The Power of Dissonance

[Barrett Dorko]

An answer, finally

If you don’t know that your instincts are leading you, you’ll assume that your actions are reasoned and appropriate. I’m guessing that a lot of people “fall in love” this way. Sometimes there’s a price to pay before too long.

Tavris and Aronson put it this way:

The ultimate correction for the tunnel vision that afflicts all of us mortals is more light. Because most of us are not self-correcting and because our blind spots keep us from knowing that we need to be, external procedures must be in place to correct the errors that human beings will inevitably make and to reduce the chances of future ones.

I imagine that for many reading this the procedures of scientific experimentation come to mind. Another “external procedure” in the clinic would be the accepting presence and touch of a therapist who understands the deep model of neurologic function and doesn’t care what the patient “looks” like. Maybe a student of mine.

Tavris and Aronson again:

Once we understand how and when we need to reduce dissonance, we can become more vigilant about the process and often nip it in the bud. By looking at our actions critically and dispassionately, as if we were observing someone else, we stand a chance of breaking out of the cycle of action followed by self-justification, followed by more committed action.

Think about that.

A bit more soon.

[Barrett Dorko]

In my original post here I said: “Maybe I should promise a little more and expect a little less.”

Now that I think of it, my expectations have a duality I’ve not begun to reconcile. That is, my expectations are both high and remarkably low. I always supposed that I belonged to a profession that followed the evidence only to find that it didn’t, and then I watched the concept of evidence itself mutated into a narrow view of “outcome only” evidence that many now refer to as “evidence based practice.” This has been awful to witness.

There’s a passage in a thread titled “Tenar’s Revelation” that comes to mind here: “Tenar did not feel joy…She put her head down in her arms and cried. She cried for the waste of her years in bondage to a useless evil. She wept in pain because she was free.

What she had begun to learn was the weight of liberty. Freedom is a heavy load, a great and strange burden…It is not easy. It is not a gift given but a choice made.” (This is from one of Ursula K. Le Guin’s fantasies)

It is followed by this:

We must not believe the many, who say that only free people ought to be educated, but we should rather believe the philosophers who say that only the educated are free.

Epictetus
Greek Stoic philosopher and former slave

For those who choose to remain the same despite the introduction of dissonant ideas, and these ideas make more sense if examined, there is this to consider:

Education leads toward freedom, but “freedom is a heavy load, a great and strange burden…It is not easy.”

No wonder so many choose less education rather than more.

[Barrett Dorko]

The true meaning of silence

More from Tavris and Aronson:

Becoming aware that we are in a state of dissonance can help us make sharper, smarter, conscious choices instead of letting automatic self-protective mechanisms resolve our discomfort in our favor…The goal is to become aware of the two dissonant cognitions that are causing distress and find a way to resolve them constructively, or, when we can’t, learn to live with them.

There is something distinctive in this passage that made me stop reading for a while. I began to think of those times in my own life where I concluded that “living with it” is the choice I occasionally make when faced with dissonance. I notice that this decision requires that I remain silent though I want to speak. I also notice that the silence itself is troublesome because as Tomas More says in A Man for All Seasons, “Quin tace con secere,” which is Latin for “Silence gives consent.”

Of course, I don’t want those with whom I disagree to think that I’ve given in to their point of view, but there are mitigating factors, first and foremost, friendship. As Israeli Prime Minister said of Ronald Reagan, “When a friend makes a mistake the friend remains a friend, and the mistake remains a mistake.”

I have a number of friends in the therapeutic communities that practice in a fashion I consider, well, misguided. (Notice I didn’t say absurd. These are my friends after all) We don’t discuss the treatment of patients and we certainly don’t discuss theory.

My silence is my gift for my friend. And, in the end, it is another way of dealing with dissonance that is both thoughtful and, ultimately, useful.

[Barrett Dorko]

Popper's Paradox and The Final Answer

Karl Popper told us how to deal with dissonance. He pointed out that scientific ideas are scientific in nature only if they can be falsified and that the real work of scientists is not to look for evidence that their theories are correct, but to look as hard as they can for evidence that their theories are false and that the closest a scientist can ever come to proving that his or her theory is true is failing to find evidence that the theory is false.

He used this argument to demonstrate that many things are not sciences because they cannot be falsified. He said, “Whenever a theory appears to you as the only possible one, take this as a sign that you have neither understood the theory nor the problem which it was intended to solve.”

(Thanks to The Writer’s Almanac for parts of this)

That part about not looking for confirmation of your theory meshes with Tavris and Aronson’s most powerful point regarding how to deal with dissonance. I’ll quote it below, but let me say this:

Once we have invested our time, money and passion, being confronted with contradicting evidence is humbling, and most people will avoid such a situation, Karl Popper notwithstanding. So we shouldn’t be surprised that seeking disconfirming information and/or avoiding people whom we know may carry it around in their heads. I’m pretty sure that’s why most therapists I personally invite to this site either never show up or don’t remain.

There’s also this. Time and again when ideas are being deconstructed here, the proponents of the discredited theories retreat rapidly to a charge of personal attack and/or a defense against charges never made. We hear, “You guys say we don’t get good results,” for instance. This isn’t said, but it is expected to be said, and no personal attacks are permitted on Soma Simple.

Tavris and Aronson on page 228:

Understanding how the mind yearns for consonance, and rejects information that questions our beliefs, decisions or preferences teaches us to be open to the possibility of error. It also helps us let go of the need to be right.

It’s that last line – let go of the need to be right – that encapsulates the attitude I need to adopt. I’m convinced it will help all of us who try to do a better job of treating patients.

[nari]

..let go of the need to be right

Could this be quoted to the marketers of EBM??

Nari

[Barrett Dorko]

Consonance via Routine

Nari,

The marketers of EBM are Mesodermalists, so I wrote this at breakfast this morning.

We counteract a deep feeling of insecurity by making of our existence a fixed routine. We hereby acquire the illusion that we have tamed the unpredictable.

Eric Hoffer in The True Believer

I have the distinct impression that therapists who struggle with the complex nature of chronic pain in their patients would feel a whole lot better if they simply relinquished their need for control. I’m not suggesting that this will be easy, but I’m convinced that a thorough understanding of modern neuroscience as it relates to this problem will lead them to conclude that controlling the patient’s behavior and sensation is a lost cause.

Of course, therapists with a mesodermal bias are unlikely to concede that the body is as unpredictable as Ectodermalists claim that it is. In my mind it comes down to geometry – the nervous system is fractal and the mesoderm is not. (I’ve written about this here)

The Mesodermalist who perpetually chooses that tissue to blame, those tests to do and those protocols to follow reduces dissonance via routine. Maybe it’s that simple to explain why we cannot make a dent in their logic or practice.

Maybe they need to hear this from Richard Powers in Gold Bug Variations:

Science is not about control. It is about cultivating a perpetual condition of wonder in the face of something that forever grows one step richer and subtler than our latest theory about it. It is about reverence, not mastery.

I have concluded that it comes down to being thoughtful rather than right. I seek the former much more than the latter.

Now I just have to work on acting that way.

[nari]

We have mentioned the control factor in various posts for some years and you are right to conclude that this is part of the problem/s with traditional therapy.

I don't think we intentionally set out to control; it is part of the meme that PTs know more than patients about the body's mesoderm and therefore patients need to be compliant with what we ask them to do, or they won't improve. That thought reduces dissonance.

Broken down to its elements, we expect compliance and obedience in order to solve a problem the patients know more about in the first place. The problem is pain, and we don't know their pain, they do. But accepting that fact is enhancing dissonance.

Oddly enough, we nurture the very meme that creates dependency, although we may aim to lessen dependency. It's a part of the social structure: my doctor, my PT, my chiro, my hairdresser, my trainer, my pharmacist...

Nari

[Diane]

Nari, these are all social groomers of one kind or another - dependency on them enhances troop cohesion, which we now know as the 'economy'. Another thing it might do is elevate self-esteem in a very occult way - i.e., if "I" have all these people/ "my" people, who I've hired to "groom" me, "I" can feel, just for a little while, that I'm "worthy" of the attention. We are still primates.

[nari]

In the private sector, I'd agree with you, Diane; it's all tied up with the economy and goodwill and whatever; but in the public sector I see it differently.
Those PTs are paid a salary, regardless of how many patients they see, and total freedom to treat as they see fit. I have seen many PTs change in attitude when they move from public to private where they indeed become social groomers and more bequeathed to doctors.

I think a PT who chooses to stay clear of the private world already has good self-esteem and, although still trapped in a routine assessment system, remains more open-minded in clinical reasoning. There are quite a few who would answer the question: What do you practise? Kaltenborn, Maitland, Bobath, Mulligan, Carr and Shepherd....? with:
I practise according to me.

They are all mesodermalists, but they are thoughtful, too.

Nari

[Diane]

I agree with you Nari,

PT who chooses to stay clear of the private world already has good self-esteem

I wasn't referring to a PT self-esteem, rather that of the individual who has his or her "own" PT etc etc.

[Barrett Dorko]

Nari,

I'm glad you mentioned that to be a Mesodermalist does not mean that you aren't thoughtful. Too often I imply something else, but now at least I have dissonance theory to blame for my bad behavior.

[nari]

Diane, yes, on re-reading, you did mean it was the individual who 'has' a PT. Although I could argue (nicely) that patients can preen and prop a PT's self-esteem.

Barrett,

Some mesodermalists are worse than others with their tenacity towards tissues; which could imply they are not thoughtful at all. Does that help with the dissonance factor?

Nari

[EricM]

Not sure whether this should go here or in Manual Magic, I suppose it could go anywhere. I was browsing Mind Tweaks and read a series of 4 articles about 'The Secret,' a new show I don't think I've seen yet, and sensed a connection between what I was reading and some of physiotherapy's pains.

1. The Secret: A Rant Against Self-Help Pseudo-Science
2. Why The Secret Seems To Work: The Serial Debunking Begins!
3. 10 Rational Reasons The Secret *Seems* To Work
4. Hit and Miss: The Brain's Bias

I particularly enjoyed the fourth article describing confirmation bias.

[nari]

Good link, Eric. The confirmation bias section is very relevant, I think.

Nari

[konradej]

some thoughts

Barrett,

I appreciate your comments and pose some questions:

"my expectations have a duality I’ve not begun to reconcile. That is, my expectations are both high and remarkably low."

Wouldn't you suppose most of your classess come with this same duality towards you? I propose you teach to the part of the class that expects much..., Ultimately I believe it to be most productive to not have any expectations at all.(Do what you do, simply because you love doing it, no attachment to outcome) Can one be dissappointed without first having an expectation??

Secondly,

The biggest lesson I have learned in my marriage is to choose Love over being right. When you say thoughtfulness, I believe this implies love, and approaching our patients with "this" vs. any personal attachment, attachment to outcome, or "being right" mentality serves us all better, but most importantly the patient.

Excellent Thread!!:thumbs_up