See me.....not the DC.

I had two situations recently which put me front and centre before other more "mainstream" health professionals shall we say- one situation was social in nature...the other, in a more professional setting.  The social setting was the introduction dinner of a prestigious social club my wife and I just joined.  Our friend, who pledged us to the club, was given the task of introducing us to the rest of the new members with a "bio" she put together.  So as she reeled off a list of our "credentials" both academically and in practice....I happened to glance over to the table of "prominent" physicians, surgeons and anaesthesiologists.  Need I say more?  Rolling eyes, snickering, the arrogant "get a load of this guy" smiles to each other and so on and so on.  The second situation was much more covert and subtle in its "vibe".   The other professionals and I shared a common patient, so they called and wanted to get together and discuss... really.... just what they were doing for my patient.  So out came the laptop and powerpoint and I got a long "evidence-based" presentation on their approach.  Then the real reason came for their call.  They had a small "concern" about a recommendation I had made to the patient's mother (the patient is a child) as an at home strategy for the child- apparently I had tread on their "territory" and "caution" and "concern" was needed on my part.  As it turns out, after some "clearing the air", they were utilizing my recommendation anyways because the "opposite" recommendation was not working but far be it that it would come from lowly ole me.  Nonetheless, I bit my tongue keeping the EQ hat on and a calm, cordial demeanour.

How did it affect me, you might ask.  Well,  the childhood, limbic part of my brain felt no differently than anyone else whose felt discriminated against because of race, religion, sexuality, gender, age, appearance etc.- hurt, alienated, inferior, low self-esteem, rejection and of course.....anger.  The nice clothes I had on, the car I was driving, the money in my bank, the success and joy my practice brings me....all those things on the "outside" that would seem to portray "this guys has got his shit together" is no shield for those feelings of "disaffection" and "estrangement" that, in my opinion, no one should have to feel.  Can we grow stronger from it?  Sure....but it doesn't change the fact that it is unfair and in direct opposition of each and every human being's inalienable right to equality and love.

SEE ME......NOT THE DC.

Anyways enough about "woe is me", lets talk big picture for a moment.  Lets extrapolate my individual situations, which perhaps could be just isolated incidents or a figment of my imagination (but I venture to say its common), to that of the chiropractic profession.  

First an everyday metaphor of sorts.  

When I was in university we used to play a card game (usually involving a beverage or two) called "Asshole".  I'm sure many of you are familiar but for those who are not, a brief description-  It's a game of hierarchy whereby (in the case of 4 players) there is a President, Vice-President, Secretary and Asshole...the lowest on the hierarchical chain.  The idea, by process of eliminating your cards first, is to not be Asshole and move up the chain to the Presidents spot.  The reason?  Because the beginning of each new game is never a level playing field.  The President always gets the best two cards from the Asshole and the Vice President gets the Secretary's best card.  Distinctive advantage.  I've been in games where the same guy was the "Asshole" for many hours and, when we played, we took our positions seriously- the President or Vice President could order the Asshole to do anything he/she wanted....get me a beer, order the pizza, bring me my slippers...basically you were a slave.  Fun game.  

So what's my point?

Equal opportunity in the health care marketplace does not exist.  The plethora of practice management groups are a testament to that. Unlike a new medical school grad, we just can't hang a shingle outside our door and expect the flock of patients to come in the door or have a hospital position waiting for us when we're done. They have the two best cards- Cultural and Sapiential authority.  When we graduate we need a plan.  We need to be business entrepreneurs as well as "doctors" to put food on our families' table and carve out a living for ourselves.....never mind the student debt.  Any wonder why franchise places like The Joint have materialized.  They are born because the marketplace of starving, struggling chiropractic grads demanded it.  That's capitalism.

When a government or insurance company makes a decision to cut us out of publicly or privately funded health services some of us yell hooray for the "gift" of "freedom".  I used to think that.  But as I reflected on it more over the years, I realized this isn't about philosophy or practice styles.... its about professional discrimination, defined eloquently by Paul Lell as, ""Any state tax-supported facility providing service for a common condition that denies employment to a licensed professional qualified to deliver that service as has been determined by agreed research".   The war cry of "we don't want to be a part of the "system" anyways, it prevents us from doing our thing, correcting subluxations and I don't want to play by their rules!"....again been there and done that but again we miss the glaring injustice before us....THEY ARE SAYING WE ARE NOT WORTHY OF SERVING PATIENTS BECAUSE WE ARE DIFFERENT OR SOMEHOW INFERIOR!....and yet our patients still come to us...not enough of them....but they come.

Let me remind you of the definition of racism,

Racism can be defined as “an oppressive system of racial relations, justified by ideology, in which one racial group benefits from dominating another and defines itself and others through this domination. Racism involves harmful and degrading beliefs and actions expressed and implemented by both institutions and individuals.

Now lets make a play on words,

"Professional"-ism can be defined as "an oppressive system of inter-professional relations, justified by ideology, in which one professional group benefits from dominating another and defines itself  ("we're not real doctors") and others through this domination.  "Professional"ism involves harmful and degrading beliefs and actions expressed and implemented by both institutions and individuals.

*As an aside, I, as a white Caucasian male want to in no way to offend those who may feel that my parallels are in any way at all like the civil rights movement of our earlier times.  It is true, we have not suffered overtly in the way the black community had in the past and I am deeply respectful of that.  I make the distinction between overt and covert discrimination quite clearly.

I believe many chiropractors are not perhaps considering the consequence of how this greater "ism" further isolates the profession and increasingly unlevels the playing field for the health care consumer dollar.   If the playing field is rigged unfairly and stakes are high, it may force those with the disadvantage to perhaps "cross" the line in terms of ethical business practices (whether they are consciously aware of it or not), forcing those among us charged with regulating our brethren to step in to maintain the right to regulate ourselves (or we will have that privilege taken away) which in turn, turns our brethren back against us calling us "traitors", "sell outs" and a whole host of other names.   It denies the opportunity for the profession to grow financially, as a profession, which leads to both decreased patient experience for all its individual practitioners (as opposed to a select few) and decreased pools of resources to fund its own research, handcuffing its own ability to serve the marketplace.  Continuing down the domino line, our schools face increasing challenges to recruit new talent to "pursue" our dwindling piece of the pie and fund its operations.  Perhaps forcing them to lower standards to keep numbers up.  Further weakening our status.   

If you were ever to hatch a plan to create chaos within a faction of a larger society, rule number one is to isolate them and deny them the ability to ever win the game you're playing...then just sit back watch the infighting and implosion ensue.  Straights vs Mixers, anyone?  Have you been on any chiropractic facebook pages lately?  The plan is working.  Now, instead of working together we just try and impose our "wills" onto to each other....looking for the same domination that's being covertly imposed on us.  Almost comical......almost.

Now some of you reading this may think I am suggesting a conspiracy of some kind against our profession.  Actually no, I look at it as a form of natural selection in process.  Our extinction, if it ever occurs (not my preference), will ultimately  be as a result of what we do to ourselves not what others may or may not do to us.  Like nature, the environment and our response to its demands will determine our worthiness, if you will.  

Chiropractic is not ordained any privilege from up above....we have to work for it.  I am more committed to serving humanity than the term or word or practice of Chiropractic.  If Chiropractic in its current form, ceases to exist or changes its form and function, than I have a decision or "evolutionary adaptation" to make and.....ME...NOT THE DC.....will make it.

I conclude this non-pessimist, non-optimist but "realist" essay with this statement,

I DO NOT HAVE THE ANSWERS.....BUT ADAPT WE MUST... IF NOT FOR OUR GENERATION BUT FOR THE FUTURE GENERATIONS OF CHIROPRACTORS THAT COME AFTER.

Oh, Oh! Chiropractic Blasphemy! The body DOES NOT heal itself?!

Found a document from the University of Ottawa, recently, that got the cogwheels (and turns out, my most recent phase of "writer's block") of my brain moving.  Fascinating and thought provoking. They laid out 3 approaches to defining health.....allow me,

1.  The Medical Model
"Health is defined as the absence of disease and the presence of high levels of function."  Here's a "wordy" example they used,
"A state characterized by anatomic, physiologic and psychologic integrity; ability to perform personally valued family, work and community roles; ability to deal with physical, biologic, psychologic and social stress..." 

2.    The Holistic Model
In an attempt to broaden the medical perspective, WHO came up with, 
"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". 

3.  The Wellness Model
Further discussion then led to a more dynamic model,
"The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment.   Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities." 

Ok...let those stew in the crockpot of your mind for a bit .....but I do like that last one.  

Now the definition of heal, here's 3 different sources,

"to become sound or healthy again."

"to make healthy, whole or sound."

"to make sound or whole."

Well,.....Crap!  While we seem to be getting better (or at least attempting to) at defining what "healthy" means, what does it mean to be "sound" or "whole".  Wait right there.

Ewwwww.....this is interesting, "sound" means,

"In good condition; not damaged, injured, or diseased"

And "whole" means,

"free of wound or injury : unhurt (2) : recovered from a wound or injury : restored"

So after all that, here's where I'm at in my own stage of either growth or regression (I'll let you decide, for your sake's):  On the tenets of pure physiology alone, the body does not heal itself since the organization and reorganization of both local and systemic properties is never the same as the previous status quo of the body prior to "damage".  More like "Repair and Adapt" to me.  You can't be made "whole" again since, and this is my philosophy speaking, you are already "whole" every second that you are alive.....and maybe dead but I simply don't know.  I've always told my patients that, to steal a line from Star Trek, the "prime directive" of the body is to help us survive ONE MORE DAY, to buy another 24 hours so that we, and all the finiteness and limitations of our minds, can make our next choice.  That choice then determines the next physiological change within our bodies.  And so on and so on.  That is the "mechanist" in me talking.  But since I am a "both/and" being.......

The "neo-vitalist" in me cannot ignore the aspect of the human spirit in this equation.  It is truly remarkable to bear witness to the multitude of transformations (and perhaps regressions) that occur to people when the "physical" manifestations of "damage" are doing their "thing".  I wonder.....if they say a cell cannot be in a state of growth or defense at the same time, is it possible that, while the cell "defends", somewhere else in the totality of our evolving and emerging being, growth is happening?

So, wonder I will..... 

My Lesson from Improv- Content vs Context

A few years ago I found the urge to express myself in a new way so I took up acting at our local theatre school, The Prairie Theatre Exchange.  It eventually lead to a spot in "Adult company" where I actually acted in a full fledged onstage production.  Both the most frightening and the most exhilarating experience of my life (well I suppose I should include jumping out of an airplane as well).
Anyways, I remember some of the funnest times in theatre school was the games our instructor had us play to help us get comfortable and creative at the same time.  One such game was, of course, improv.  There was only one rule to improv- YOU WERE NOT ALLOWED TO DENY ANOTHER PERSON'S REALITY.  In fact, you had to build on it to keep the scene moving.  Ummm...I thought to myself, what a great rule for Life.  Seek to understand another person's reality or perspective and then find a way to build on it.  Not necessarily agree or accept it blindly if you choose not to but learn to stay "in scene"and "on stage" with your fellow actor.  Denial of another person's reality creates contradiction and conflict which can lead your fellow actor to "exit, stage left".  Now you, he/she and your "audience" are robbed of what potentially could be a transformational moment in this play called "Life".

Which brings me to our topic of content vs context.  Simply put, content is YOUR experience and knowledge while context is about the meaning of your experience and knowledge to SOMEONE ELSE.  I call it the "WHAT" and "SO WHAT" of information.  The great teachers in life know this "secret" distinction.  They teach their information with context.   Information (or content) that has more meaning to their audience because,
A.  the audience could see the value of the info from their own perspective lenses.
B.  the audience related to and retained more easily the content presented.

In today's age there is no shortage of information or content but a large shortage of context in relation to that information.  The how and why a person is presenting information has become more important than the information itself.  Consider the reality that the same "content" can have a totally different meaning (or function) if it is put in a different context.  Let me illustrate, using a common examination finding seen in many medical or chiropractic offices.

Finding- L4 Patellar tendon reflex decreased (aka MSR) (+1)

Interpretation #1-Dr. Smith, medical neurologist- Lower motor neuron finding, correlate with other motor and sensory findings to rule out disc pathology or peripheral nerve lesion- refer for MRI imaging or electrodiagnostic testing and then an orthopaedic surgical consult.

Interpretation #2- Dr. Smith, chiropractor-  Could be a red flag but likely a product of an L4-5 subluxation compressing the L4 nerve root.  Adjust it and watch the magic happen.

Interpretation #3- Dr. Smith, chiropractic/functional neurologist- Rule out red flags and/or compressive lesion at the cord level (again with other motor and sensory findings) but also likely a product of an imbalance between the anterior and posterior muscle compartments of the lower limb mediated by the ponto-medullary reticular formation in the brainstem.  How do I get that area to reset the gain on those Renshaw cells?

All three interpretations are essentially right given their own unique models of reality and of the situation.  The problem lies in the contradiction and conflict that these interpretations would cause if the three practitioners were in the same room together.  Content vs Context issues are bad enough in the world of diagnosis as it is, particularly with the languaging and terminology that is involved.  My greatest teachers (and they are the rarest of rare) are the ones that can take the same content (such as an examination finding) and give me many of the contextual meanings behind that content so that I may see how another set of eyes would interpret that information.  This would allow me to be in the same room with the other practitioners and, provided the others stayed open minded and flexible in their communication, to be in a position to respect their reality and build on it with a dose of mine.  Now, no one exits stage left, and something can be accomplished.  The play goes on.

I have not utilized (at least not consciously) nor been trained in Neuro-linguistic programming (NLP) but some of their "presuppositions" do make an awful lot of sense to me.  Namely,

-"The meaning of the communication is the response it elicits".  Seems straightforward but how often when we engage with another, do we allow our own agendas to cloud our ability to ascertain the response we are getting to what we say.  Made even more difficult by those who are really good at feigning the fact that they are actually listening to you.
-"There are no failures in communication, only outcomes".  Again, seemingly straightforward but difficult in practice since a part of being human is the emotional charge we attach to many of the exchanges we have with others.  Just ask my wife.
-"In interactions among people, the person with the most flexibility and variation of behaviour can control the outcome of the interaction".  And I have written about this before, this presupposition strikes right to the heart of the importance of training your EQ, emotional quotient, as a mandatory skill for success in life.  It is the hallmark of every successful person I know and even those that don't have it, and appear successful on the outside, limit their potential influence in the world to an even larger degree by not developing it.

So since every interaction in life is an improv, what would my life look like if I played with the cardinal rule in mind?  Even better if I reminded myself that it could be a fun game to play.

Passive-Aggressive behaviour and the Modern day Viking

(Special thanks to my new facebook friend and colleague Danielle and my other buddy Steve for the inspiration behind this piece....and both for two very different but good reasons)

So I'm flipping through the "Telly" the other day and I stumble upon the History channel and a new show called "Vikings".  As you can imagine it's set as an early period piece and the brutal life of Vikings in and around the 10th Century.  There was a scene in its pilot episode whereby the tribe gathers into a village "hall" and conduct a makeshift criminal trial of one of its inhabitants who is accused of killing a fellow tribesman and taking his land.  Long story short, without a whole lot of lawyer talk and presenting evidence, the village votes unanimously (and it must be unanimous) to convict and sentence him to death.  Brutality aside, the "convicted" does get to choose the death of his choice (as he matter-of-factly chose the beheading route)....and life in the village goes on its merry way, business as usual.

  

Assuming these types of shows are relatively accurate depictions of the dog eat dog life of earlier human history, I can understand why they are so popular and watched by many today.  There's a certain appeal to how disputes and differences were settled in our earlier days.  Cross me, wrong me, mock me, touch my family and I would either kill you or teach you a really painful and not so forgotten lesson. Brutal, uncivilized....yet simple.  And we humans love simple.  And it would seem, at least in the Western Civilization, that we love to indulge in these active-aggressive fantasies as an outlet to our stifled feelings of stress and aggression by switching on the TV at the end of each day.  Even many of the brutal modern day period shows (ie-Banshee)  appeal to the simplicity of settling disputes mano-a-mano (even the women on these shows are kicking ass).

So I have a theory.  As man's developmental and evolutionary trajectory progresses (and continues to progress) thru the ages and we become (as a whole) a little more "cortically civilized" and a little less "limbically loutish", aggression takes on a whole new meaning.  Since its no longer appropriate, nor legal, to be actively aggressive, we have chosen instead to be passively aggressive- "active's" less obvious but no less aggressive little sister.  Today's passive aggressive person can grind on you for YEARS.  Instead of the old fashioned quick and be done with settlement of differences and disputes, we have the slower festering, toxic and life sucking affects of passive aggression.  

You know who they are in your life and, guaranteed, you've administered your fair share of passive aggression tactics as well.  I know I have.  So let's review the specs of today's modern day "Viking";

-Generally negative attitudes towards many situations in life and other people, especially when those people are not in the room.

-At work, they tend to avoid responsibility and are lousy at accepting criticism, even constructive criticism that would help them further their career.

-Slight paranoia in that they think others have it in for them.

-Pass off their unhappiness to outside factors.  Their emotions are a result of "you made me feel this way!"

-Given a suggestion to do a task, they will avoid doing it out of spite, despite it being a better option.

-Easily offended. Takes things people say and misconstrues them as attacks.

-Sarcasm or feigned sarcasm is their favourite weapon especially with the targeted person in the room.  Its their way of pushing buttons and winning the "power" struggle with you.  Beware, they are good at it and have had years of practice especially the narcissistic passive-aggressive.....the most lethal kind.

-Fear of intimacy.  For them, intimacy is a sign of dependency and they do not like to feel dependent on anybody or anything.  

-They do not communicate well.  And this is a funny one because they feel others do not communicate well with them and, as a result, they refuse to communicate well with others.  In fact, their behaviour has trained others around them to avoid communication.  On that note, the passive-aggressive loves the internet-email, chat rooms, facebook forums-are the training grounds for this warrior.  They love the fact that tone and lack of visible non-verbal cues can't be picked up by the victims of their disdain.

-They rarely delve out genuine and authentic compliments to others.

-The hallmark of a passive-aggressive is avoiding direct conflict but being real sneaky about their disdain.  For example, if a passive-aggressive person lives in an apartment and their upstairs neighbour constantly blares music, the person might imagine (and in fact will replay that scene over and over again in their mind) going to the neighbour to ask them to turn it down.  Instead, the irritated tenant will do something more subtle to try and get their point across, like turn up their music to try and drown out the neighbour's music.  Some might even talk to the building manager but for many this action is even too confrontational.

So how do you know if you're a passive-aggressive?

A)  If you've just read that list and you now think that I am specifically talking about you.....you are definitely passive-aggressive.

B)  If you've just read that list and you are in complete denial of possessing any of those traits and are now completely offended that I would even suggest that you do......sorry, still passive-aggressive...and I'm sure you'll find a sneaky way to get back at me.  Let me save you the trouble.....you win and I surrender.

I was actually surprised to learn that a passive-aggressive personality is listed as a disorder with the American Psychological Association.  Aha!  A chance to speculate on the neurological substrates of passive-aggressive behaviour.  As I have been preaching for awhile now, we can no longer study behaviour in a vacuum separate from the underlying neuro-functional and neuro-anatomical components and its subsequent far reaching effects on health and healing.  

It would appear that passive-aggressive behaviour falls on the Obsessive-Compulsive spectrum which points to an area known as the dorsolateral prefrontal cortex (DLPFC).  Loops between the DLPFC and Basal ganglion and then subsequently reinforcement by limbic loops between ventral striatum and amygdala develop their plasticity over years of observation (starting with their parents most likely)and then practiced over and over again.  Imbalanced approach and avoidance behaviours get these people stuck in their obsessive thoughts about what's wrong with others and what's wrong with life and then stuck in their compulsion to express and then avoid.  Essentially, they get high on it.  Its a monster in marriages and I would venture to say a leading cause of divorce today.

Are there ways to address and deal with this cunning and effective modern day "Viking"? Yes, according to many self-help magazine articles, blogs, advice columns and books but I'd just as soon to suggest..............

Pass me the fucking battle axe.

    

Enjoy the Silence-The Neuroscience of Socio-Emotional learning

"Words like violence break the silence

Come crashing in, into my little world

Painful to me, pierce right through me

Can't you understand? Oh my little girl."

Generation Xer's or anyone with an affinity for 80s music might recognize those words above.  Vivid are my memories of seeking solace alone on the bus after an exhausting day trying to scramble my way through high schools' toughest subject....a game I like to call "Social Snakes and Ladders".  Every time I thought I had made progress toward Square 100 at the top of the board, I'd land on a "snake" which would slide me down to lower levels of the pecking order, so to speak.  Battle worn, licking my emotional wounds, I'd head straight for my 5th row seat on the bus, whip out the Sony Walkman and get lost in the sounds of Depeche Mode, Tears for Fears, Simple Minds or Platinum Blonde. 

"Vows are spoken to be broken

Feelings are intense, words are trivial

Pleasures remain, so does the pain

Words are meaningless and forgettable"

So while the boys of Depeche Mode implored me to "Enjoy the Silence"........I couldn't.  Thoughts of insecurity, low self-esteem and the theatre company of woulda, coulda, shouldas used to perform at their "Vaudeville" best on the grandest stage of all.......my brain.  And my neuronal "audience" had no problems staying transfixed for this spectacular performance...."Encore! Encore!", they'd yell.  Assuming maybe some of you can relate to my youthful experiences (hopefully....or I really am pathetic), I use this entry to perhaps shed some insightful light on just how impactful those years of "Daze and Confused" really are to who you are today.

I don't think it's a surprise to many that most of our most important emotional and social learning occurs during our early years when our primitive brains are in control.  A great deal of learning takes place before we have the cortical systems for explicit memories (more on that in a bit), problem solving or perspective.  Ah, perspective.  There's a biggie.  Imagine having 30 pieces of a 100 piece puzzle and no cover box to refer to.  Consequentially, many of our most important socio-learning experiences are organized and controlled by reflexes, behaviours and emotions outside of our awareness AND distorted by our immature brains.  Think about the times when you've experienced an emotion for seemingly no reason at all or one that so does not fit the situation at hand (we'll call that an "over-reaction").  "Where in the hell did that come from?', you might ask yourself.  Enter implicit vs explicit memories.

A chart to peruse.  Please note those points in red.

Implicit Memory	Explicit Memory
Early Developing	Late Developing
Highly functional at birth	Matures later with the hippocampus and cortex
Sub-cortical/Amgydala bias	Cortical/Hippocampus bias
Emotional	Organized by language, visual images
Visceral/ Sensorimotor	Organized within episodes and narratives
Context-free and lacks source allocation	Conscious organization of experience
Procedural learning	Construction of Narrative to put Emotion into Context
Behavioural patterns

That emotional reaction or subcortical behaviour you couldn't put your finger on before? That's a triggered implicit memory.  Its key to remember that memory, whether subconscious or not, is an associational process where things that happen at the same time become linked to each other.  Implicit, subconscious memories, created in dysfunctional situations years before can repeatedly lead us to re-create unsuccessful but familiar patterns of thought, emotion and behaviour.  One only needs to see a chiropractic political meeting in action to see evidence of what we're talking about here.  

The two neurological structures involved here (with a little help elsewhere) are the amygdala and hippocampus.  The amygdala, which is the predominant limbic structure when we're young, loves to accentuate sensory inputs which heightens awareness of specific aspects of the environment and then generalize them.  Think, "Mountain out of a mole hill"...think, "Judging an entire book by its cover"....think, "Every thing bad always happens to me".  The hippocampus, on the other hand, can inhibit reactionary limbic responses, over active attention and stimulus response.  Its involved in the ability to discriminate and make distinctions without over generalizing.  When we can retrieve an implicit emotion from the "files" of the amygdala and transfer it over to the hippocampus, we can begin the process of weaving that emotion into a conscious narrative that puts context to that emotion.  Processing our emotions and behaviours this way offers us the possibility of writing a new story.  There are reciprocal connections between the amygdala and the hippocampus, so the activity of one can inhibit the activity of the other.  As a pertinent aside, stress hormones has been shown to damage neural networks of explicit memory in the hippocampus.  Ummm, well that explains a lot.

So how do we know which structure predominates in our life.  Well, I bring us back to my youthful days of listening to Depeche Mode's "Enjoy the Silence".  Silence is an ambiguous stimulus that tends to activate systems of implicit memory in the undisciplined mind.  When there's silence between 2 people, many people (especially in new relationships)will automatically assume that the other person is thinking critical thoughts.  Now there's a high school flashback....."She thinks I'm ugly", "He thinks I'm fat".  Similar reactions occur during relaxation without distraction.  Emotions, images and thoughts that emerge in conditions of low stimulation or absence of distraction may hold clues to early implicit learning.  Those who need constant activity and distractions to "relax" have implicit memories that are driving them.

How do you like silence?

......Words are very unnecessary

They can only do harm.......

Single female seeking.......

This is a slightly edited reprint of a post I did on another forum.  Dug it up the other day and thought it worth posting here.- JW

I am looking to see what this site is all about and hoping to meet someone to chat with, become friends, meet, and who knows...? I am professionally employed in _______ and have lived here for about 5 years now. I am a curvacious woman with a pretty face.  I'm looking for a man with six pack abs, great sense of humor and great teeth. If you ask me for a picture I just might send you one! 


Ever seen an ad like this? Maybe you have. My guess is amongst all the single ads found online or in print, the burning desire for great alignment or posture as a pre-requisite for a mate is rare.....how bout "must have lightning fast nerves and a well integrated sensorimotor system"? No? Not quite up to par to "must have" six pack abs, sense of humour, money or great teeth?
A respected colleague and friend has stirred me to ponder that question which was posed based on his most recent Palmer experience....that is "if you were the last chiropractor living, would the profession still live? General consensus on BJ Palmer was, yes, he was the consummate self promoter and great marketer of our beloved profession. Given that the root meaning of profession is "to profess", I banter among the 4 corners of my brain this question, 

"Now, in 2013, how should we best promote our great profession? What niche? What point of interest? What appeal to today's dog eat dog vanity world does our underutilized profession (5-6%!!!)have to offer?!"

Surely, we can crack that anti-aging, salon-loving, botox-injecting, silicone-implanting, brazilian-waxing, butt-lifting, teeth-whitening hetero-, homo-, metro-sexual world.....phew, thats quite a mouthful. People buy what makes them look good for

THEIR "other",
SOME "other"
or in some cases just plain "others", that's for certain.

Gawd, I envy those dentists and their teeth loving ways. I've seen many a hot women be repulsed by a poor schlep's not so "pearly whites". Why can't they be just as repulsed by a C1 AILP inducing head tilt or a C2 PRS inducing lower shoulder....you should see my repulsion watching those TV anchors delivering the news. "I would never sleep with that anchorwoman", I say, "That is some ugly forward head posture on that beast." 

Tongue in cheek aside, the looking good business is big money. Even a beloved, fearless, self-admitting narcissistic mentor of mine owns up to not going cheap when comes to a day at the salon. Perfect hair, perfect teeth, perfect nails...perfectly handsome married male no longer seeking....

As a side note I have had one patient (female) in my 15 years of practice who specifically came to me to reduce the "ugly" thoracic kyphosis that would absolutely ruin her wedding day. Pure aesthetics. No problem I say. I thought I had stumbled upon a brand new field of cosmetic chiropractic. 6 months later, success....she was very happy, she got what she came for and we haven't seen her since.

But what about making people feeeelllll goooood, you might ask. What about health, you might also ask? Well, you're right, its also big money. But the game is played a little different here. Are people coming in to feel good or feel better? Ummm...is that a difference, I ask my sulci? Less than 5-10% of new patients walking into our office come into our office for pure "wellness" check ups, and usually they've been referred to by a current patient and they came in to see what the buzz is all about. So that leaves 90+% coming in the door hoping to "feel better" from "something" that ails them. Do the spas own the market for feeling good and being pampered? Everytime I come out of one I have one of those huge, long drawn out "AAAAHS!"...... do my patients have one after every visit? Not likely.

Ohhhh, process driven vs event driven experiences, you say. A day at the spa is an event. Multiple, seemingly similar visits to the chiropractor to <cue in Robin Leach> "fix" those "Lifestyle choices of the dumb and dumber" doesn't seem quite as appealing to our instant gratification world. And yet, some of us manage to eek out a pretty good living at it. WHY??!! And why not every single chiropractor? We seem to know the answer, but I'm not 100% sure.....is it really just as easy as perhaps providing a " not coveted, but necessary health care service sought out by a growing number of "disillusioned by traditional health care" despots who yearn to be "heard" and "cared" for...provided by those with a sprinkle of extraordinary clinical skill and a dash of superb soft skill." 

I don't know, you tell me......and tell me how I fit all that into a slick, knock em off their pants marketing campaign. I'm just a lowly blogger (read, by maybe, 12 of my colleagues who can stand me) hashing my thots and writing them, verbatim, on this medium.

If I were single again and I was looking for a potential mate, here's what my ad would say........

SINGLE HANDSOME (don't laugh) MALE SEEKING SINGLE FEMALE- MUST HAVE SYMMETRY AND BALANCE IN POSTURAL ALIGNMENT, UNIMPEDED NEURAL SENSORY SYSTEMS TO GENERATE ACCURATE INTERNAL AND EXTERNAL REPRESENTATIONS OF HER OWN ENVIRONMENT AND PICK UP THOSE CUES OF MY OWN, UNIMPEDED MOTOR SYSTEMS TO GENERATE SKILLFUL USE OF HANDS, LEGS AND OTHER BODY PARTS FOR BEDROOM ACTIVITY, WELL SYNCHRONIZED HEMISPHERIC ACTIVITY TO ENGAGE IN WHOLE MINDED AND INTELLIGENT CONVERSATION WITH AFTER THE BEDROOM ACTIVITY, ADEQUATE AMOUNTS OF ACCESSIBLE DOPAMINE FROM THE VENTRAL TEGMENTAL AREAS FOR THOSE TIMES OF THE MONTH WHEN YOU MIGHT GET A LITTLE BIT BITCHY, A CAREER, PURPOSE AND PASSION FOR LIFE WOULDN'T HURT..............................................AND GREAT TEETH.

Stimulus-Bound vs Goal-Directed Behaviour Part 2

In our last post we alluded to, among many things, the importance of INHIBITION- the ability of the higher centres in our brain to wrestle control away from our lower (and more demanding) centres of our brain.  A brain which is under more subcortical control is one that is held hostage by more primitive drives such as sex, food, threat and instant rewards.  In this state, it is very difficult to develop the AWA skills of change management, particularly when well ingrained negative plasticity has developed in the CNS.

As a review, neuroplasticity is the ability to build (and maintain) a pathway in the CNS.  We can have;

Negative plasticity- which will produce negative outcomes such as PTSD or chronic pain.
or
Positive plasticity- which will produce positive outcomes such as mastering the guitar or healthy cortical modulation of sympathetic activity (via PMRF activation).

As doctors, we are exposed to the negative, and sometimes positive, aspects of neuroplasticity in our patients every single day.  They are reflected in our patients' pain syndromes, muscle imbalances, altered gait mechanics, postural distortions, autonomic imbalances and so on.  They are also reflected in our patients' return to normal function and resultant maintenance of that function via our interventions and recommended self-care protocols.  So does the same principle apply to our topic of Stimulus-Bound vs Goal-Directed behaviour and change management?  Is spending your money impulsively (and not paying down debt) to "keep up with the Jones'" a form of negative plasticity and therefore a reflection of the maturation of your CNS?  Well the short answer is yes.  For some reading this, you may have felt a little twinge in the gut just now.  But thats the first step to change.  The truth, however, is that we have examples of both negative and positive plasticity in our lives.  My advice.....don't change a thing with the positive plasticity thats working for you and change the negative plasticity that's not working for you.  Sounds simple but most people suffer from some form of  anosognosia, which is just a fancy way of saying that sometimes you don't know what you don't know.  And in the arena of negative plasticity, ignorance is NOT bliss!

Consider the physiological blind spot that we all have.  That small area on the optic disc of the retina that contains no photoreceptor cells.  Well guess what?  You don't know its there because your brain fills in the gap and literally makes things up to fill in the visual representation of that spot.   This can be measured and, to go a step further, used as an objective measure of brain function.  Our brains are incredibly adept predicting machines.  Starved of the necessary information that it needs (as in the case of a subluxation), it will make things up to account for the void.  Perception may not reflect reality as a result.

So now the question is, do we have cognitive or emotional blind spots with regards to our behaviour?  What things do we "make up" in an effort to provide a rationalization for our own "blind spots"?  Better yet, can we measure it, change it and then measure it again?  Yes and yes.  Neuroscience suggests that psychology is a reflection of physiology, specifically neurophysiology.  This may come across as a deterministic (which is distinctly different from mechanistic) concept but it is not, because there is no room for change in determinism.  On the flip side, emergent vitalism (or neo-vitalism) allows for the limitless confounding variables that shape and mould who we are now AND who we can become.  We truly are greater than the sum of our parts since, as epigenetics has proven, our environment plays a role in that evolution as well....but I philosophically digress.

I promised in the last post to address this idea of assessing and changing our own inhibitory skills so that we can shift our behaviours from more stimulus-bound to the goal-directed kind.  Let's use the backdrop of a nice little scientific review written by Douglas Munoz and Stefan Everling in Nature (2004)entitled "Look away: The anti-saccade task and the voluntary control of eye movement".

As an aside, I think many chiropractors are missing an opportunity to improve their assessment of the nervous system by not becoming trained in the examination of the eyes.  The eyes and the spine are embryological homologues and therefore stayed wired together for life.  Therefore, from a neurological perspective, what happens in the eyes....happens in the spine.  And the eyes are not buried underneath 5 layers of muscle, adipose tissue and skin so it makes for an easy qualitative, and with the right technology, quantitative evaluation.  So for me, those two little globes are like vertebrae to assess.

First line of the article.  "The anti-saccade task has emerged as an important task for investigating the flexible control we have over behaviour".  In this task, participants must suppress the reflexive urge to look at a visual target that appears suddenly in the peripheral visual field and must instead look away from the target in the opposite direction.  Ladies, think of this test as a measurement of your husband's ability to not gawk at a well-endowed woman walking towards you as the two of you stroll past holding hands.  Get the picture.  A simple way to perform it is to hold out both your thumbs approx 40-50 cm apart and randomly wiggle one thumb and then instruct the person you are testing to dart their eyes in the opposite direction of the wiggling thumb.  Can they inhibit the reflexive urge to look towards the target stimuli (wiggling thumb) known as an automatic saccade?  Disorders or dysfunction in the executive centres of the brain (namely the frontal lobe) find it difficult to suppress this urge revealing a deficit in top-down inhibition.  There are several other tests you could do to test frontal lobe maturation but beyond the scope of this blog.

Frontal lobe and eye exercises such as pursuits, saccades and various other brain "gym" activities therefore become great ways at building plasticity for the inhibitory skills necessary to develop goal directed behaviours.  There is a caveat, however.  You must be specific to the hemisphericity, or under-connected side of the brain otherwise exercises or activities that target the wrong hemisphere or are too bilaterally general will not create that positive plasticity in flexible behaviour control and can in fact, worsen an already existing negative plastic state.  This, of course, must be skillfully assessed.  Targeted plasticity after a skilled assessment is the key to rubbing the neuroplastic genie.  Be open to being checked by someone trained in a comprehensive functional neurological assessment.

You never know, you might just be cured of your anosognosia.