Practical Science on Movement and Pain
Practical Science on Movement and Pain
This post is a little philosophical, and you may even find it offensive, so I will apologize in advance and keep it mercifully short.
I have done a lot of reading on the internet about the many different approaches to manual therapy. Some ideas are good, some are not so good. And some are rather obviously wrong, but somehow extremely resistant to correction in the face of huge amounts of conflicting evidence. And they seems to pop up everywhere, in different therapies that have different origins, like a weed that always needs to be pulled. Of this latter group of ideas, two different patterns of thinking really stand out in my mind.
The first pattern is one that I have written about a lot on this blog – the tendency to treat the body as a mindless piece of meat, while ignoring the role of the brain in giving it all the qualities we actually care about, like how it moves and feels. This leads to a treatment approach that completely ignores the nervous system while focusing exclusively on the physical tissues of the body. Eyal Lederman calls this the “postural structural model“. Paul Ingraham calls it structuralism, and Diane Jacobs calls it mesodermalism. Whatever you call it, it basically means an approach that is all hardware no software. Many physical therapists have expressed a lot of frustration that education for PTs remains mired in structuralism, and fails to incorporate new and interesting information from neuroscience and pain science.
A second common belief that is quite resistant to conflicting evidence (especially among massage therapists) is that clients can be treated with “energy” work. There are many different forms of this idea, but all essentially embrace the philosophy of vitalism – that idea that there is some essential force or energy (chi, prana, elan vital, the breath of life) that is unique to life, that can be manipulated by a therapist to optimize a client’s health. It doesn’t matter that such an energy has never been discovered, or that its discovery would be the most profound and shocking development in the history of science, requiring a major overhaul of physics, chemistry and biology. The belief in vital energy persists even in the face of all the obvious arguments against its existence. And yet, this stuff gets taught at massage schools, alternative medicine schools, and even universities.
I have always suspected that the tendency to think in structuralist or vitalist terms is due to some deep seated human bias built into the way we think. So I was very excited to read a great quote the other day by Paul Bloom which helps explain both points of view in one sentence.
Bloom’s quote is from this article, where he is attempting to explain why humans evolved in a way that makes them very predisposed to create magical or supernatural explanations for observed phenomena.
Bloom explains that humans evolved separate cognitive mechanisms for understanding the physical behavior of inanimate objects and the intentional acts of agents such as animals or humans. So humans have a built in hardwired intuitive sense of physics, and completely separate intuitive sense of psychology.
For Bloom, this means that:
For those of us who are not autistic, the separateness of these two mechanisms, one for understanding the physical world and one for understanding the social world, gives rise to a duality of experience. We experience the world of material things as separate from the world of goals and desires. The biggest consequence has to do with the way we think of ourselves and others. We are dualists; it seems intuitively obvious that a physical body and a conscious entity—a mind or soul—are genuinely distinct. We don’t feel that we are our bodies. Rather, we feel that we occupy them, we possess them, we own them.
And this means that:
we perceive the world of objects as essentially separate from the world of minds, making it possible for us to envision soulless bodies and bodiless souls.
For me this is a great description of why vitalism and structuralism are two sides of the same dualistic coin. Vitalism is essentially the belief in a “bodiless soul”: an animating force that exists outside the physical realm and is not reducible to it. And structuralism is the metaphorical flip side of the coin – the tendency to treat the body as a physical object, as opposed to an intelligent agent with feelings, thoughts and intentions.
Well there is a lot more I am tempted to say here, but I promised I would make this short, so I will leave it at that.
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Leave a comment and let me know what you think. (But I reserve the right to not follow any comments that go too deep.)