Another reason therapists don't know

[PatrickL]

So, could one say we are both self-correcting and self-limiting?

I like that, although I still prefer "we have a capacity for", rather than "we are"

[Barrett Dorko]

It seems we're going over old ground here.

Let me ask this: In the enculturation of a child, which really begins to bear fruit around the age of two to three - what's going on there?

[PatrickL]

Barrett, why don't you just state what you understand is going on during the enculturation of a child at ages 2-3? Why should we have to go through this process of guessing what point you're driving at?

[PatrickL]

If we possess homeostatic mechanisms that effectively keep nociception derived from ischemia to tissues in check, there would be no such thing as pain with a mechanical origin. But there is. So it stands to reason that we are either not self corrective, or our self corrective mechanisms are ineffective. Either way it doesn't make sense to state that we are self corrective.

Can anyone address this post directly?

[Jo Bowyer]

Thanks Jo,
So, could one say we are both self-correcting and self-limiting?

And how!! Imo the tendency to 'learned helplessness' is getting worse with each generation. Some of my patients employ a battalion of experts in order to cope with day to day existence.
Dog psychologists are the latest must have in South London.

[Barrett Dorko]

Directly? Do you need more than what surrounds you?

I wrote Kindergarten Cop a long time ago and repeatedly demonstrate the power context holds sway over our behavior at every class. I say specifically the word "suppression of self-correction" and now I read that the concepts of self, self-correction and culture are being questioned as even existent. Now you say self-correction my not be effective even though countless people in pain recover without consciously doing anything.

I'm beginning to wonder.

[Jo Bowyer]

So it stands to reason that we are either not self corrective, or our self corrective mechanisms are ineffective.

Our self corrective mechanisms can be over ridden.

[John W]

So it stands to reason that we are either not self corrective, or our self corrective mechanisms are ineffective.

Our ability to reason can be ineffective, that doesn't mean we don't possess an inherent ability to do it. It helps- and not infrequently hurts- to undergo formal education to improve this inherent human capability. People are complex.

I'm concerned that some are suggesting that informing (without scaring- that's why it's called "therapy", right?) a patient that they have no control over factors/forces over which they have no control, e.g. the culture, is somehow threatening to their self-efficacy. Are we to lie to patients and tell them that they can control things that they can't? Is it not the role of the therapist to help the patient re-establish where their embodiment within the culture ends and the culture itself begins? We enter that "third space" with the patient in an effort to assist them in working that out. It's a rare privilege to be allowed in there, and I frequently don't make it. But I keep trying because that's what I signed on for.

The flip side of the coin to self-efficacy is acceptance. I would suggest going to Bronnie Thompson's site to learn more about how important that is in recovery from pain.

Has anyone ever had a patient divulge that they were the victim of some kind of physical abuse by a spouse or significant other? I have. What did you tell them?

[PatrickL]

I'm out

[BB]

Here's my attempt to simplify the description of my thoughts on the many things being discussed.

Regional pain (as described by Hadler) is remittent, by definition, meaning it goes away. Moreover, it remits with a natural course history, meaning that whatever mechanism involved is one that takes place without the need of intervention.

We have the capacity for the remittance of regional pain syndromes without need of intervention. Despite this capacity, the process can be thwarted by maladaptive coping mechanisms.

Self correction, is a narrative used in attempt to move the individual in the direction of self efficacy with this process.

Ideomotion, as described by Barrett, is a theory as to the mechanism of remittance.

Our role when treating is to encourage progression of, or remove barriers to, the natural course history, especially if we can show particular manners of improving the efficiency of the process.

[BB]

I dont think its reasonable to argue that if it wasnt for our culture of medicalization, our self corrective mechanisms would work just fine. I argue that collectively, humans have decided that there a greater survival needs to attend to other than the instinct to regularly move in a manner that keeps peripheral nociception in check.

I think it's reasonable to assume that if certain threats to our coping weren't present our problems would remit just fine. However, it is likely unreasonable to assume that this state of things will or maybe even should occur. As you said, there are needs involved in being social animals that may be in competition with a need for resolving pain.

Treating pain requires intervention in the form of education as a minimum. Therefore we are not self corrective.

This is only true if getting rid of pain required treating pain. Becoming a patient is optional, yes?

[John W]

Treating pain requires intervention in the form of education as a minimum. Therefore we are not self corrective.

This is only true if getting rid of pain required treating pain. Becoming a patient is optional, yes?

Exactly. Becoming a patient is a CHOICE. Unfortunately, within the current perverse culture of medicalization, it often turns out to be an unwise one.

My neighbors in the village in Grand Bassa County, Liberia didn't even have the choice to become a patient with a mechanical pain problem, and lo and behold, they didn't suffer from chronic musculoskeletal pain problems.

Somewhere at this site is a paper about the relationship between affluence and the exponential growth of treatment methods for pain. Have we conflated the possession of wealth with having more choices? What good is having a multitude of options if you don't really understand what those options provide? Does the culture drive the "myth" of having choices?

Do you watch any TV?

[John W]

Evan stated:

In the context of physical therapy, it seems very challenging trying to label/differentiate between qualities of movement that are not necessarily observable. For these reasons , I don't see any explanatory value for utilizing terms like volitional, non volitional, and ideomotion.

I think it's useful for patients who are stuck in the protective stage to understand that movement is inherent to life, and they can be divided into distinct categories: excitomotor (breathing, swallowing, blinking), sensorimotor (startle responses, reflexogenic movement), and ideomoter movement. My experience is that when you explain this to patients, and also that ideomotoric movement exists to maintain oxygenation to nervous tissue, that they become more willing to explore movement and it may even improve somatic awareness. I think that's a good thing.

I think this makes sense and it's defensible. It's certainly better than telling them that "trapped emotions in the fascia" or "tightness in the TFL" are inhibiting their movement.

[Mark Hollis]

If we possess homeostatic mechanisms that effectively keep nociception derived from ischemia to tissues in check, there would be no such thing as pain with a mechanical origin.

To me it reads as if the statement assumes that either a) we only possess homeostatic mechanisms whose top or sole prioritisation is to keep nociception derived from ischemia to tissues in check whereas there may be other priorities that at times take precedence or b) we don't have other structures and mechanisms that may override or mediate the homeostatic one, so my child falls in a fire but I won't pull her out because it would create nociception for me? Part of our self (in self correction) is the incorporation of other selfs isn't it?
,,

But there is. So it stands to reason that we are either not self corrective, or our self corrective mechanisms are ineffective.

Actually way I see it is that our 'self' mechanism (however it is produced to give a sense of self that has
- internal loci of control perception
- to focus on some small aspects of external reality
- and create a narratable intention
- that to actively render may involve the physiological cost of nociception)
is able to override our corrective mechanism at times and at times it is vice-versa (nothing stops me mulling over existence like a good kick in the shins)

Can I ask why one of the contra statements to 'we are self corrective' which would be 'we are other [selves] corrective' or even 'Our other corrective mechanisms are not effective' is not also as contentious?

[nari]

Jo

Our self corrective mechanisms can be over ridden.

Exactly and I suspect on occasions, over ridden by the therapist who is concerned about having less control over the patient. This is a general statement, not aimed at anyone in this thread.

Nari