like that. Here science sets boundaries and makes accurate, perhaps undesired predictions. A little magic would be nice, but I have to remember where in my life it truly belongs.”

It is the theory which decides what we can observe.

Albert Einstein

I find these few words quite profound, and, for our purposes here, right on point. After all, if we don’t begin with fanciful notions of “energy flow” and the like we won’t waste any time imagining that they will explain what we’re seeing when we are working manually in the clinic. Instead, we’ll attend to the anatomical and physiologic reality of touch and its consequences. Think about what Kendall’s theory of muscular dysfunction (stretch weakness) and posture (the more erect the better) didn’t allow her to see. Her method of practice inevitably followed and the magic that manual care might have become in her hands was forever lost. I think that manipulators of various sorts suffer from the same problem.

Bottom line – there is a difference between magical thinking and magical practice. The former is fun but irrational in the clinic. The latter is a result of sensible thought.

And in the clinic it stands a much better chance of leading to success.

[Diane]

sound like acupuncture or myofascial release?

Yes, and it also sounds like SMT, Mulligan, MacKenzie and several other bony disc-y spinalesque mesodermal approaches one could name. I'm glad you said

I think that manipulators of various sorts suffer from the same problem.

I think so too. Don't all of them deserve to be named and "decloaked"? Or should that be "defrocked"? Aren't all of them magical thinking to some degree/major extent? Don't all of them say the same thing, some version of it works, we don't know why, we think it must have to do with discs and facets, here, pay us $x and we'll teach you the glamorous tricks we've dreamed up.

Don't all of them claim to be "scientific" in the complete absence of theory in that they've counted the people who improved by using these tricks against those who didn't? Didn't they then say, look, our tricks don't work with all these people, but with these ones, they do. Therefore, we have made a science-based prediction about who to use our tricks with.

[Jon Newman]

Hi Diane,

Aren't all of them magical thinking to some degree/major extent?

I'm not so sure about this. They may wrong or incomplete but not magical. The energy medicine folks are appealing to something that can't (not just "doesn't") happen in our natural world.

That's how I see it anyway.

[Barrett Dorko]

I didn't attend the lecture in Boston but heard of a therapist pointing out that mobilization of the shoulder joint simply didn't have the effect on the connective tissue we've always imagined it did. This, to me (because it's backed up by credible evidence), would mean that the thinking of the manipulator would be magical because it violated the known or possible effect of coercive force.

I think there may be a subtle but important distinction here between that and the use of active exercise, which has its place and might very well move things in the right direction.

Perhaps we can say that magical thinking may or may not lead to effective practice but that truly magical practice is a consequence of rational thinking.

There's room in such a statement for some forms of mesodermal intervention when the mesoderm is the problem, which certainly occurs.

[Diane]

Jon, I agree! I wasn't referring to anything other than the propensity to assign magical qualities to some tissues that they don't have, or assign magical qualities to moving them that don't exist, or to mistake the procedures involved as magical maneuvers that suffice, both as treatment and as objects of study/research in lieu of real understanding or theory. I think all the mesodermal approaches are therefore as "magical" as any so-called "energy" work, when we look hard at them. They just avoid using the term, and thereby manage to escape overt criticism. I'm saying, they also lurch along with a big credibility gap that they don't even acknowledge, possibly because they can point to bone in pictures or on a skeleton and say, look, it exists. I'm not sticking up for "energy work", I'm saying, show me how one is less "magical" than the other.

[Diane]

Some additional thoughts arrived while I was in the shower.
To quote DaVinci, of a popular TV show about a city coroner, "Here's how I see how it went down."

1. A hundred or so years ago, when there was a sudden proliferation of kinds of "doctors" and ways of treating the physical body manually, plus an awful lot of leftover religious/spiritualist thinking, plus a lot of socially-reinforced entrepreneurial drive happening, certain pathways were laid down within the realm of human primate social grooming.*

2. Most of them were about mesoderm. Not much information about the nervous system was readily available.

3. The ruts deepened and hardened and served as channels/cages/riverbeds for thinking within which new generations of practitioners were trained.

4. The procedures worked enough of the time, and were lucrative enough, to be self-reinforcing.

5. They gained a panache of historicity and tradition.

6. It's what we have to work with today. It's by no means all we have to work with, because there has been a neuroscience revolution meanwhile, but when I say "it's what we have to work with" I mean, it's what is in front of us for us to deconstruct.

7. The "energy" concepts are just the first layer of something much deeper and broader, archaeologically and socially.

8. The more we shine a light of neuroscience on all this, the more the mesodermal constructs as an entire group of thought systems/approaches/procedures look silly/wrong/incomplete/merely avaricious.

9. Any soft tissue approaches/mesodermal theorizing that derive from this type of thinking are clearly ridiculous. This does not mean to say that their bony mesodermal underpinnings are not equally ridiculous, only that the hard tissue practitioners are careful not to use the energy word when they talk. Instead they talk (depending on what branch of the mesodermalism family they're from) about innate intelligence, subluxations, lesions, stuck facets, discs or entire vertebrae even, that have "moved" and must be "moved back into place", etc., or else they just don't say anything and rely on the effect of the magic trick itself to sell their ever proliferating courses.

*The discovery of antibiotics in 1928 effectively highlighted medical doctors while eclipsing the other doctors of human primate social grooming. Prior to this, e.g., during the pandemic of 1918, and in the face of endemic rampant communicable diseases such as cholera and TB, U.S. osteopathic physicians (from their own stat keeping) claim a slight edge in patient survival than any of the other "doctoring" profession of the day. In the U.S., osteopaths agreed to adhere to standardized medical education, but chiropractors declined in favor of becoming their own sort of "doctor", to the present day. The entry of PTs into the human primate social grooming family occurred as a division of labor within the burgeoning and wildly successful medical arena and a number of factors, including war and other social changes:
1. The need to rehab many amputees, polio victims;
2. Women were free to attain gain independent livelihoods;
3. Physical culture was no longer a pastime for the idle rich - it had became popularized.

[Barrett Dorko]

Diane,

Mind-blowing. And absolutely the case. This is too big a thing to see for most, and I'm reminded of what Bertrand Russell said about water: "We cannot know who it was that first discovered water, but we can be pretty sure that it wasn't a fish."

Isn't it interesting that the magical arts have always kept a careful eye on scientific progression, often using it to their advantage prior to the public's general awareness?

Maybe this is precisely the case with our ectodermal emphasis here. Eric Matheson once said that "It is as if Barrett is shouting back at us from the future," and I feel certain he would say the same of you. Ironically, it isn't the future where we live, it is the present. This illusion is created by the fact that our mesodermal colleagues are living in the past.

They just don't know it.

[Jon Newman]

Living in the past I think is accurate. Now there's revolution but they don't know what they're fighting.

[Diane]

Barrett, maybe this site helps us build a counter-flock.

"Watching a giant flock of birds swoop across the sky as one, or a school of fish darting this way and that, it's impossible for our minds to conceive of a process that unites so many individuals so seamlessly."

"We now know that such synchronized group behaviour is mediated through sensory modalities such as vision, sound, pressure and odour detection. Individuals tend to maintain a personal space by avoiding those too close to themselves; group cohesion results from a longer-range attraction to others; and animals often align their direction of travel with that of nearby neighbours. These responses can account for many of the group structures we see in nature, including insect swarms and the dramatic vortex-like mills formed by some species of fish and bat. By adjusting their motion in response to that of near neighbours, individuals in groups both generate, and are influenced by, their social context — there is no centralized controller."

"For individuals within groups, survival can depend critically on how local behavioural rules scale to collective properties. Pertinent information, such as the location of resources or predators, may often be detected by only a relatively small proportion of group members due to limitations in individual sensory capabilities, often further restricted by crowding. Close behavioural coupling among near neighbours, however, allows a localized change in direction to be amplified, creating a rapidly growing and propagating wave of turning across the group. This positive feedback results from the ability of individuals to influence and be influenced by others, and allows them to experience an 'effective range' of perception much larger than their actual sensory range."

"We are beginning to comprehend more fully how individuals in groups can gain access to higher-order collective computational capabilities such as the simultaneous acquisition and processing of information from widely distributed sources. Group members may come to a consensus not only about where to travel but also about what local rules to use. Thus, like the brain, groups may adapt to compute 'the right thing' in different contexts, matching their collective information-strategy with the statistical properties of their environment."

"...today there is a rapidly expanding and vibrant community of biologists, engineers, mathematicians and physicists for whom flocking serves as inspiration. Such group behaviour holds clues about the evolution of sociality, and also for the development of novel technological solutions, from autonomous swarms of exploratory robots to flocks of communicating software agents that help each other to navigate through complex and unpredictable data environments."

It's certainly not easy moving or flocking against the mesodermal current. But maybe together, here at least, all of us can.

Jon,

Now there's revolution but they don't know what they're fighting.

I think they are trying to maintain the status quo against actual reason.

[nari]

Diane,

I think they are trying to maintain the status quo against actual reason.

For some reason (pun intended) this sentence bothers me. It's accurate, but its implications are pyroclastic. This means that a majority of PTs in the world fight against reason and follow magic, as interpreted by Barrett et al.
So their clinical reasoning is based on the wrong premise, but for them it is sound reasoning, developed in a complexity that grew like Topsy from the dark past. Is that a reasonable synopsis?
Puns aside, it would indeed be true that pisces physiotherapeuticus is dead in the water, or on the shoreline, anyway. Some of us are shouting from the future, but I think the fish need more to get to deep water.

A PT I was talking with yesterday maintained that TransAb activation was essential for improving various forms of incontinence. She is very successful with this strategy and has been for about ten years or more. I found I could not argue with this; she simply gets excellent results. That's hard to argue with...but we can all think of X reasons why it works.

Nari

[Barrett Dorko]

Nari,

No doubt it's bothersome. My experience has been that most are oblivious or blatantly in denial. When approached with good evidence to the contrary they refuse to look at it. This site alone would alter virtually anyone willing to read it but you know how that goes.

Last week I spoke to about 40 people at the convention in Boston. Not a single one had ever heard of a BB such as this, and this included the directors of two PT schools and several faculty. They appeared intrigued but I don't see any spike in registration and certainly nobody there has contributed a thought. Maybe they don't have any.

They want magic, but they are unwilling or unable to do what it takes to perform it.