Saturday, February 13, 2010

Embodied Cognition

Consider this: you are doing a jigsaw puzzle. You have started out - as most people do - looking for the easy pieces that make up the frame of the puzzle.
You did this because those pieces have a straight line on one side - making them relatively easy to pick out of the heap of a thousand or more pieces.

Now - as you start working on more difficult parts of the puzzle - you pick up each new piece and try to match the individual pattern and shape to other pieces that are already in place.
While you are doing this - you are automatically turning the piece you are holding around on it's different axes - trying to see if the piece will fit.

At this point allow yourself a break - lean back and start thinking. ;-)

Chain Of Command

What just happened?

I won't lie to you: I don't know.
But what I do know is that by examining this question we are one step further along in solving the problem of how to treat chronic pain.
That's a bold claim - but one I feel very confident about.

Here's why:
your brain is - as you will know - a great pattern recognition machine.
It's also pretty good at mental rotation and judging distances, etc. - just think about driving a car and trying to get through a tight alley; your brain creates a map of the space surrounding the car, factors in the dimensions of the car and "tells" you that you will fit through.
And as with everything else - some people are better at that stuff than others ;-) (think fighter pilots or Air Traffic Controllers).

So mentally rotating the piece you are holding in your hand should be pretty easy - right?
It is; but still most of us prefer to do it "in real space".

a) Brains are lazy
b) Brains take all the help they can get
c) the Brain doesn't care about the bodies boundaries
d) computation can take place anywhere

Let me explain:
a) Brains are lazy

Thinking uses up a lot of energy - tons of it.
And since brains evolved under circumstances where food was scarce saving energy makes sense.

Which brings us to:
b) Brains take all the help they can get

It makes sense to transfer the workload away from the brain.
Why not use a calculator instead of solving the problem in your head?
Why not write something down instead of remembering it?
It makes evolutionary sense to use "outside" help instead of having the brain do everything by itself. It's much more efficient that way.

You can of course debate these points as long as you like - they are by no means watertight ;-) - but what I'm trying to get to is this:
c) the Brain doesn't care about the bodies boundaries

"We" normally have the strong feeling to be inside our bodies.
Metzinger and others have shown that this feeling of "I" can be transferred to just about any place you want.
You can swap bodies with another person within a couple of minutes.
I myself had my hand "replaced" with one made of rubber which felt really weird - and that took just 20 seconds or so.

We also know that tools are quite easily and readily incorporated into the body schema - walking sticks, surgical tools and what not become parts of "us"; and if you want to speculate - sometimes even emotions and feelings come with that (just look at how some people feel and talk about their cars).

And here's why this is important:
the artificial boundary between "us" and the world simply doesn't exist.
We are part of the environment - and our surroundings are part of us.
We act on our environment - but also react to it.
And: most times we aren't even aware of how our environment "makes us do things".
As an artist I know how weird it can be when you are forced to take pictures like this ;-)):

Meet Emilia

Marketers, Magicians and others have known this for a long long time - and make a pretty good living off it.
Psychologists are just starting to unravel these complex relationships and describing what happens inside the brain when we encounter such situations.
Just read any book like "How we decide" and you will understand what I'm getting at - or watch Richard Wiseman's videos on YouTube.

Now you might think - as I did for a long long time - how is that helping me understand chronic pain - or even better: how is it helping me in treating chronic pain?
The answer:
d) computation can take place anywhere

Let's repeat:
a) Brains are lazy
b) Brains take all the help they can get
c) the Brain doesn't care about the bodies boundaries

If a+b+c are true - then d also has to be true. ;-))
The Brain doesn't care where the solution to a given problem comes from - as long as it's there eventually.

Just look at phantom limb pain:
using a Mirror Box a lot of people can achieve a significant reduction of pain within a few minutes.
The Brain has a problem - it tries comparing different sources of input and output which don't fit together (it has an unsolvable computational or information processing problem); by using a mirror "you" transfer this problem to the environment.

By doing this you are "reframing" the problem - making it easier for the brain to do it's work.
So part of the overall computing process now happens outside of the body and out of the brain.
The mirror image of the moving hand is like a computer moving ones and zeroes around.
It's all just information - which in itself is completely meaningless without context.

I could go on about this for a week or so ;-) - and maybe I will at a later date - but for now I want to leave you with this:
the treatment of chronic pain hinges on the fact that we - as therapists - have to find a way to make it easier for the brain to deal with the situation at hand.
By transferring the problem to the environment we reduce the complexity of the problem - make it easier to solve - and the Brain can stop creating pain.

Just look at how little help a toddler for example needs when learning to walk:
his or her gait pattern without help is often pretty unstable - but even the softest touch suffices to make it much more robust. All your one finger touching his hand does is provide him with input; the brain doesn't have to compute a problem in 4 dimensional space anymore (don't forget the importance of timing!) - but it can reduce the problem to a 2 or 3 dimensional one.
Let me rephrase: your finger is not providing physical support - but informational support only - telling the brain "Look - just treat this part of space as a constant - because it's as stable as the surface this body is walking on".

Get it yet?
Don't worry - I didn't either.
It takes a while to sink in. ;-)

This is the hard part about the science of embodied cognition - getting your head around the concept of you not actually being where you think you are.
The illusion of having this egocentric worldview is so strong and so pervasive that we just can't override it.
But if we look closely enough we can spot it out of the corner of our eyes. ;-)
Like Douglas Adams wrote in the Hitchhikers Guide: flying is easy - just throw yourself at the floor and try to miss. ;-)

In order to show you how this actually looks when applied to patients I will talk about sensory discrimination training in another post.