Suppose this were true

[Barrett Dorko]

Suppose this were true:

Pain and body image are closely related. We always experience pain as projected into the body. When you throw your back out, you say, “My back is killing me!” and not “My pain system is killing me.” But as phantoms show, we don’t need a body part or even pain receptors to feel pain. We need only a body image, produced by our brain maps.

Norman Doidge M. D.

In the thread to follow I’d like to explore what I consider a major shift in my thinking. As usual, this shift wasn’t the result of a single experience, bit of reading or event in the clinic. I think that shifts of this sort are the consequence of many things, and not all of these events have anything at all to do with therapy – unless you think everything actually does. And I do.

The two books leading to this shift are The Body Has a Mind of Its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better by Sandra Blakeslee and Matthew Blakeslee and The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge.

These books are written in a conversational manner and both contain leading edge neuroscience, or, perhaps more accurately, brain science. I feel that what they teach us has enormous implications for both our theory and practice, and that’s what I want to explore here.

More soon.

[Diane]

I look forward to deconstructing this relatively recent info (first heard about virtual bodies from Butler) about the human antigravity body/brain here.

The books are both good.

There are brain science podcasts for with interviews of the writers of both books; #26 is Doidge's interview and #23 is Blakeslee's interview.

[Barrett Dorko]

Thanks Diane. If not for your guidance toward Ginger Campbell’s site I’m not sure I’d know about any of this.

Belief is an essential function of the brain designed to extend our senses.

From Why We Believe

What I’m suggesting here is that Doidge’s statement about pain be taken seriously, mainly because he has supported it with a wealth of excellent evidence from wonderful sources. And if this is true (“…we don’t need a body part or even pain receptors to feel pain. We need only a body image, produced by our brain maps), then why are we focusing on the peripheral tissues and biomechanical implications of movement to such a great extent?

It’s a huge question, and I think that we may find some part of an answer if we look in any number of places. Despite their number, I doubt we’ll ever answer the question completely.

Today I’ve chosen belief as a starting point, and though I could easily say that this choice is random, I rather doubt that anything I write is all that random on an unconscious level – and that’s where my writing begins.

In Blakeslees’ book page 39 is devoted largely to the nature of belief as it relates to what we each feel about our body’s shape, also known as body image. This is opposed to body schema. The former is learned, and body schema arises from a felt sense – and these two things may be wildly dissimilar. I’ll speak later of what a disparity might create, but right now I’d like to focus on the connection between learning and belief.

I’ll quote again from Why We Believe:

Gregory W. Lester PhD., a psychologist on the faculty of the University of St. Thomas in Houston, suggests that belief is an essential function of the brain designed to extend our senses (Why Bad Beliefs Don’t Die Skeptical Inquirer November/December 2000). We use belief to create a model of that part of the world we cannot sense simply because our senses have limitations. For instance, I believe my house is where I left it before I came to work this morning. I can’t sense it in any fashion, but in order to efficiently find my home after I leave work tonight, my brain has to create an internal “map” composed entirely of belief and independent of my senses. Without this, my senses alone are inadequate when it comes to finding my home. My belief “knows” where it is though my senses have no clue that it currently exists.

Understood in this way, belief is seen as an important and necessary way of sensing the world. If the brain’s primary function is to assist in our survival (and it is), something like belief’s tendency to extend our senses serves a biological purpose. In short, belief enhances our tendency to survive, and as such it will form neurologic patterns that prove remarkably resistant to change.

So, to recap:

• Belief serves a biological purpose.
• The primary function of the brain is survival.
• Our senses seek to insure our survival.
• Beliefs extend our senses.
• Because of their connection to our senses, beliefs are resistant to change.

Assuming that Lester is right, any discussion of practice that relies upon a belief system will be perceived by many as a threat to their personal survival mechanisms. To put it another way, it is extremely difficult to question anyone’s belief system without getting into personal issues that have no real bearing on the problems inherent to any practice that is not based on evidence or accepted methods of reasoning. My own experience with alternative medicine practitioners certainly indicates that Lester is on to something. (end of quote)

Now let’s turn from the way many therapists choose to order their practice and look at the presence of painful sensation. If a therapist believes that a painful problem should look a certain way, and if this aspect of its appearance cannot be found in the therapist’s senses, what will happen if the patient continues to insist that they hurt?

Here we see a clash of beliefs, and until they can be understood as survival mechanisms very little progress can be made in the clinic.

Body image is learned, and everything we learn is wrapped completely in a web of belief that is as complex as you might imagine.

How can we sort out what we believe from what we know to be evident as the end result of careful study? And how does our belief about our own body effect the way we practice? Isn't the patient's body image something we should take into account? Can we manipulate it with certain therapies? Can we sense how our personal images enter into this equation?

Many questions, I know.

More soon.

[Nick]

Great stuff, Barrett.

A question re: your example about believing your house is where you left it - is this type of belief constructed based on sensory experience? and what role does memory play in belief? And how does the persistence of memory shape this? And, finally, what about beliefs that are not connected to some sensory experience - or is there always some connection to a felt sense of something???

More questions...

[Erica]

This is good. Ironically I just ordered those books! Listened to the podcasts on Blakeslee's book-really good stuff. From what I remember, she said that the alternative therapies like Feldenkrais use successfully the body scheme awareness map. One wonders if someone has poor body awareness, how does the map change or morph, so to speak? Or how can we as therapists use other maps to enhance the awareness map? I wonder...
Erica

[BB]

We use belief to create a model of that part of the world we cannot sense simply because our senses have limitations.

This is a very interesting way of looking at belief. In terms of representational maps, could belief be the map of the world that we must navigate? Not only physical, but culturally, socially? It would make sense. Belief in neural terms could be the construction of everything that is non-self in order to guide our interactions with it.

How can we sort out what we believe from what we know to be evident as the end result of careful study?

Keeping in theme with maps, I tend to navigate by landmarks. When I look at an actual road map I must first find a landmark I'm familiar with and then work my way through the map in relation to something I already know.

And how does our belief about our own body effect the way we practice?

Profoundly, as is evident for me in the significant change in my practice in the past few years.

Isn't the patient's body image something we should take into account?

This is pretty much how I conceptualize what I'm doing these days. It makes things so much simpler.

Can we manipulate it with certain therapies?

Belief? I believe so. Moseley's work seems to indicate that you can. I think that you can't help but manipulate belief with any therapy, whether you are reinforcing it, adapting it, or tearing it down.

Can we sense how our personal images enter into this equation?

I think of this too quite a bit while I'm treating. I think about all the non-verbal non-conscious clues that are being passed back and forth and that I better be peddling out explanations that I confident in or they will pick it up in a heart beat.

I'm not sure if you were looking for an actual list of answers from anyone, but I always really enjoy the exercise of answering your questions.

An anecdotal side note from a second visit with a patient that occurred this week:

I have been using the representational maps in my explanations more and more. I have a patient right now with a complicated history, childhood sex abuse, anorexia, substance abuse. He has pulled himself through quite a bit and tells others of his stories now I believe because it is therapeutic to him. He has come to see me for his chronic pain. As we were talking about the maps, and he had made it clear that he was glad to talk about his past even if I myself was not necessarily comfortable hearing it, I mentioned the passage in the Blakeslee book about anorexia and body maps (body image of a large person with a distorted body schema as well). He immediately replied that he knew this to be true. He said that victims of rape often take on the body image of their attacker (he said this was true of himself and of many others he had talked to whose attackers had been large) and felt certain that this is why many victims of sexual abuse later develop anorexia. Also of note with this patient, I showed him ideomotion for about 10 minutes at the first visit, limited in time by the length of the subjective history and my caution in doing too much with him given his pain state. He came back this visit stating he was pain free for about 3 hrs after that first visit for the first time in 20 years.

[Diane]

Patients have so much to teach. It's hard to learn what they can teach unless you can build a space where they can share out what they need to. Sounds like you built a safe space there Cory.
Hat's off.

[Barrett Dorko]

Wonderful replies, as usual, and I suppose that some who only read have some thoughts of their own. We’d all like to see them.

I'm not sure where belief ends and understanding begins except to say this: understanding is malleable, much in the same way the brain maps have been shown to be. Belief, well, not so much. But I must regularly remind myself that belief in various things provides many people with a level of comfort they simply cannot relinquish.

The problem, I think, is when therapists begin to throw the word “belief” around without considering what it implies. How many times have I been asked, “Do you believe in chiropractic/manipulation/core strengthening/strain-counterstrain/unwinding/postural correction?

Last I heard, none of these methods were immune to scrutiny by the scientific method. This makes them distinct from religion and therefore no real “belief” is required.

Often enough I am also told something like this: “Well, I believe in [insert any number of “energetic” therapies here] because I’ve seen it work."

Ironically, explanations for this “working” are now available, and I’ll be getting to them soon, but if a therapist begins with belief rather than understanding it’s very hard for them to hear and consider anything rational.

They are more likely to defensive and angry than grateful. I would know.

[Barrett Dorko]

Believe nothing, no matter where you read it or who said it, not even if I have said it, unless it agrees with your own reason and your own common sense.

Buddha

If you’ve 15 minutes to watch a video on your computer today I can’t recommend the following any more highly. Go here and type Michael Shermer into the search function. There you’ll find at the top of the list Why people believe strange things, and you won’t be disappointed. I only hope to one day speak as well and present my ideas with as much clarity.

Consider these quotes from Blakeslees’ book: Your body schema is a physiological construct…(and) your body schema expands with the clothes you wear.

Remember that the body schema (as opposed to body image) arises from a felt sense, and that it isn’t learned or believed in so much as it is a function of our awareness, and we all know that awareness is remarkably variable. The range of awareness is dependent upon learning as well.

I see all of this deeply connected to what we now know as peripersonal space. Thanks to Diane, I have found a great link to a definition of this here. Take a moment to read it and then consider this question:

If any tool I hold expands the peripersonal space I possess, are there any obvious limits to this expansion?

[Diane]

I don't know that there are any limits to the expansion of personal space, especially if one of the associated values is greed..

I think there are big implications in treatment, because it seem pretty obvious based on this information that our brains have the ability to include patients in our own peripersonal space, and patients' brains will include manual therapists in theirs, which is precisely why developing good, well-maintained treatment boundaries is important.

The plus side of it is that one can learn to feel all sorts of things that don't feel quite "right". Images of these will form visually. It's important to not "believe" what your inner eye "sees" too much; it IS important to feel the things that can "change", stay on these things until they do, then move on. Style is important, not in terms of fashion or good looks, but kinesthetically, in terms of gentleness, in terms of how kind you can make your touching be. (The patient's insula will be in there taking notes on how skillful you are at not perturbing it.)

The down side of it is that mythical treatment constructs can be easily maintained, things about which Michael Shermer would gasp at if he knew, myths about treatment of structure.

[Line M]

Maybe it's a language thing, it seems to me that in the context of the above written the word assumption gives a better description than the word belief.

The limits of in the peripersonal space holding a tool are set with the degree in which a person is able to control and handle the tool one is holding. I can imagine holding a tool for the first time it is not part of your peripersonal space and learning to adapt to it it becomes part of your space.

[Jon Newman]

Hi Line M,

The limits of in the peripersonal space holding a tool are set with the degree in which a person is able to control and handle the tool one is holding.--Line M

I think you're onto something here although I'm not sure that "control" is necessarily the focus even if it might be necessarily involved. What I'm suggesting is that perhaps it is the action effect that is responsible for changes in the mapping. Notice this from the Blakeslee link in Barrett's last post.

The moving tool was incorporated into the monkey's body schema, Dr. Iriki said. When the monkey held the tool passively, its body schema shrank to normal size.

[Barrett Dorko]

The Sweater Test

While grocery shopping this morning I noticed that there was a large display of sauerkraut and it got me thinking a bit more about the significance of peripersonal space. I know that the grocer had something else in mind, but I hate sauerkraut, and despite the Pennsylvania Dutch tradition of eating it for luck on New Year’s Day I’m not gullible enough to stomach it. I know that others who hate it as much as I will eat it though. The issue here is the absence of superstition on my part, and I’d like to think that my naturalistic worldview pretty much eliminates that. I’m sure there are others here who feel the same.

But let me ask you this: I hand you a sweater, just your size. It’s attractive; it’s clean and seemingly new. I ask you to simply put it on, and just as you drop an arm into the first sleeve I tell you that it was once owned by a famous serial killer. What are you going to do?

The power and variability of peripersonal space is exposed with something like this, to say nothing about what it may reveal about our deepest and most irrational fears.

[Nick]

Shifting Beliefs

From Blakeslee - page 43:

"But while the schema is largely a function of body parts in motion, your body image draws on a a larger web involving your lifetime's library or personal experiences and memories. Your body image is an amalgam of beliefs - attitudes, assumptions, expectations, with an occasional delusion thrown in - that are likewise embedded both in your body maps and in the parts of the cortex that store your autobiographical memories and social attitudes. Your family, peers, and culture provide the content; you provide the interpretation." [emphasis mine]

This passage jumped out at me more than any other in the entire book. I have been thinking a lot about how different experiences, particularly traumatic ones, can deconstruct the sense of self and also the role of reinterpretation. What difference does it make when one actively examines their beliefs and experience rather than being a passive participant of the what the culture endorses? It is also interesting in light of the relatively rapid and dramatic shifts in culture and how new technology facilitates fragmentation of group experience (think broadband vs. broadcast).

Back to Blakeslee:

"For most people, important beliefs about the body begin to bubble into consciousness in early adolescence. By the end of the teenage years, these beliefs have congealed into a coherent body image, right along with religious beliefs, political attitudes, and stereotypes. All are highly resistant to change in later life."

These may be resistant to change, but they certainly can and do change. Not without MUCH anxiety - at least in my experience. I think this relates to a certain tolerance for uncertainty and the willingness to be lost. And it most certainly relates to the cognitive dissonance thread.

The Blakeslees state that the potency of belief can drown out body sense. I would add that it can also block understanding - in a way that is probably less willful than it often seems. "...being at war with yourself, even when it is all happening beneath the level of your conscious awareness, is a miserable experience." Am I alone in sensing this war within my patients? Within myself?

[Barrett Dorko]

Nick,

I don't think you're ever alone here (I underlined the same passage in the book), but I can't speak for the rest of your life. I've my own issues with this, as you know. Too often in the midst of my peers while speaking I feel completely alone.

"Creating a culture between your hands" is something I suggest while teaching. I know that this may be difficult in the face of so many opposing messages, but I think it's easier than might be predicted if the understanding of the therapist is sufficient and the education of the patient is done well enough.