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  • Umwelt

    Nevertheless the difference in mind between man and the higher animal, great as it is, certainly is one of degree and not of kind.

    Charles Darwin
    We must first blow, in fancy, a soap bubble around each creature to represent its own world, filled with the perceptions it alone knows.

    Jakob von Uexkull
    Uexhull called it the umwelt, and suggested that a serious observer would do their best to “step into it” in order to understand the world through another’s senses. This idea became a foundation for the field of ethology, and there’s a lot there to consider for serious clinicians.

    We can enter the patient's peripersonal space, create a context that we both inhabit and then learn together. All of this is possible, and therapists can seek such things each time a session begins.

    We can enter their umwelt.

    Note: This entry was inspired from some pages in the book written of here.
    Barrett L. Dorko

  • #2
    Many patients come from markedly different perspectives to occupy the same rehab department.

    Is it possible to carefully consider each umwelt as you move from one to the next?
    Barrett L. Dorko

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    • #3
      Moving from one place to another in the course of a day is common for me.

      I began today in a facility that houses a number of patients that would be homeless otherwise. If there's anything obvious in their history that lands them in a skilled nursing facility I don't see it. Each Monday there's a well-attended meeting where a preacher really lets loose.

      I end my day in a beautiful place full of old Episcopalians. No fire and brimstone there.

      I know a lot about handling and the nervous system, but my ability to enter either of these buildings and into the presence of the patients without difficulty is where my real skill lies.
      Barrett L. Dorko

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      • #4
        If I have any particular talent at all it is precisely this: the ability to acculturate quickly and seamlessly to a variety of individual scenarios- or umwelts. Maybe I just have a lot of mirror neurons, and this aspect of my physiology has prompted me to seek out a variety of different cultural contexts- from West Africa to Dutch Harbor- where I can put them to use.

        The treatment room is the ultimate immersion into another's space- one they themselves can't quite find the words to describe despite it being their own aporia. This unutterable space is not without common metaphors and experiences, however, that can get two neuromatrices in "tune" for a potentially therapeutic interaction.

        I treated a former ballet dancer the other day. As she was describing her gradual descent into incapacitating neck pain, she indicated that she didn't do anything about it for such a long time because, as a formal dancer, she was used to having pain. Having worked with ballet dancers in the past and having played with injury myself I understood what she was saying, so I asked, "What if you had to dance tonight?" She assured me that she could do it- somehow, if she were in shape, of course.

        I replied, "Good thing you don't have to perform then." She took a deep breath and relaxed.
        John Ware, PT
        Fellow of the American Academy of Orthopedic Manual Physical Therapists
        "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
        “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
        be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

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        • #5
          John,

          Exactly.

          I watch other therapists struggle with this ability and have come to realize that many don't even appreciate its importance. It seems they've decided to play the roles of stern disciplinarian, funny hairdresser or kindergarten teacher - switching from one to the next for no particular reason.

          It's pathetic.

          Of course, if I spoke of the umwelt to them their eyes would glaze over after about ten seconds and then they'd add this to the list of things that make me strange.

          So I keep my mouth shut.
          Barrett L. Dorko

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          • #6
            burst their bubble (from the inside)

            I like the analogy of the soap bubble. Without entering this bubble and the ability to relate with the patient, an interactor model of intervention is unlikely to take place. The mention of this ability to enter the patient’s peripersonal space as a talent is interesting and might explain why some therapists might not appreciate its importance. Maybe nurture/nature did not allow the development/connection of adequate number of these mirror neurons as John W indicated.

            Then, there are two options:
            1) fMRI for all students before entering PT school to assess the presence of these connections.
            2) Attempting to relates to the these therapists by entering their umwelt before attempting to make changes to it

            This leads me to the questions. How reverent do we need to be of the individual’s unwelt, once inside the bubble, seeing the flaws in the way they understand the world? Can you burst this bubble or only deform it as much as possible to accept new concepts/perspective?

            Sorry for the lack of clarity of this comment. It is my first one. I hope that the process of posting comments will help strengthen connections between my neurons to clarify my ideas and assist their delivery.

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            • #7
              It's a great question, and well put.

              I think gentle alteration rather than bursting is best. We can do this if we remain calm.

              I know that's not easy.
              Barrett L. Dorko

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              • #8
                I don't know how much of this ability (social/mutual exchange) has to do with skill. Certainly one can get better at it and in that aspect it requires practice, but I don't see the skill as the most essential aspect. At one of Barrett's early courses I attended (1982 ?), I recall what he said in response to the question "could you address the spiritual aspects of this work?"
                Barrett simply replied "well, you have to love your patients." End of discussion.
                If given enough time and discipline I suppose just about everyone could learn to play piano. Yet, clearly some are much better at improving than others. I propose this to be a function of LOVING TO PRACTICE.
                Those of us who practice PT in this way get something back from the patient not recognized or valued by others in our profession. It is not about evidence or effectiveness. It is about a two way street where as much therapy is received by the therapist as given to the patient.
                I am healthy because of what I receive from my patients. It is called serving and certainly not limited to physical therapy.
                Compare that to " man my wrists are sore from doing all those mobilizations."
                Gil

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                • #9
                  Great conversation here.
                  It makes me think of the chameleon - changing colours and blends with its environment.
                  Yet recently, this ability has been studied in more depth and found to be rather important in communication between two chameleons.

                  Now the chameleon image fits us even better.
                  We don't see things as they are, we see things as WE are - Anais Nin

                  I suppose it's easier to believe something than it is to understand it.
                  Cmdr. Chris Hadfield on rise of poor / pseudo science

                  Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                  We don't need a body to feel a body. Ronald Melzack

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                  • #10
                    Gil,

                    Thanks for this rememberance. You're one of the very few in this world who were there and now here. Your devotion to practice, not to me is evident. If ever you see anyone devoted to me in this way - please shoot me.

                    A couple of things come to mind: 1) The love bombing that I hear of continuously taking place in the MFR community in an obvious effort "to recruit and/or convert" others to their spurious point of view. And 2) The essay P.T. In Service, which, as an idea, has never caught on.

                    Something interesting about that particular piece of writing. I offered it to a PT at a booth in the exhibit hall of a convention once. The booth specifically promoted "service" as a career opportunity. Never heard from her afterward. And it was the last thing I wrote for PT Magazine, where several other of my essays had appeared. I remember the editor telling me that "No one ever heard of Herman Hesse." (I will readily admit I mispelled his first name. It happens)

                    I don't write for them anymore.
                    Barrett L. Dorko

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                    • #11
                      Small children see right through kindergarten teachers who act like kindergarten teachers. (You know what I mean.) And then they raise hell.

                      You either speak child, or you don't.

                      You either honor and value the opportunity to be allowed into someone's umwelt, or you don't.

                      Most therapists, most kindergarten teachers don't. Sad. But it explains a lot.

                      Caro.
                      Carol Lynn Chevrier LMT
                      " The truth is, people may see things differently. But they don't really want to. '' Don Draper.

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                      • #12
                        true color

                        The chameleon is another good analogy. It shows the complexity of the task of entering in the patient’s “true umwelt” or true color. Even if some my might have more skill/aptitude/desire to change color and relate with another being, it is a natural part of social interaction, which happens both ways. Just as we change color during the interaction so does the patient. This can make finding the true color of the chameleon very difficult.


                        Also, can we have a balanced interactor model if we are “stepping in” the patient’s bubble (the patient waiting for the therapist to get in and alter the shape of the bubble) or should the patient and therapist step in a new bubble (meeting in a color half way) to promote a flourishing interaction for both parties?
                        Last edited by ahboncainri; 12-02-2011, 10:03 PM.

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                        • #13
                          Whatever your name might actually be:

                          I can appreciate what you're saying, and would agree that the patient will inevitably change, and, to some extent, they should.

                          But so many that I see these days are sufficiently debilitated as to make any additional effort very difficult - and communication requires some effort. They're that sick and their stress level (defined as living someone else's life) is off the charts.

                          In the main, it falls to me to change.
                          Barrett L. Dorko

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                          • #14
                            Barrett,
                            Nice response with emphasis on what really needs to change. I don't see where this is so complicated. Again, what is needed is an interest in what we are dealing with and I can guarantee it is not faulty biomechanics. Nothing new age here. Therapy goes back a long time. Why has it lost its attractiveness?
                            Gil

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                            • #15
                              Why has it lost its attractiveness?
                              $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
                              Barrett L. Dorko

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