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I have discussed in previous posts how scientists often use intentional or psychological metaphors to describe the functions of different body parts. For example, autoimmune disease happens because the immune system for some reason “thinks” that body parts are foreigners; perception depends on how higher levels of the nervous system “predict” incoming sense data from lower levels; visual illusions happen when the brain makes a “mistake” about the meaning of sense data from the eyes. And pain is understood as the product of a system that “wants” to protect you from what it “thinks” is a physical threat to the body. This metaphorical thinking, which Dan Dennett calls the “intentional stance” is ubiquitous in biology, and plays a role in helping scientists to imagine and describe the awesomely complex workings of the body. Of course, metaphors have limits, and therefore using them presents a risk of overreach. Thus, like scientific models, metaphors are always in some sense “wrong” but may be useful.
However, it has been claimed that psychological metaphors in the context of cognitive science are never useful, and represent a fatal flaw called the “mereological fallacy,” which occurs when a part is confused with the whole. Under this view, it is wrong to say that a brain thinks, because only a person can think, and brains by themselves are just gobs of neural goo. This is true in a literal sense, but don’t scientists already know this? When world-renowned neuroscientist VS Ramachandran says that “pain is an opinion” is he confused? It doesn’t seem like it – Ramachandran advanced our understanding of phantom limb pain, which is quite a puzzle without proposing that some unconscious parts of the brain have the wrong “opinions” about the state of the body. But I recently saw arguments on social media that Ramachandran is committing some fundamental philosophical errors that undermine his theories, as well as popular models of pain. I disagree and here’s why.
Some googling reveals that the term “mereological fallacy” does not generate many hits, and most relate more to philosophy than science. Further, nearly all references trace back to a single source of authority – arguments made by Max Bennett and P.M.S. Hacker, who takes the radical view that the entire field of cognitive science is plagued by misunderstandings about the difference between persons and parts of persons. Their arguments are highly technical, and perhaps have some merit in particular contexts, but they do not seem to be widely accepted and have been severely criticized by John Searle and Dan Dennett, two absolute giants in the field of philosophy of mind and cognitive science.
Below is an extended set of quotes from Dennett, explaining why there is nothing inherently wrong with making statements like “the brain thinks.” In fact, the “poetic license” afforded by this language may be “precisely the enabling move that lets us see how on earth to get whole wonderful persons out of brute mechanical parts.” Here’s Dennett:
“The use of psychological predicates in the theorizing of cognitive scientists is indeed a particular patois of English, quite unlike the way of speaking of Oxford philosophy dons…
When I began to spend my time talking with researchers in computer science and cognitive neuroscience, what struck me was that they unselfconsciously, without any nudges or raised eyebrows, spoke of computers (and programs and subroutines and brain parts and so forth) wanting and thinking and concluding and deciding and so forth.
….
It is an empirical fact, and a surprising one, that our brains – more particularly, parts of our brains – engage in processes that are strikingly like guessing, deciding, believing, jumping to conclusions, etc. And it is enough like these personal level behaviors to warrant stretching ordinary usage to cover it. If you don’t study the excellent scientific work that this adoption of the intentional stance has accomplished, you’ll think it’s just crazy to talk this way. It isn’t. … it pays off handsomely, generating hypotheses to test, articulating theories, analyzing distressingly complex phenomena into their more comprehensible parts, and so forth.
…
It is not just neuroscientists; it is computer scientists (and not just in AI), cognitive ethologists, cell biologists, evolutionary theorists all … teaching their students to think and talk this way … If you asked the average electrical engineer to explain how half the electronic gadgets in your house worked, you’d get an answer bristling with intentional terms that commit the mereological fallacy – if it is a fallacy.
It is not a fallacy. We don’t attribute fully fledged belief (or decision or desire-or pain, heaven knows) to the brain parts – that would be a fallacy. No, we attribute an attenuated sort of belief and desire to these parts, belief and desire stripped of many of their everyday connotations (about responsibility and comprehension, for instance).
… For years I have defended such uses of the intentional stance in characterizing complex systems ranging from chess-playing computers to thermostats and in characterizing the brain’s subsystems at many levels.
The idea is that, when we engineer a complex system (or reverse engineer a biological system like a person or a person’s brain), we can make progress by breaking down the whole wonderful person into subpersons of sorts – agentlike systems that have part of the prowess of a person, and then these homunculi can be broken down further into still simpler, less personlike agents, and so forth – a finite, not infinite, regress that bottoms out when we reach agents so stupid that they can be replaced by a machine.
…
Far from it being a mistake to attribute hemi, semi, demi, proto, quasi, pseudo intentionality to the mereological parts of persons, it is precisely the enabling move that lets us see how on earth to get whole wonderful persons out of brute mechanical parts. That is a devilishly hard thing to imagine, and the poetic license granted by the intentional stance eases the task substantially.
…
When [Francis] Crick asserts that “what you see is not what is really there; it is what your brain believes is there,” …[this] is intended by Crick to be understood at the sub-personal level. The interpretation in question is not of (personal level) experience but of, say, data from the ventral stream, and the process of interpretation is of course supposed to be a subpersonal process. …
There are also plenty of times when theorists’ enthusiasm for their intentional interpretations of their models misleads them. For instance, in the imagery debate, there have been missteps of overinterpretation – by Stephen Kosslyn, for instance that need correction. It is not that map talk or image talk is utterly forlorn in neuroscience, but that it has to be very carefully introduced, and it sometimes isn’t. …
In conclusion, what I am telling my colleagues in the neurosciences is that there is no case to answer here. The authors claim that just about everybody in cognitive neuroscience is committing a rather simple conceptual howler. I say dismiss all the charges until the authors come through with some details worth considering.”
Here is a link to the full Dennett paper.
Here is a link to a previous post on Dennett’s intentional stance.
Here is a link to a post on the idea that all models are wrong but some are useful.
Here is a post on the hierarchy of different systems in the body (e.g. organelles, cells, organs, brains, people), all of which have some degree of agency and decision-making ability.
Unfortunately, cancer is so prevalent in society that it is likely we’ve all been affected by it in one way or another. This article is the story of how one of our colleagues dealt with a breast cancer diagnosis, how she managed it, and what we all need to learn from this in order to help someone who walks through our clinic doors and may need our help.
Lessons From A Massage Therapist Turned Cancer Patient – Meaghan Mounce
Most of us in business are likely trying to generate some consistent content that either gets the attention of new people to book in for appointments or possibly getting some people we haven’t seen for a while to come back to our clinics. Content creation can be tough, but here are some good tools you can put in place to create new content.
My Writing Process: The Mental Tools I Use to Produce Consistent Creative Output – Emily Rudow
Manual therapy is rife with pseudoscience and trying to apply it. This is commonly seen in high-performance sport where an athlete will do just about anything possible to gain an edge over the competition and their favourite therapist applying whatever new modality they can use to gain an edge. Every time the Olympics are on we see a new thing applied to athletes, however, these fads usually come and go, but why?
Olympic Pseudoscience – Tokyo Edition – Steven Novella
This article blends really well with the above one. What does Kinesiotape really do? Well, it kinda depends on if you like it.
Is Kinesiology Tape (KT) A Placebo? – Marc Surdyka
As a profession, we need to keep pushing for evidence-based practice in order to be taken seriously as a health care entity. In order to do that many of the old teachings surrounding the profession either have to be updated or let go of completely, including the myth of healing hands.
The Myth of Healing Hands – Paul Ingraham
I think it’s safe to say we’ve all had this happen.
That person comes in, and as you try to have a chat with them and do an assessment, they’re looking at either the clock on the wall or their watch.
They give you that look of disdain and just want you to let them get on the table.
They are basically coming in with an expectation that they booked an hour and expect a FULL hour on the table.
Well…not so fast, there eager beaver!
I wish I could say experiences like this were isolated incidents, but sadly this happens all too often.
So, what do WE do and how do WE handle this?
The idea for this blog post stems from a Facebook discussion (why do I keep getting ideas from these?).
Someone commented that assessment is essential, but hands-on is what they’re paying for. I would say this is true in some instances but not all.
This is most likely the case in a spa environment. I should preface this by saying I have absolutely no experience working in a spa but have been a customer. When someone is going to a spa for a strictly relaxation massage, and nothing stands out on their intake form that could be a red flag (I’m not sure, do spa’s check for those things?), then by all means, the person should get an hour on the table within reason.
However, if you’re working in a clinical setting, the rules change.
Doing some sort of assessment is a necessary part of treatment, and we are responsible for doing this. Now, this doesn’t necessarily have to be a bunch of orthopedic tests, it can simply be a conversation, but it’s still necessary.
This is part of our responsibility as healthcare practitioners, and it is part of what we should do to protect the public. It’s one of the things that differentiates healthcare from a spa setting. Now don’t get me wrong, I’m not saying there is anything wrong with working in a spa setting and working on strictly relaxation massages. I’m just saying there is a difference, and that difference needs to be taken seriously. And yes, there are people who come into clinics for a relaxation massage, but there should still be some aspect of an assessment.
Let me lay out a little scenario for you.
You and I work together with a bunch of other Massage Therapists in a clinical setting. For example, I work with a patient who had been in a car accident for several weeks but never really do any kind of assessment because the patient just wants to get on the table.
When they try to book their next appointment, I’m full but you have a spot open the following week they can book, so they jump at the opening.
When they come in you start doing your assessment (cause you’re a rockstar at it) and the patient gets really annoyed because they want to get on the table.
Then you end the treatment about five minutes early so you can go over some movement and homecare.
This makes the patient even angrier because they want that entire hour of massage.
They leave the clinic infuriated and call your regulatory body and file a complaint against you because of your treatment. Then, because their responsibility is to protect the public, the regulatory body HAS to investigate. So you get the dreaded phone call from them and have to talk to investigators over the next month, all while being worried you’ve done something wrong, and your career is in jeopardy.
Believe it or not, this has happened, and fortunately, it didn’t go anywhere.
Could you imagine this happening to you?
Now, don’t get me wrong, I have some patients that I’ve seen for years where it’s a quick conversation and they’re coming in for the usual thing and they say:
“just the usual thing.”
I’ll simply ask:
“nothing new going on?”
This comes after years of seeing the person and having an excellent therapeutic relationship with them, all the while knowing at other times they open up and tell me something new is going on, and that trust is built with them.
With this is the ability to read your patient.
This is an important skill to develop and is crucial to building a good therapeutic relationship.
There may be times when that person who has been in a car accident comes in and is just dealing with too much that day, where the best decision is to get them on the table to help deal with the stress they’re dealing with. However, the next week they come in, their mood is better, their body language has changed, so you can do more assessment and homecare. The ability to read what is going on with someone takes time to develop. Understanding that person’s body language, what they say to you as soon as they walk into your treatment room, and the look on their face as they talk can all be clues as to how today’s treatment will progress.
However, we cannot take the approach that everyone who comes in is going to get their full hour on the table because we have a responsibility to help these people to the full capacity of our ability. Let’s face it; you’re better than that!
The example we used above probably happens more often than we’d like to admit.
I mean I doubt people are getting reported to their regulatory bodies on a regular basis for doing an assessment, but the patient’s expectation that they should be able to come in and get right on the table is likely quite common.
While this can be partially the patient’s issue, I think we also have to look at ourselves. This isn’t an expectation in the other MSK professions, so why would it be in ours?
If this is commonplace it’s because we have allowed it to happen as a profession.
To truly be accepted as a healthcare profession we must use the tools we have to fullest of our potential in order for the profession to step forward. Quite simply, if it is commonplace where patients expect nothing but purely passive treatment, a culture change is necessary.
And that starts with each of us. We can sit back and blame schools, regulatory bodies, and associations (don’t get me wrong they play a role here too) but the only way we can make this shift is by each of us making this change (if we haven’t already) and OUR patients expecting something different when they come in for treatment.
The greatest way we can influence a culture change is by starting with ourselves. When other therapists see us doing it, hopefully it will influence them to change. More importantly if a patient is booking in and expects assessment, treatment, homecare because that’s the norm, it’s also what they will expect when they see other therapists.
As Ghandi said “Be the change you wish to see in the world”. For us: “Be the change you wish to see in the profession”.
We all know how important self-care is. This is a great interview with some great tips from a fellow Massage Therapist that you could recommend to a patient, or maybe even use yourself.
Part of what I love about this post is how it is challenging an outdated way of treating someone (with an outdated narrative). But also I love that it is encouraging questioning professionals and what they do, in a respectful manner.
Thoracic Rings And Integrated Systems: Paleolithic Or Pathfinding? – Greg Lehman
Musculoskeletal conditions make up a large part of the cost on healthcare. Great to see that more attention is being paid to these conditions so that we might collectively treat it much better.
New report aims to make musculoskeletal health a global priority – Vivienne Reiner
I love analogies! This is a great analogy of how we can better serve our patients when they come to see us (which we should all be striving to do).
Patient Centred Care Isn’t A Self Serve Buffet – Taylor Laviolett & Jocelyn Kirton
Ohhhh biases, don’t we LOVE them? I know I love mine! On our most recent podcast we talked about how our beliefs can actually create our identity, but it’s really important to challenge any of our beliefs so we can grow as practitioners and this article helps show us why.
Why trying to prove yourself wrong is the key to being right – Thinking Is Power