The Chasm

[Barrett Dorko]

I have the sense that the Gradient thread is coming to an end though some comment from the right person might revive it.

So, I have an idea for a new thread along similar lines and wanted to introduce it today. It will be episodic because I think that offers the greatest opportunity for response and it also generates the most views.

Episode #1.

Have a therapist place their hand on the shoulder of another and ask them what they’re doing.

There are actually two categories of potential answers – mesodermal and ectodermal.

The mesodermal answer:

My hand’s on the upper trap. Some pressure of a certain sort will inhibit its contracting or stimulate some guarding or spasm, depending on a number of factors.

The ectodermal answer:

Prior to the manual contact with the clothing I entered the patient’s peripersonal space, so, in actuality, their brain began to change at that moment. Now I’m deforming the epidermis and sensing the response of the patient’s nervous system via the muscle’s palpable alteration.

A winding thread and multiple links to follow.

[Barrett Dorko]

Abstraction

Episode #2
(The following is largely inspired by Frank Rivers’ The Way of the Owl: Succeeding with Integrity in a Conflicted World, in the chapter titled Master Abstraction)

The interesting writer, the informative speaker, and the accurate thinker operate on all levels of the abstraction ladder, moving quickly from higher to lower.

Adapted from Language in Thought and Action by S.I. Hayakawa

Let’s deal with the concept of abstraction within the context of manual care first of all. At the lowest level of abstraction are material objects that we can observe and touch. Perhaps here we should say “palpate.” High-level abstractions on the other hand are remote from our senses. They can’t be seen directly and palpation isn’t possible.

Consequently, our common experience of low-level abstractions can be agreed upon simply because the physical reality of such a thing can be easily quantified. Consequent to careful study and good evidence we can reasonably assume that given certain conditions any low-level abstraction will exist in a certain way and react to outside forces predictably. Ultimately, it’s Newtonian physics – and that’s hard to argue with.

Problems begin however when we cannot agree upon which portions of the material world we need or should attend to and which we can ignore. The mesodermalist’s tendency to dismiss the significance of the ectoderm (the skin, its invested nervous system and the brain) is a case in point. Their lack of appreciation for modern neuroscience’s discovery of mirror neurons and peripersonal space augments the size of the space between the two communities of therapists as they’ve been clearly defined here on Soma Simple.

Today I think that we might find some reconciliation between these groups if we further explore the concept of abstraction.

More soon.

[John W]

As a former mesodermally-dominant thinker and practitioner, I can confidently say that although I was aware of patients' reactions to me as I entered their space, I didn't place much clinical importance on it. I didn't consider in any depth how patient expectation and experience played a role in the pain output. I assumed that most reasonably educated patients had an accurate idea of how and why they hurt, which is why I didn't spend much time trying to educate them about pain. (This, of course, matched what they had been told or what they inferred from the treatment interventions they had already received from the referring physician, i.e. injected or oral anti-inflammatory drugs.)

I essentially ignored the skin and it's inherent relationship to the ectodermally derived tissues, and in fact saw it as more a barrier or curtain to the "real show" that was going on beneath it. I recall during my OMPT residency training that one of the favorite phrases the director liked to use was "find the cause of the cause." I now understand that such thinking comes from a reductionist, biomedical mindset that invariably leads to a fruitless search for some esoteric, usually joint-related problem below the surface. We were simply not apprised of the significance of the skin and its dense network of mechanoreceptors.

Thus, our abstractions of the "cause" of pain were all baseless and erroneous ones. Today a patient related to me that in a book about his life and work Einstein talked about having "thought pictures." These varying level abstractions were obviously based on a very deep understanding of the laws of physics and led to a more complete, accurate and useful model of matter, time and space. Our abstractions in PT, based on the mesodermally derived "brick and mortar" have evolved from very superficial and fragmented thinking about the human organism, and don't accurately or usefully direct our treatment interventions.

[Barrett Dorko]

Abstraction (from the Latin abs, meaning away from and trahere, meaning to draw) is the process of taking away or removing characteristics from something in order to reduce it to a set of essential characteristics.

From Midmarket.com definitions

Simply put, the two categories of thinking, meso and ectodermal, are at odds in two important ways. They disagree about the substance and properties of connective and contractile tissue at the lowest level of abstraction (material), and the mesodermalists appear to consider the skin itself a high-level abstraction. They just don’t consider it part of the material they’re handling. As John said, and something I admit to myself many years ago, "I essentially ignored the skin."

Nothing good can come from this situation – and nothing has.

[bernard]

"I essentially ignored the skin."

[Diane]

Bernard, the image you posted - did you make it? It would make a great book cover for a book about ectodermal derivatives.
PS: If you made it, may I use it elsewhere?

[bernard]

I added the flag, only. :embarasse

[Barrett Dorko]

Episode #3

By now this thread’s title has become self-explanatory. Both groups stand on ground they perceive as solid and quite understandably defend vigorously the basis of their theory.

But together we look into the void between us and wonder how we might at the very least make it smaller. Any effort to reach the other side at this point is fraught with too much uncertainty and danger to make it practical and, in my experience, few make the attempt. But perhaps we can find something to stand upon in the middle of this divide; something we can both agree upon in both a material and abstract sense that explains our common experience in the clinic.

Before I get to what those stepping stones might be I want to mention what I think currently populates the empty space between. Perhaps you may have already guessed – it’s the multitude of methods employed by the “alternative” medicine community. Across the spectrum of massage (and it’s a wide spectrum) are a variety of techniques whose “theory,” and I use the word in the loosest possible way, stand upon nothing solid whatsoever. They endure because somebody somewhere was once helped in their presence.

Are there solid bits of evidence that might explain them? Is it possible that in propping these methods up with actual science we can find a bridge to the other side?

More soon.

[bobmfrptx]

.

Episode #1.

Have a therapist place their hand on the shoulder of another and ask them what they’re doing.

There are actually two categories of potential answers – mesodermal and ectodermal.

The mesodermal answer:

My hand’s on the upper trap. Some pressure of a certain sort will inhibit its contracting or stimulate some guarding or spasm, depending on a number of factors.

The ectodermal answer:

Prior to the manual contact with the clothing I entered the patient’s peripersonal space, so, in actuality, their brain began to change at that moment. Now I’m deforming the epidermis and sensing the response of the patient’s nervous system via the muscle’s palpable alteration.

Barrett,
I would change a few words in the ectodermal answer:
I treat right on the skin so I would omit the clothing contact...also, I realize you are palpating muscle which is what you believe you are feeling, but the changes go to the cellular level so I would answer....and sensing the response of the clients system via the celluar alterations. (muscles are composed of cells and cells to me gets a little deeper and more pertinent to the global changes)
My 2 cents.
bob

[John W]

Bob,
I think that Barrett's reference to a muscular response is the most informative and practical abstraction to use in this case. Referring to cellular responses is needlessly microcosmic and confusing, and implies that we may know more what's happening than we actually do.

In short, there's something to be said for the KISS principle: Keep it simple, stupid.

No offense meant towards you, of course.

[Barrett Dorko]

Yes John. We're trying to reach across to the mesodermalists, not repel them with, well, I'm not sure what.

[Jon Newman]

I agree with John W. The context of the sentence speaks to that which we can detect in the clinic.

Also, Barrett specifically states "Now I’m deforming the epidermis...". This will happen with or without direct skin contact assuming the person is not wearing a lead suit or some other non-deformable clothing. True?

[Barrett Dorko]

No amount of knowledge behind the biology of mental images is likely to produce, in the mind of the possessor of the knowledge, the equivalent of the experience of any mental image in the mind of the organism that creates it.

Antonio Damasio in The Feeling of What Happens: Body and Emotion in the Making of Consciousness

Floating about in the chasm between us are the purveyors of theory and method that seem to “work” but are not explained using the mesodermal mindset or even simple scientific logic. In order to see what we in the ectodermal community have to offer without resorting to fanciful notions of telepathy (Damasio wouldn’t care for that), teleportation, “past life” or “tissue” memory and biologically implausible “restrictions” our traditionally trained colleagues must see through the distraction and somehow separate our message from theirs.

In my experience, this requires some, and most are unwilling to do it. It requires discussion – and, so far, virtually none who are capable regularly engage in this.

Maybe we should all read a little more Damasio.

[bobmfrptx]

Barrett
I will be adding more to this thread in the next few weeks. Separating the body into parts works for discussion, however the body is a whole organism with with multiple processes which work synergistically. Defining actions based on a part leaves out too much information , cellular motility for one and its dependence on the ECM. Also, how does Ramachandran know that we like to see people sitting pretty based on aesthetics and not based on some hardwired signal which is part of the bodies effort to function maximally. For example sitting upright as opposed to slumped increases the ability of the lungs to fill with air. good discussion.

[Luke Rickards]

Bob,

Of course it's cultural. Have you been to India, for example? No one there sits up straight.