“Have you seen something like this before?” Something we hear regularly in our clinic. Regularly enough to reflect on what a good answer might be. What are they getting at?!
My last blog asked the question of whether humans are objects or subjects. I hope on reading you recognised parts of both. The reality is that as humans we are not objects. We contain ears, lungs, platelets, DNA. But we are not them! Similarly we are not subjects. We contain thoughts, emotion, beliefs, interaction, ideas, consciousness. But we are not these either. We are a mysterious blend of both. This requires us to approach people both as subject and object. The mind embodied. The body enminded?! But what about pathology. Maybe we can claim these are objects? On closer inspection pathology has both sign (object) and symptom (subject). Whether it is cancer, ACL reconstruction, MS or fibromyalgia pathology clearly has a huge subjective component. It effects our affect. Our thoughts, beliefs, feelings.
Embodiment is a helpful concept ensuring we view people as both object and subject. Alva Noë provides a good example of embodiment in his book “Action in Perception”. This takes a phenomenological approach to vision and perception. He starts by dispelling the myth that the eye works like a camera (an object). That a 2D picture is NOT imprinted on to your retina. Never mind how the 2D becomes 3D! The retina is made of various rods and cones that do not capture image but are sensitive to light and colour. Experimental evidence shows that wearing inverse glasses, which should (under this premise) flip your vision from left to right do nothing of the sort. Instead they initially produce incoherent vision and after a period of time our vision becomes coherent again (with normal left-right perspective). This leaves 2 options. Firstly that our vision is a mental representation, an output of our mind of the world (a subject). It makes sense of optical illusions amongst other inconsistencies in vision. This would be a subjective or idealist approach. For Noë this is too cumbersome and inefficient. Storing all your visual experience inside your mind. If this was the case then it is strange that we do not see as a picture or painting with clarity even into extremes of our vision. Instead we see with acuity in our central vision but less clearly in the periphery.
The other option is Noë’s enactive model which looks to resolve problems with both overly objective and subjective views to perception. It is objective (or realist) in that it suggests we see the real world not how our mind represents it. Although our minds ‘read’ affordances that might be offered by what we see (eg shelter from a roof, nutrition from an apple, comfort from an embrace). The retina design explains not only that we don’t see in picture, representation or snapshot. But indeed it can make sense of illusion. The retina has not evolved uniformly. Instead the fovea is packed more densely with cones. This sweetspot encourages active vision which relies on the person (objects) sensorimotor skills. We have to search. Shift focus. Investigate. At the same time our minds (subject) have to not only direct this attention but it has to form perspective. It is estimated somewhere between 3-7 months old we start to develop depth perception. Before this we see in 2D not 3D. This is learned using sensorimotor skills. We have visual capability and apparatus but no perception. Without the ability to move around our environment. Investigate it. Experiment with it. Why is this?
Vision is complex. It is twofold. 1) How things appear. 2) How things are. You simultaneously perceive both the ellipse and circularity of a plate when viewed from an angle. Perspective means we know the distant tree is not a miniature. Because not only have we seen it up close but from a variety of positions and distances. Perception is both actual and ‘perspectival’ not either or. Looks (how things look to us) are not the relationship between an object and our mind but more of an object to its environment.
This is all very interesting but so what? Could this enactive view help us approach pain and pathology? Firstly this view accentuates the environment as well as the mind. Undoubtedly the 2 interact. Just as pain and pathology can interact with the environment. This view offers pain as a sensation. Qualitatively different to vision. Maybe more like a combination of touch, proprioception, kinaesthesia. An afferent/efferent loop used to engage with our environment (both internal and external). Pain instead of being actual or uniform across environment gains context. It encourages people to get perspective through pain. Perspective helps us know the real world. Our environment. The more perspective data the person acquires the more they get to know their environment via pain. Maybe when I am here doing this it is worse. Maybe I can do this with no adverse effect. Maybe that wasn’t as bad as I thought. Exploration. Discovery. Perspective. Perhaps we can suggest trying something different over the next few weeks to see if anything changes. If I do this does this change anything (starting to sound like symptom modification). I often see people for whom their pain or pathology is so negative they struggle to explore it. They have only quantity of pain or pathology. A binary presence. Yes or no. No quality. This can be problematic. It often leads to avoidance which reduces perspective and knowledge of the environment and how it impacts on pain and pathology. For this reason I am an advocate of painful exercise (with appropriate guidance). When people stop at pain we can miss the quality of how long it lasts, does recovery get easier or more difficult with time, does pushing a little make it any worse or better, is it consistent or variable?
Affordances (what physical objects can do for us) may extend into activites as well. We may perceive certain activities with positive subjective affordances (feeling better, stronger, in control) as well as physical (less swelling, easier breathing, reduced bleeding). These activites may involve human experience such as exercise, sleep, diet, social interaction or ‘technologies’ such as medication, medical aids, adapted environments. If we take this seriously then our rehab environments are essential but more important still the home and habitual environment of the person. This is the bit we tend to see and therefore consider the least. Skilful exploration of the environment is required. Especially as this is often done by proxy. In the race for productivity this can be viewed a luxury in healthcare. But this is integral to an embodied and/or enminded approach. The enactive model highlights how things depend and change disposition according to their environment. How something looks is more about the relationship of the object and environment than mind. The focus on the environment lends itself to external cueing to discover how things are.
So have you seen something like this before? Well not exactly. Each person unique. Every context nuanced. But we have seen many familiar (or familial) features in presentation. We have perspective. Maybe we can share this and help people develop their own.
Again my slides for this part (and the rest) of my CauseHealth talk are available here:
Be more human. Be less robot.
Thanks for reading this far.