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The Power of Dissonance

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  • Dissonance certainly produces anger, whatever the equation format. It's often a veiled anger, but it's there. We don't have to guess to whom it is directed in Barrett's case.
    I personally have seen it as a reasonably polite sort of anger, that someone could challenge the harvested, cut and dried chaff of joint and muscle work.
    As a friend of mine said today, as we tramped through forest, physiotherapy has never had a direction to move towards; it was always Gray's Anatomy and whatever was produced through studies and trials on the myology and arthrology sections. The directional path was never complete as it ignored the brain and nervous system. This was never challenged and still isn't, for the great unwashed PT community.



    • Many of the discussions that start polite, but that end (or continue) with anger, on the EIM MySpace forum can be attributed to such a response to dissonance, I think.

      We still have a guy on the pain forum who thinks I personally hate McKenzie's MDT system. This only makes sense as a response when you consider the alternative - which is to rethink an existing and reinforced belief system.
      Jason Silvernail DPT, DSc, FAAOMPT
      Board-Certified in Orthopedic Physical Therapy
      Fellowship-Trained in Orthopedic Manual Therapy

      Certified Strength and Conditioning Specialist

      The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.


      • Which is why I keep asking, if the goal is to get others to listen, to learn or to accept then shouldn't one of the, if not the primary, strategies be to keep the dissonance at a minimum. There still seems to be a need to prove "we" are right and "they" are wrong, which is the point of a debate or argument, but not teaching. If the evidence is really as overwhelming and indisputable as claimed, then there is no need to address already existing belief, only to present new thoughts alongside what already exists. The person will eventually realize the two beliefs are incompatible and will slowly discard the one that doesn't make sense. That is what happened, in one way or another, to everyone who posts here.

        If a person is presented with dissonance we know the likely outcome. What is the saying about doing the same thing over and over and expecting different results?


        • Randy,

          Your strategy might be useful if the students were all just entering the educational institutions we've created, but it cannot work if they've already invested time and money and emotion into practices that oppose physical reality. These are the therapists I'm faced with. They're adults, so I don't treat them as five year olds and I don't have much time either.

          Most "get it," others never will. It's clear that their problem is with the information offered much more than the way it is presented.

          Given the same task, I'm wondering what you might discover about this, and if you were to attend one of my workshops I think you'd be amazed at what you see happen when people are offered any alternative to the way that they already practice, especially when that alternative implies that old "tools" must be discarded.

          Your comment about right and wrong is appropriate, but there's a difference between needing to be right (a bad thing) and simply being right, which commonly occurs in scientific inquiry. What we're talking about here is another's reaction to the realization that they were wrong. See post #1.
          Last edited by Barrett Dorko; 30-09-2007, 03:06 PM.
          Barrett L. Dorko


          • A popular and enduring thread like this often ties together others from the past that explore similar subjects. For this one, How Might We Grow? is relevant as well as Health, happiness, comfort or survival?. The latter returns again and again to how therapists may tend to exploit the need for happiness in their patients while working hard to avoid changes in their own practice that might rob them of their own.

            It’s ironic but true that the same practice that makes our managers uneasy (rapid improvement, individualized care, short periods of application and easy technique) would make most therapists happy. Well, probably.

            At the core of all this is dissonant sensation, and we must remember how everybody instinctively distorts the new information that leads to that discomfort. (See what I did with the swaying car above, post #137)

            I often hear this from workshop attendees: “I have to go back and do an inservice on this material next week…” At this point they stop speaking because though they know what they want to say to their colleagues, (it’s clear to me now) they also know what sort of anger will rise as a result. They’re scared, and I can hardly blame them. I have felt the same fear countless times. I’ve lost friends, alienated students and referral sources and struggled to make a living at times for this very reason. I do it anyway, and feel I have no choice.

            Maybe now I can point them to this thread and suggest that they talk about dissonance theory before they begin. It will never eliminate entirely the anger others may decide to feel, but it may provide some understanding and a “shield” for the messenger.
            Barrett L. Dorko


            • Barrett,

              This time my post wasn't directed at you. I'm convinced that you already understood my point probably long before I made it. What I see on this site though, from everybody, including myself, is that every thread has a long stretch and often the entire thread is about, "We are right and they are wrong". I've found this Dissonance thread to be interesting. It provides psychological insight into why people react the way they do, and even if it turns out to be inaccurate, it also provides insight into why we think they react the way they do. I find it equally interesting to question why WE act the way WE do. (That maybe a rhetorical WE). If we know the results of dissonance, then why do we so often provoke it intentionally? What is the psychological label? The need for affirmation?

              I mentioned earlier that I am an atheist. I see this same phenomenon with many atheists, they become almost militant in their desire to point out what they see as the irrationality, superstition and ignorance of those who believe in a God. (Watch Bill Maher for an example) I agree with much of what they say but if their goal is to reduce the irrationality, superstition and ignorance then it is a poor strategy to confont believers with the error of their belief. It is much better to try to ignore the topic of religion entirely. To argue for the value of rationality, logic, and reasoning. It becomes apparent that in using these tools that disbelief must be the default position and the believers then must make a choice. They can either choose to reject their faith, they can choose to reject science or, do as most do and reserve a portion of their mind for the belief in faith while embracing logic in the rest of their lives. Physical Therapy and related topics, of course, aren't a religion, but the belief systems carry all the same emotional baggage as any other belief. That is just the nature of people. Fortunately too, I think that there is no need for this sequestering of thought in PT, I think if given time, most people can reconcile their earlier belief with newer ones. I think many here have done that.


              • The irony of the anger I no doubt provoked by the above post in the hearts of the religious isn't lost on me.


                • Originally posted by randy Dixon
                  What I see on this site though, from everybody, including myself, is that every thread has a long stretch and often the entire thread is about, "We are right and they are wrong".
                  I do not think so.
                  • We do not try to convince everybody. We let the readers make their own opinion.
                  • We bring explanations that fit, in a better manner, the facts.
                  • We are using scientific arguments that destruct irrationality and beliefs.
                  • Not a bit of religion, there!
                  Simplicity is the ultimate sophistication. L VINCI
                  We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                  Everything should be made as simple as possible, but not a bit simpler.
                  If you can't explain it simply, you don't understand it well enough. Albert Einstein


                  • Randy, I agree with your sentiments, but not necessarily the language used.
                    To say: We are right and they are wrong suggests, to me anyway, that we are declaring a truth which they are ignoring, in preference of their beliefs. And as truth does not exist, just as the notion of best practice doesn't exist, anyone who is convinced he/she is right should perhaps rethink...

                    I don't think we do that as a whole; we argue on the side of reasoning and logic using what seems to be the most sensible approach to a problem of pain or dysfunction. Of course, people being what they are, things get heated. I've heard long and cranky arguments about the appropriate price of bus tickets, too. (Not here) Dissonance appears consistently with thinking folk.

                    I agree physical therapy carries a lot of baggage based on belief, faith and tradition, and I get your point about atheism vs faiths. I think with many PTs the problem is similar to that of religion: ie, those who cling to traditional thinking/faith vs those who think via logic and reasoning. But it doesn't mean it is any easier to change people's views on appropriate clinical practices.

                    Sometimes, it is clear it is a waste of effort; some will never change. But others can combine what we are promoting along with their established views, as you suggested. It depends on their ability to see value in both; and I suspect/hope that is what we are aiming to achieve.

                    There is a risk of evangelism on both sides of the ectoderm/mesoderm debate, but the altars are different. One is based on traditional thought and the other on new thinking. History is littered with such situations.

                    But at least nobody gets beheaded or burnt at the stake or sent to Australia.

                    Last edited by nari; 02-10-2007, 12:33 PM.


                    • Nari,

                      The very distinction between mesodermalists/ectodermalists is an "we're right, they're wrong" construction.


                      Your post could also be written "But we really are right, and they really are wrong".

                      Are either of you really arguing that it isn't common to talk about how wrong the "mesodermalists" are approaching things or how wrong their thinking is or how right the "ectodermalists" are?

                      If so, I think you need to reread the whole thread about cognitive dissonance.

                      Are you going to make me break out quotes?


                      • The very distinction between mesodermalists/ectodermalists is an "we're right, they're wrong" construction.
                        With all due respect Randy, it isn't. It is a differentiation in order to make sense out of two different focuses in PT. One of which is "righter", not because I say so but because it is more congruent with science of the past 20 years instead of with tradition of the last hundred.
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                        "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

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                        • Randy,

                          Refer again to my recently saying that there's a difference between needing to be right and being right. One of the things that makes discourse about therapeutic reasoning and intervention is that quite often someone gets to be right. This "rightness" shouldn't be lorded over another but we have to acknowledge it and defend it.

                          The implication, of course, is that someone else is wrong. If they can't take that, well, maybe they should stay away from the scientific application of physical modalities for the treatment of dysfunction and/or pain. Maybe they should do Reiki.

                          I should make up a badge with the words Tea Party, encircle it and put a line through that.
                          Barrett L. Dorko


                          • Return to Alex's Road

                            I’m increasingly pleased with the effects of the dissonance lecture I’m giving. I can refer to it later in the day and, so far, people seem to understand why I’m doing this. They give me less trouble as well.

                            I’ve learned a great deal about this from the students I face so often. In a way, they represent a kind of enemy; the kind of enemy I need if I’m ever to progress as a teacher of something as strange as Simple Contact.

                            I wrote an episode of “The News…” a while ago titled “Alex’s Road” that you can find here. It contained a line from Ender’s Game I always liked:

                            “There is no teacher but the enemy. No one but the enemy will tell you what the enemy is going to do.”

                            I’m sure that this is true, and that the dissonance I offer makes some students into enemies. It’s my job to then turn them into my teacher.

                            I’m getting close.
                            Last edited by Barrett Dorko; 08-10-2007, 03:28 AM.
                            Barrett L. Dorko


                            • Aristotle on happiness

                              According to a story told on Studio 360 this weekend, “Aristotle called habit ‘the foundation of virtue,’ and what he believed was that the value of an action lies partly in its ability to repeat itself; to become something more than just random. You don’t hear the word ‘virtue’ much anymore and the word habit usually refers to something unwanted or out of control. But Aristotle, from the vantage point of ancient history, saw the development of habit as a way to move toward happiness.”

                              I felt that this viewpoint fit here if we consider the habits of thought many therapists possess and how happy these have made them. This also connects to the Health, happiness, comfort or survival? thread of a few weeks ago.
                              Barrett L. Dorko


                              • The more self-conscious we are – the more fragile our identity – the more we shut down the undermind. As people feel increasingly vulnerable, so their access to, and reliance on, information that is faint or fleeting declines. They become not just physically but also mentally clumsy, losing access to the subtler ways of knowing. Conversely, the less self-conscious we are, the more ‘at home in our skins and minds’, the more it seems we are able to open ourselves to the undermind and to the mental modes through which it speaks.

                                From Hare Brain, Tortoise Mind: How Intelligence Increases When You Think Less by Guy Claxon

                                I worked with this woman in standing for several minutes, demonstrating in full view of the class and getting all of the characteristics of correction I could possibly want. In addition to this she volunteered that her range of motion in several planes in numerous joints had distinctly improved and that with the movement there was far less pain; that is, while I was handling her.

                                In my experience, this sort of response is very common though I’m not sure it’s all that meaningful to anyone involved; therapist, patient or witness. Soon you’ll see what I mean.

                                After she sat down I asked her to again assess her cervical range. She turned this way and that, remaining completely silent for nearly a minute (though it seemed a lot longer to me). “I can’t say whether or not it’s any different,” she said finally.

                                I couldn’t help but wonder aloud why this careful self-examination was both so prolonged and unrevealing. In my experience, people with chronic problems such as hers were acutely and rapidly aware of any change. In response she grew perfectly still and quiet, though I saw her eyes narrow. I should have known what this meant.

                                After class and all but this woman and one other remained, she asked me why I hadn’t created a network of therapists that she could now contact for further care. She thought that this was what she certainly needed but the class wasn’t enough and she wanted more. I talked about how I’ve found that my influence is in no way enduring or especially popular among participants but that I give all the advice I can to those who wish to continue on their own, as she might.

                                From there our conversation degenerated, beginning with her telling me that “no one understands what you’re talking about” and continuing with her description of the advice I’d given that didn’t resemble what I always say. The other remaining student stood there with her mouth agape.

                                On the drive to the next city I replayed this ugly exchange in my mind, hoping to learn from it. These days I focus upon the power of dissonance and what it motivates so many to do. But I’ve concluded that there are people out there who are much better at attacking than I ever could be at defending. My only hope of eliminating what happened on Wednesday is to always remain silent when confronted with this, though that is hard for me. Very hard.

                                Perhaps this woman’s remarkable lack of awareness should have been a clear warning to avoid her. After all, Claxon makes it clear that such people are both fragile and difficult to communicate with in the way that I do. Their frustration may lead them to attack, and there’s no defense I can muster that can match this.
                                Last edited by Barrett Dorko; 20-10-2007, 07:29 PM.
                                Barrett L. Dorko