cairn

Musings on new learning


Over the past week I’ve been reading a book on embodied cognition, Intelligence in the Flesh: Why your mind needs your body, written by Guy Claxton. In this book, Claxton argues that we place far too much emphasis on abstract ideas of language and intelligence, and fail to recognise how intertwined our body and brain systems really are. It’s fascinating and raises many ideas and questions for me when I think of our pain experience.

To add to my musing, I had the great pleasure of attending the Australia and New Zealand Association for Contextual Behavioural Science conference in Wellington where I had the opportunity to have my mind blown by Steven Hayes and colleagues talking about a way of viewing language and behaviour from a functional contextual perspective (lots of links in this post because I can’t hope to do justice to the topics and I hope you’ll take the opportunity to click through to read more).

The truly weird thing is the links between these two aspects of being human: the one in which language is viewed in the context of whole body systems, and the one in which language (and thought) is viewed as a behaviour that develops as we grow and make connections between what is “out there” and what is “in here” – and all the abstract things in between.

I have no idea where this post will lead to, but here goes!

Let’s begin by thinking about how a baby experiences pain. Not that long ago it was believed that because babies can’t remember early life experiences and don’t have language to represent their experience, they didn’t feel pain. This, despite all of us knowing that when a baby is surprised by something external to them, when they want or need something, and times when they respond dramatically to an injection or being bumped, they react! And they react loud and clear.

Babies grow up into toddlers, and as they do we notice they develop associations between symbols and objects and experiences they interact with. Kids without hearing, in an environment where they’re surrounded by people using sign language, quickly develop the capability to represent experiences and objects with movements that mean something both to them and to those around them. Embodied cognition approach argues that the network of physiological responses flows in cycles between body and multiple parts of the brain to stamp “expected” patterns that begin to represent the world around us, and inside us. And we develop associations between internal and external objects that ultimately loop around many bits of the brain to ultimately be represented by symbols – words either spoken or gestured. Actually, according to Guy Claxton, these initial representations unfurl like ferns as a welling-up of associations and actions with multiple potential associations and actions that are either dampened down by past experience or allowed to develop dependent on intentions.

So, for example, a baby has a bunch of signals from his or her belly that flow and cycle around to various parts of the brain and endocrine system that represent what we know as “hunger”. Maybe initially it’s an urge to recapture that warm, safe, satisfied experience of having a full belly, but over time these signals develop more complex associations, with some representing “hunger”, others “milk”, “food”, “mummy”, “give me”, “want” and so on. As the baby develops, the associations between experiences and representations become far more complex and largely out of our “conscious” awareness, and these representations begin to develop a life of their own, so that as a two-year old, around dinner time, all those associations of “hungry”, “milk”, “food”, “mummy”, “give me”, “want” clamour for attention and the toddler has a melt-down! Seriously, perhaps for a toddler, being given a carrot which doesn’t fit with all those associations of  “hungry”, “milk”, “food”, “mummy”, “give me”, “want” actually doesn’t fit with the representations the toddler is trying to achieve at dinner time.

Let’s think about pain then. When a baby experiences the “yukkiness” of an empty belly – or the absence of “warm”, “mummy”, “food”, “safety” – he or she responds by crying. A baby’s whole body gets in on the act (you go watch one cry!) – and we respond. We use a bunch of words to talk to a baby when they fall down or get hurt – and they quickly learn that falling down or getting hurt isn’t nice – and that someone will come get them when they cry. Over time these experiences accumulate and the words we use for pain become associated with lots of unpleasant experiences like – cold, hungry, sad, tired, afraid, ouch, scratch, sore, comfort, abandonment, worry and so on. Soon enough any time we hear the word “ouch” or “pain”, or see a scratch or someone falling or ourselves falling, this constellation of associations are all activated, some more than others! Given how long we’ve been pairing all these associations together, it’s no wonder that pain, any pain, holds a whole bunch of meaning for us, many of which are deeply physical but also psychosocial.

At the same time as we make these connections, we’re also beginning to view “me” or “I” as somehow separate from what happens to us, and we’re all familiar with our internal narrative. This narrative contains not only the words we use to describe or narrate what’s happening, but also all those experiences and associations that go along with them. In contextual behavioural science, the representations of words, concepts, and all the associations between where, when, and how we connect these things are viewed as just as important as the words themselves.  This matters when we begin to believe that the representations (words, language) actually ARE what they “stand in for”. So, for example, if the word “pain” links with a whole bunch of experiences body processes, including perhaps not being helped to feel secure, or of fearing the worst, or of bad things happening to others around us (in life or TV even), it’s likely we’ll be experiencing those things as if they were happening in real life now. Pair that word with body experience which brings the whole to life again (in ways we can’t always express in language), and it’s no wonder many people are truly afraid of what’s going on – and act accordingly, perhaps without not really realising that this is happening. It’s like the unfurling of associations and actions occur independently of what we call “conscious thought”.

I know this is a fairly simplistic account of what I’ve been reading and learning about – and I have much more to learn and explore! But it strikes me that if our bodies are so comprehensively intertwined with the “what it is like” to be living in our world, it’s no wonder that only providing education about pain may not always be as powerful as we’d like. It helps me understand why experiencing our bodies doing things in different contexts while feeling safe/secure is so necessary. It also gives me more confidence that using metaphors (which represent our world or situations in symbols that straight words may not elicit) helps draw on these embodied representations and may elicit change more quickly than trying to “convince” or “tell” someone what’s going on.

I’d love to hear your thoughts – join in the conversation and let’s help each other make sense of this very groovy neuroscientific approach that integrates the social into our biopsychosocial framework.

7 comments

  1. Bronnie, many thanks for your timely blog. By coincidence, I am currently reading (and struggling to understand) “The Embodied Mind (1991)” by Varela, Thompson and Rosch. The other book that I found to be well worth reading (at least twice) is “The Body in Language (2000)” by Horst Ruthrof. It has become glaringly obvious to me that our teaching in pain medicine has studiously avoided dealing with the vexed question: “What is it like to be in pain?”

    The short paper “Time to flip the pain curriculum” by Carr and Bradshaw (Anesthesiology 2014; 120: 12-14) makes the powerful point that “the standard pain curriculum resembles an approach to driver education in which classes in combustion chemistry and auto mechanics were mandatory, while on-road training in courtesy and defensive driving amidst traffic were optional.”

    1. I like that analogy! It’s not just courtesy and defensive driving, it’s about respecting that this machine is being driven by an independent agent who may not be going to the same destination as the health professional!

  2. This is a fascinating post to me on so many levels! The first one, as a professional communicator, I’ve always been struck at how powerful words are and how a simple turn of phrase can have such a dramatic impact. I had never really connected the emotional impact with how people originated and associated their words.

    Secondly, as a patient with a chronic disease, the study of pain is very important. As you point out that a word to a baby or a toddler can be associated with many things. We don’t stop making those associations when we grow up. An interesting example of this recently was discussing infusion therapy with some other RA patients. The ones who had their infusions in a comfortable, private environment had very different words to describe their experiences than those who were in a more clinical, group environment with, for example, terminal cancer patients. Those experiences helped define both the emotional and the physiological meaning of the word “infusion” for both sets of patients.

    Thanks for a great, thought-provoking post and links to some very interesting materials.

    1. Thanks Carla, you raise an equally interesting thought too – I hadn’t put together the idea of “infusion” and what this means, but you’re quite right, it definitely does point to how we construe and create meaning from what goes on in treatment, life and all those other things we read about and see.
      I am continuing with my learning in this area so you can bet there will be plenty more that I’ll post on these topics, I think they’re really important for both clinicians and people living with pain.

    2. Words are more powerful than we think. I know people in their 60s who are STILL dealing with issues of low self-esteem based on a parent’s repeatedly reminding them, as children, that they will never succeed. (“You NEVER do it right!”, “You ALWAYS screw up!” “You’re such an idiot.”, etc.).

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