Warm body with a license

[PatrickL]

Maybe "shallow" or "deep" isn't the best word to delineate between explanatory models. I think Diane would suggest "less wrong", which I think usually means an proposition has less depth in terms of factual support to back it up.

but what is less wrong? melzack's explanatory framework? a biopsychosocial model? both those still boil down to the list I wrote earlier;

1. provide non threatening sensory/discrim input
2. provide novel salient sensory/discrim input
3. don't provide a noceboic treatment narrative/context

It makes a lot of sense to deconstruct other models... and it is good to be able to say I can recognize the absence of a deep (explanatory) model framework when I see it. But we cant really make a claim that the "deep model" we espouse is "less wrong" if no one can plainly state what that deep model is.

In Australia at the moment, our politicians on both sides are being criticized for lacking vision and leadership... for not having the guts to risk their position and power for the sake of their ideology (whichever way it leans). The Prime Minister is laughing stock because, although he was a great opposition leader (read: mudslinger), he appears to not know how to govern... he is most comfortable when he is fighting/opposing.

Is this a problem for us too? Could it be that we get so invested in opposing the "mesodermalists" that we lose sight of a broader, more long term goal of building a framework for the future?

I suspect that if we were to plainly describe the "deep model" in its simplest terms, as defined by the evidence that supports it, the model itself would still provide scope for the continuation of many "methods" that we are uncomfortable describing as "defensible".

[Keith]

I suspect that if we were to plainly describe the "deep model" in its simplest terms, as defined by the evidence that supports it, the model itself would still provide scope for the continuation of many "methods" that we are uncomfortable describing as "defensible".

Agreed - there is some low hanging fruit (explanations for MFR, CST, VisManip) that would literally need to change what they 'call' their techniques...but there are many others who could lay a claim to plausibility. This is a drawback to attaching your guidelines to the adherence to a science (neuro-) that is still in its infancy.

Respectfully,
Keith

[Bas Asselbergs]

I suspect that if we were to plainly describe the "deep model" in its simplest terms, as defined by the evidence that supports it, the model itself would still provide scope for the continuation of many "methods" that we are uncomfortable describing as "defensible".

Well, I agree to a certain extent.
But IF the iffy methods change their explanation to fit the deep model, it automatically means they have changed/modified their model/explanatory framework. And that is a bit better.
I do not think there is any model or framework that can NOT be "abused" by CAM and woo providers.

[caro]

Yes. Which is why these days, it's the motivational-affective part of the person's NM that interests me. How do we help distressed people find their Trouble café, like Giuletta?
.
Are we conversant enough in those matters?

Jo often talks about how she communicates via e-mail with some of her patients. I can see very well how that would make sense and how that could help eliminate some sensory input and how that could be very meaningful to a sensitive human NS.


I think a lot of that locus of control we so care about here resides in that M-A...

[BB]

Josh, I understand that "novel input" is about providing a stimuli that the cns will attend to. I agree that input doesn't need to be novel in order for it to be salient. Maybe non threatening and salient fits better?

I personally like the term, "disarming." The input needs to be relevant and disarming. I do feel that "novelty" retains importance. But it need not be novel as in "that's something I've never experienced before" in so much as "I've never thought about it that way before."

[caro]

I am reminded of that great Smashing Pumpkins tune.

Disarm you, with a smile.

[John W]

I personally like the term, "disarming." The input needs to be relevant and disarming. I do feel that "novelty" retains importance. But it need not be novel as in "that's something I've never experienced before" in so much as "I've never thought about it that way before."

I try to convey the novelty concept to patients by telling them that they currently have a certain opinion about moving their _____________, and it's not a helpful one. I've already tried to educate them that movement is what they need to get better, and hopefully they are starting to change their attitude towards moving their ___________- that it won't disintegrate, herniate, rupture or explode if they move it.

[PatrickL]

But IF the iffy methods change their explanation to fit the deep model, it automatically means they have changed/modified their model/explanatory framework. And that is a bit better.
I do not think there is any model or framework that can NOT be "abused" by CAM and woo providers.

I'm still not sure what the deep model is. So it makes this conversation about it a bit strange. Can you articulate it, bas? Perhaps the deep model is "people in persistent pain need only three things. Empathy, permission to move and some hpsg?"

My point is that out of the "iffy methods" there would be some for which a major change in explanation would not be necessary in order to be congruent with the "deep model" (obviously some would need a major overhaul). And that would be because the "deep model" is very broad in scope (as it's strength is drawn more from loose consilience of hypotheses than robust evidence.

I think there is a neurophysiological explanation for any technique out there in manual therapy land. I suspect that the existence of a variety of methods, with defensible (but probably superfluous) explanations will serve the culture better than ongoing laments about how the culture is too screwed up to realize that all they really need is empathy, some hpsg and permission to move instinctively.

These 3 messages are, in my view too counter cultural to gain any (enough) traction, even if they are supported by some science (note: the science supporting them is not strong enough to justify the extent to which they are defended by, well, I'll just say Diane rather than vaguely saying "people here"). I suspect that the adversarial/oppositional framing of the problem- which in general, is the way it is framed on ss (dichotmizing the manual therapy population into those who have a deep model vs those who don't, or ectodermalists vs mesodermalists, or interactors vs operators) - creates a situation where each "side" has to dig their heels in, not only to defend their argument, but to also defend their ego from for example, having spent a decade or so with heels dug in. I think we eventually start seeing "depth" in models that aren't particularly deep, and we start seeing strength in evidence that isn't particularly strong. I just think that the dichotomizing/oppositional approach creates charicatures of the opposing side (I have literally drawn a few of these) and blinds us to a path of less resistance.

I'm not suggesting that the oppositional approach should be disbanded by anyone, I plan to do more cartoons to make certain points. All I'm suggesting is that when a group keeps telling themselves the same story for years and years, the story runs the risk of being understood and argued as fact, when it is more likely an hypothesis. And that makes the story less appealing to others.

[Diane]

What is deeper than the brain, I wonder?

[PatrickL]

is that your deep model, diane? pain is in the brain?

[Barrett Dorko]

Patrick,

I haven't said one time that "the culture is screwed up." Your anthropomorphizing it as such displays a distinct misunderstanding of how I see it.

The culture is just a thing. It maintains its control by enticing us to buy crap we don't need and by endlessly recycling fashion.

[PatrickL]

i was referring to the therapy culture, barrett. Sorry for not making that clear.

[PatrickL]

I suspect that the adversarial/oppositional framing of the problem- which in general, is the way it is framed on ss (dichotmizing the manual therapy population into those who have a deep model vs those who don't, or ectodermalists vs mesodermalists, or interactors vs operators) - creates a situation where each "side" has to dig their heels in, not only to defend their argument, but to also defend their ego from for example, having spent a decade or so with heels dug in. I think we eventually start seeing "depth" in models that aren't particularly deep, and we start seeing strength in evidence that isn't particularly strong.

I'd also add, and this probably a more important point, that when one is thinking in an oppositional manner, and is motivated to defend a specific position, one can begin to interpret any arguments against said position as an argument for the opposition....

• "you're questioning ectodermalism???? You must be a mesodermalist!"
• "What's my deep model? How about I tell you who doesn't have a deep model!"
• "You don't think the brain preferentially attends to input from the skin? You must think you can specifically affect deeper receptors while ruling out the influence of skin!"

This is really what stifles debate on SS, in my view. None of these retorts are reasonable. There's some sort of strange hesitancy to state anything that might be construed as support for the "mesodermalists" (none of which participate in debates here anyways) for what appears to be concern/fear that if you "give them an inch they'll take a mile". And there is a tendency to jump all over anything said by anyone that is anti-ectodermalism... as if thats proof of their suffering from "mesodermalitis". This is what keeps SS on the moebius strip. It's like participating in a political debate. Just because I criticize a left wing policy, it doesn't mean i'm a die hard supporter of the right. Just because I question the view that a colour is black, it doesn't mean i think the colour is white.

I still find value in participating here on ss because I know I can come here with any new piece of info and see it interpreted by folks with a very strong bias towards a particular way of thinking about pain and manual therapy. I can then go elsewhere to see an interpretation from the other end of the same spectrum. But in the end, I don't see that there is sufficient evidence to justify this us vs them conceptualization of the therapy culture. The culture is screwed up... because it is comprise of humans who are prone to confirmation bias, motivated reasoning, post hoc errors. I just dont see that evidence supporting the "deep model" (whatever it is) espoused by SS regulars is strong enough to justify the certainty with which it is held up as being "least wrong". I get the sense that those who label themselves "ectodermalists" like to think that they have super critical thinking powers that free them from the trappings of confirmation bias, post hoc errors, motivated reasoning etc, and distinguishes them from the aimless herd of mesodermalists. I'm open to being corrected on this point. But as I see it, the same human errors are at play here at SS. I see an inability to critically appraise a preferred perspective.

[gilbert]

Patrick, the dichotomy I see is between practitioners who have bothered to educate themselves about pain science and those who haven't.

I'm not suggesting that the oppositional approach should be disbanded by anyone, I plan to do more cartoons to make certain points. All I'm suggesting is that when a group keeps telling themselves the same story for years and years, the story runs the risk of being understood and argued as fact, when it is more likely an hypothesis. And that makes the story less appealing to others.

What story are you referring to here? I see a huge array of parts to the 'story' here on SS, some of which are clearly toward the FACT end of the spectrum (primacy of the nervous system in the pain experience, value of TNE, poor correlation of tissue damage and persistent pain, etc) and some that might lie further toward the HYPOTHESIS end of the spectrum (superiority of skin deep interventions, etc). Sorry if these aren't representative examples but hopefully you get my point. The value that I find is in making myself think more deeply about what I am doing and why.

[nari]

Hmm, here I was carefully composing in my brain a response and Gilbert summed it up along the lines while I was thinking.

I agree, in the broadest sense, it is about those who understand a modicum (or more) of pain science and those who choose not to at this point, for whatever reason. Changes in well-established work practices take time.

I see the "deep model" as pain being output of the brain primarily and the importance of psychosocial aspects plus TNE.