Barrett L.
Dorko, P.T.
E.O.
Wilson’s latest book, Consilience: The Unity of Knowledge (Vintage
Books 1998) presents many ideas perfectly relevant to any thorough discussion of
the deep model of human functioning. I wanted to say a few things here about
what this might mean to therapy’s search for a greater understanding of
painful problems.
Wilson defines Consilience
in this way: “Consilience is the key to unification. I prefer this word over
“coherence” because its rarity has preserved its precision, whereas
coherence has several possible meanings, only one of which is consilience.
William Whewell, in his 1840 synthesis The Philosophy of the Inductive Sciences,
was the first to speak of consilience, literally a “jumping together” of
knowledge by the linking of facts and fact-based theory across disciplines to
create a common groundwork of explanation. He said, “The Consilience of
Inductions takes place when an Induction, obtained from one class of facts,
coincides with an Induction, obtained from another different class. This
Consilience is a test of the truth of the Theory in which it occurs.”
“The strongest appeal of
consilience is in the prospect of intellectual adventure and, given even modest
success, the value of understanding the human condition with a higher degree of
certainty.” (Note from Barrett: I really like Wilson’s concession to
uncertainty here. He reminds us in this way that science is about making the
best possible sense out of a given series of observations. It is not about
“knowing” anything for sure every time you propose something.)
Later in the book Wilson
writes about a typical colony of ants. He wrote an entire book entitled “The
Ants” a few years ago, so I assume he’s an expert.
…Scores of biologists
working independently established that ants organize their colonies with many
chemical systems like those used to transmit alarm. Their bodies, we discovered,
are walking batteries of glands filled with semiotic compounds. When ants
dispense their pheromones, singly or in combination and in varying amounts, they
say to other ants, in effect: danger, come quickly; or danger, disperse; or
food, follow me; or there is a better nest site, follow me; or I am a nestmate,
not an alien; or I am a larva; and on through a repertoire of ten to twenty
messages, with the number differing according to caste (such as soldier or minor
worker) and species. So pervasive and powerful are these codes of taste and
smell that all together they bind ant colonies into a single operational unit.
As a result each colony can be viewed as a superorganism, a congeries of
conventional organisms acting like a single and much larger organism. The colony
is a primitive semiotic web that crudely resembles a nerve net, a
hundred-mouthed hydra writ large. Touch one ant, one strand of the net, and the
displacement spreads out to engage the communal intelligence.” (Note from
Barrett: I love this “crude nerve net analogy.)
Wilson points out that in
the previous paragraph (and in a subsequent one where the molecular structure of
various pheromones is discussed) “We have crossed four levels (in our
understanding)-superorganism to organism to glands and sense organs to
molecules.” He asks: “Is it possible to travel in the opposite direction,
predicting the outcome without advance knowledge of the biology of ants?” He
concludes that you can, at least with respect to some broad principles. He does
however offer this observation about such thinking as well: “These
predictions, or educated guesses if you prefer, qualify as consilience by
synthesis. With some puzzling exceptions, they have been confirmed. But
biologists cannot predict from physics and chemistry alone the exact structure
of the pheromone molecules or the identity of the glands that manufacture them.
For that matter, in advance of experiments, they cannot stipulate whether a
given signal is used or not used by a particular species of ant. To attain that
level of accuracy, to travel all the way from physics and chemistry near the
entrance of the labyrinth to an end point in the social life of ants, we need
detailed collateral knowledge of the evolutionary history of the species and of
the environment in which it lives.” (Note from Barrett: This takes into
account things like secondary gain which would be invisible to the deep model
but essential for even more certain understanding of what we see and hear from
the patient.)
If you’re still with me,
this is what I’m proposing: Physical therapy procedures for painful problems
have rarely contained a reasoning that “traveled in the opposite direction”
as is so clearly explained by Wilson. Instead, they commonly employ a “from
the outside in” method of thinking that ignores the full reality of painful
sensation. Instead of considering the subtle brain chemistries that might
contribute to something like central sensitization, they look at the muscular
activity evident to palpation and make all kinds of assumptions about its
meaning without actually considering the many contributions of the nervous
system and its vast chemistry. Therapy without such careful and well informed
thought is little more than personal training, and poorly done personal training
at that. I think that this is how we’ve arrived where you see us today;
clinics where people in pain have their exercises counted for them by somebody
other than a PT, and no real time is ever spent in unique and personal caring
for individual problems. Protocols developed for generic problems (there is
hardly such a thing) for all “typical” patients (no such thing) drive the
system.
A movement in our thinking
toward Consilience would change this drastically, and that’s what I’m hoping
we’ll see one day.
There’s a question I ask
all my classes now, and I hope it haunts them: If an intelligent, alien life
form were to carefully observe the human animal as Wilson suggests, much in the
same way we have studied ants, would they be surprised to see patients in pain
given strengthening exercises and little else for their problems?