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  • Therapy's Strange Loop

    I’ve struggled a bit to find a way of beginning this thread. I anticipate its being a long and surprising one. Long because the subject is so large and surprising because I haven’t yet read most of the materials I intend to use. I’m sure there are some I’m not yet aware of.

    Let’s start with this: Deep in his newest book, I Am A Strange Loop, Douglas Hofstadter uses a dialogue between two fictional characters, one a doubter regarding his basic premise (more on that later) and one a believer. They are discussing the way in which humans perceive things. I’ll paraphrase it here.

    Believer - We humans are beings whose fate it is to be able to perceive abstractions, and to be driven to do so. We spend our lives sorting the world into an ever-growing hierarchy of patterns. Being macroscopic, we can’t see way down to the level where physical causality happens, so in compensation, we find all sorts of marvelously efficient shorthand ways of describing what goes on. Fortunately, despite the chaos, the world is filled with regularities that can be counted on most of the time.

    But there’s this to consider: The one who perceives has to constantly deal with its own viewpoint, a viewpoint that may be skewed by its own “soul,” which is yet another shorthand term for our “central essence,” which is something else we fabricate a story about.

    Okay, I know that this is a rather heavy subject, but I hope to lighten it with specific examples from my own clinical experience and look forward to seeing some of yours.

    There’s no hurry. I’m not going to be far from the computer no matter where else I might be. In my second post I will explain a bit more what it is I hope to talk about here.

    All I have to do now is figure that out.
    Barrett L. Dorko

  • #2
    Hofstadter is all about self-reference. He especially likes Drawing Hands by M. C. Escher. Prior to this he was best known for a book written in ’79 titled Godel, Escher, Bach: an Eternal Golden Braid. Believe me, this book is a cult classic and it got rave reviews. I’ve had a copy for years but can’t say that I ever read it through or understood it well. Maybe that will change with the writing of this thread.

    Hofstadter contends that if we carefully examine the small brain events that wend themselves toward the symbol-making that eventually forms the story we make up about our life that we will discover something about consciousness.

    Okay, I get that. How it relates to therapy remains to be seen.
    Barrett L. Dorko

    Comment


    • #3
      i didnt have much luck understanding godel escher and bach when i tried to read it in my early twenties.maybe it wasnt luck but too many spliffs

      Comment


      • #4
        It was too deep for me I'm afraid. Had some nice pictures though, of growth curves etc., as I recall.
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #5
          Hofstadter's Meteor Metaphor

          Everything I do is some kind of modified borrowing from others who have been close to me either actually or virtually, and the virtual influences are among the most profound…We are all curious collages that grow by (fusing) with other people’s habits and ideas and styles…as if they were meteorites that came soaring out of the blue, collided with us, and then stuck.

          Hofstadter, I Am Strange Loop, pgs. 250-251

          I’m still picking out phrases from this book and letting them swim in my head for a while, hoping to find a way into Hofstadter’s basic premise and then out again so that I might post here.

          This quote struck me as especially appropriate for someone like me. After all, I mainly behave as one of those “meteorites” that flies through a town and catches the gaze of a few therapists. I glance off most with no appreciable effect, mine not being as “sticky” as the memes carried by McKenzie or Paris or Sahrmann or a few others. Hofstadter takes pains to explain this:

          Although my meteorite metaphor may make it sound like we are victims of random bombardment, I don’t mean to suggest that we willingly absorb just any old mannerism we see – we are very selective, usually borrowing traits that we admire or covet – but even our style of selectivity is itself influenced over the years by what we have turned into…

          I’m beginning to suspect that my difficulty getting other therapists to be less aggressive and threatening; to become manually accepting and non-judgmental, has everything to do with what they’ve become before they arrive in class. This isn’t news to me, but through Hofstadter’s writing I’m more appreciative of how change in others may or may not occur – and that includes our attempts to change our patients.

          Perhaps a therapist's previous contacts - the meteorites that have flown near to them - make seeing and understanding and handling others as I do nearly impossible in some instances. I think that this situation is preserved by the silence of their former teachers. There's certainly plenty of that going on.
          Last edited by Barrett Dorko; 24-04-2007, 10:12 PM.
          Barrett L. Dorko

          Comment


          • #6
            There’s a passage on page 264 that I found very interesting. Here Hofstadter is discussing viewpoints and the manner in which we “routinely transport ourselves into virtual worlds.”

            He says, “The mere act of reading a novel while relaxing in an armchair is an example par excellence of this phenomenon.”

            I’ll paraphrase here: Though what we look at in the book is just a myriad of black smudges arranged neatly in lines on a set of white rectangles, we “see” the scene described. (And should I use the quotation marks around see?) We are so impressed with this we lose sight of the room we actually occupy. In fact, we become unaware of the black smudges we are depending upon to bring us the images we “see” while reading.

            “Black curlicues on a white background, when suitably arranged, transport us in milliseconds to arbitrarily distant, long-gone, or even never-existent venues.”

            I can’t read this without thinking about how a patient’s words can do the same thing to us and ours to them, and then what we write in a chart may take yet another therapist to a place that isn’t real and/or never could be real.

            It’s far more convenient to simply ignore this way of “seeing” when we read another’s description of something, and, of course, that’s what we commonly do.

            Knowing this, how can we come closer to the “truth” behind a patient’s condition as they are passed about in the system?

            Worth thinking about if you’ve the time, and better yet if you’ve the courage and inclination.

            I think Hofstadter writes of this with a tremendous amount of courage, and, of course, he pays a price.
            Barrett L. Dorko

            Comment


            • #7
              Which way of seeing is beneficial to the patient?

              Two different therapists sitting in a room listening to the same patient may be transported to two different places. I’m sure much has to do with the therapist’s education, understanding, and training (context?). I can just imagine one PT “seeing” joint while I “see” neural tissue even though we hear the same story. We also may write the same things down on paper, but the meaning I give the words may direct a method of care quite different.

              Douglas Hofstadter states in the preface of “I Am A Strange Loop” (referring to “Gödel, Escher, Bach”),

              “And, yet despite the books popularity, it always troubled me that the fundamental message of GEB seemed to go largely unnoticed.”

              Do our patients ever walk away thinking that?

              There is also much to patient’s stories that can’t be written down but are still important, non-verbal communication comes to mind. Then there are also the things we write down that just don’t matter. I think I will forever struggle with trying to see more accurately. However, understanding a bit more neuroscience helped to put it into a hopefully more appropriate context allowing me to appreciate the right words and “visualize” the right image.


              Chris
              Christopher Bryhan MPT

              "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
              Daniel Kahneman - Thinking Fast and Slow

              Comment


              • #8
                I should also add that perhaps in reading Barrett's post, I didn't "see" the proper meaning. It's scary and sometimes I feel that with patients.

                Chris
                Christopher Bryhan MPT

                "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                Daniel Kahneman - Thinking Fast and Slow

                Comment


                • #9
                  There is an awful lot that goes on between therapist and patient that is never revealed; taking over from someone else's patient brings this home sharply. All we have is a page or many pages of what was done. If it is all purely objective, it is a matter of starting all over again, in most cases.
                  Mostly, it is attempting to erase any unreality caused intentionally or unintentionally by the other encounters.

                  Each encounter is, or should be, unique; if we move away from assembly-line, recipe based treatment, it either annoys the patient or enchants. What is lost, however, is the previous rapport the patient had with the therapist.

                  Chris is right; each of us sees a patient in quite different ways, especially if we listen properly to the patient's narrative.

                  Linking the presenting symptoms to the patient's being and their connecting with our presentation is a huge challenge.
                  Pulling techniques or methods out of a box is easy in comparison, which is why a lot of PTs do just that. In a way, it is much safer, though unlikely to be as effective.

                  As a supervisor of junior PTs and students (for what seemed ages) I would occasionally cringe at the way patients were spoken to and answered. Then again, I had to stop and ask myself: Why am I reacting like this?

                  I think that comes first in an attempt to understand a PT/pt encounter.

                  Nari

                  Comment


                  • #10
                    The Smile of Ideomotion

                    Now we’re getting somewhere. I find Hofstadter’s observations every bit as interesting as his explanations, and, of course, the former typically precedes the latter. (Notice how that last phrase is true in two ways and how it is oddly self-referential – another strange loop)

                    I can’t find this in the book, but I wrote somewhere here on Soma Simple an addition to a thread that included his comments about a smile. He spoke of this in an interview recently.

                    Hofstadter points out that anyone’s smile is unique and immediately recognized by their friends, even after an absence of many years. Despite its individualized and distinct nature, a smile can’t be measured in any meaningful way. Within each of us it is a potential within the brain and manifest as muscular activity emergent when the context is appropriate.

                    Is ideomotion similar? I am convinced it is. I’m convinced that I can get another to express this unique thing within them as easily as I can get them to smile. Of course, my ability to do that will vary with my experience and knowledge. But any standup comedian will tell you that this improves with increased exposure to the situation and a variety of audiences. The comedian also grows increasingly aware of what’s funny.

                    We’re the “comedian” and our patients are the “audience.” How do we have to be with them? What is it we can do to promote the “smile” of ideomotion?
                    Barrett L. Dorko

                    Comment


                    • #11
                      I remember reading in "Phantoms in the Brain" V.S. Ramachandran speculating about the nature of a smile and laughter. His idea was that a smile was in response to a perceived threat understood as no longer threatening. This was just speculation of course and I'm sure there is more to it. But not being perceived as a threat is big.

                      Chris
                      Christopher Bryhan MPT

                      "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                      Daniel Kahneman - Thinking Fast and Slow

                      Comment


                      • #12
                        We can easily see anger or frustration or pleasure in the written word, but I have never seen a smile in a text, unless it is specifically stated as occurring. We simply have to imagine that particular text suggests smiling.

                        So if ideomotion is a smile (and those who are experiencing it usually have a bit of a grin), connecting with a PT's spoken words can be difficult. A smile is a change in the muscle function of the face, and a forced smile is an entirely different but similar explanation. Perhaps this could be a sort of analogy: a PT requesting someone to move in a certain way, produces a forced smile; eliciting ideomotion is like a spontaneous smile.
                        I've painted myself into a corner again, so will think some more about this...

                        Nari

                        Comment


                        • #13
                          About smiles, I've read that they also function as submission gestures... I will go along with the metaphor, but only for smiles of the spontaneous sort that indicate delight and no other kind. :teeth:
                          Diane
                          www.dermoneuromodulation.com
                          SensibleSolutionsPhysiotherapy
                          HumanAntiGravitySuit blog
                          Neurotonics PT Teamblog
                          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                          Canadian Physiotherapy Association Pain Science Division Facebook page
                          @PainPhysiosCan
                          WCPT PhysiotherapyPainNetwork on Facebook
                          @WCPTPTPN
                          Neuroscience and Pain Science for Manual PTs Facebook page

                          @dfjpt
                          SomaSimple on Facebook
                          @somasimple

                          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                          Comment


                          • #14
                            I remember another piece from Ramachandran's "Phantoms in the Brain". There are apparently 2 different pathways of a smile (one authentic/unconscious, one forced/conscious). The example he used was of a patient with a facial droop, when commanded to smile produced some contorted expression. When a loved one walked through the door the person would produce a full smile. So like Nari said, ideomotion is a spontaneous smile.

                            Chris
                            Christopher Bryhan MPT

                            "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                            Daniel Kahneman - Thinking Fast and Slow

                            Comment


                            • #15
                              It’s true, smiles are of different sorts. There’s a pretty good description of the “Duchenne” smile here and some interesting comments in addition here.

                              In the second link there’s this comment: “In Duchenne smile, the facial muscles involved in are difficult to control voluntarily. Therefore, it's difficult to fake a Duchenne smile unless you smile from within.

                              The Pan American smile is a perfunctory smile. It is nothing but a courtesy smile as in the case of a flight attendant responding to a patron. It's an expression of courtesy and politeness rather than inner joy. Alas, the Pan Am airline is dead but the smile will live forever.”

                              There’s a direct correlation here to the authentic, corrective movement seen in ideomotion and the approximation of that when people try to correct via a conscious motivation. I know I can tell one from the other immediately but it would be hard to say how it is I know that. This ability is intuitive on my part, secondary to prolonged observation.
                              Last edited by Barrett Dorko; 27-04-2007, 02:41 AM.
                              Barrett L. Dorko

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