If you fancy a trip to the big smoke, and a bit of lively intellectual stimulation, all tax-deductible and CPD-claimable, you could do worse than look out for one of the events run by Le Pub Scientifique.  (Tim and Stephanie Beams of NOI group fame are behind it). I went to one of their 2-hour evening discussions at the Star of Kings on the York Way, right near St Pancras.  When I lived in London, the roads north of Kings Cross required you to travel in groups of three armed with a can of mace.  Now, as if showing me a different face of danger, it looks like the set of Ready Player One.  There are futuristic  glassfronted gyms full of people on treadmills, YouTube offices with their red logo writ blank and large, a disneyfied Waitrose nestled amongst double height winebars.  No wonder the eels are getting hyperactive on the rising cocaine levels in the Thames – you’d need to be on drugs to feel at home here.  But the Star of Kings shone like a beacon of humanity in this strange new world, inviting us in with its warmth, great burgers and hipsterish Victorian charm.  Upstairs were Roger Kerry, and Tim and Stephanie Beames, in a room which filled slowly with – mostly physiotherapists, I guess – ready to talk philosophy and pain.  Not a tracksuit in sight.

Monica Abrosimoff, the ESO’s Rising Star of 2018,  made it to ‘le pub’ after a day in clinic at Core Clapton

What is pain?

We talked about what pain is for a while.  Luckily we can always fall back on the current IASP definition

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

But Roger pointed out that the association with tissue damage was not the main meaning of pain way back in history, when it was associated with punishment or moral suffering, or a faulty constitutional makeup.  In fact, he told us, the  Goddess Poena, from which word we get pain, is the Spirit of Punishment.  (Speaking of which, we disovered that masochists don’t find the pain of whipping pleasurable, rather it is an unpleasant but necessary gateway to a subsequent pleasure.)  As society and culture evolves, it is possible that pain will take on a different meaning – indeed it seems to be moving away from tissue damage in some circles – but I think Roger said that pain in itself is an essential part of us and if we got rid of pain we would need to replace it with something meaningful.

Robots: they’d be cute if they’re weren’t so scary

Robots

Robots are not conscious beings, and therefore do not feel pain.  The whole point of using robots to discuss pain, I suppose, is that there is no pain without sentience, so it is a good device to think about the different components of pain – physical and non-physical. 

But even though robots are not conscious beings, they are becoming primitively self-aware.  Roger showed us some truly terrifying video footage of robots doing things they hadn’t been programmed to do, seeming to “wake up” to things, figuring things out on their own, learning how to have a conversation based on what they heard.  They are basically exhibiting neuroplasticity.  Yikes.  Who are these crazy scientists and can we stop them before it’s too late? Have they not read Frankenstein? Rivalling George Orwell for prescience, a not-yet-20-year-old Mary Shelley came up with the idea for Frankenstein after having a terrifying waking dream in which she realized how “supremely frightful would be the effect of any human endeavour to mock the stupendous mechanism of the Creator of the world”. (Quite!) Pre-AI, Dr Frankenstein had to rely on galvanism and alchemy to animate his creature, but the result was a self-aware being, who looked a bit human, and learnt to speak by eavesdropping on a peasant family, rather like the video that Roger had just shown us.

However we should remember that although Frankenstein’s ‘monster’ ended up on a murderous rampage, it was society’s rejection that turned him into a killer. Far from being a mindless machine out of control, he was in fact so incredibly emotional and sensitive, that he couldn’t bear the pain of rejection. All he really wanted was a girlfriend and social acceptance.  (Maybe he just needed a hug, a bowl of ice cream, a copy of “If it hurts, it isn’t love” and a good mate to remind him “it’s her loss” and sign him up to Tinder.)  It was society’s attitude rather than his consciousness that was the problem. 

My brain was quite confused during this talk, but at one point I think Roger said that if robots become more conscious we will have to find  a way to make them feel pain. It’s a safety mechanism, I suppose. Maybe it’s not the ghost we have to worry about, but the  machine.  If they don’t feel feelings, they might have to be encoded with a conscience.  Which is more reliable: conscience by algorithm or feeling?  Just a question.  I suppose we should also make sure we’re nice to them, and maybe design them to be incredibly loveable, just in case. 

Perhaps this is what they’ll look like

Consciousness:  the bluffer’s guide

Because consciousness is so difficult to understand, it is, conversely, delightfully simple to chat about without looking ignorant. You just need to be armed with these three basic pieces of information.

1. It is often referred to as the Hard Question/Problem. It is so hard that many people don’t even bother trying to understand it, even neuroscientists. In any discussion of consciousness, nodding sagely and muttering “Ahhh.. the Hard Question” will be enough to show that you are intelligent enough and well versed enough in the field  to completely understand the indefinable ineffability of the whole thing. If pressed further, simply shrug off the conversation with, “I’m with Colin McGinn on this”, a scientist who believes that by its very nature the human brain will never be capable of understanding consciousness, i.e. it’s pointless to try.  Let’s just enjoy our beer.
2. There are things called Qualia. These are units of subjective experience, of consciousness, if you like.  They are things like experiencing the colour red, the taste of an apple, the nagging ache of thigh pain.  They are  unverifiable.  I don’t  know if the colour red you see is the same as the colour red I see.  Now nobody has really figured out how the neural processes in the brain turn into these experiences, and this is really the crux of why we can’t understand consciousness and why robots don’t have it.  You might be able to programme a robot to sort out your wardrobe, but it won’t be able to do it the Marie Kondo way, as it will be unable to feel the spark of joy necessary to guide it to keep some garments and not others.  
3. There is no agreed consensus on consciousness, so your guess is as good as anybody’s.  Theories range from pansychism – everything is conscious, it’s a fundamental property of matter – to emergent theories – that it is an uber-phenomenon created by brain processes – but they have generally fallen into two camps:

The mind-body problem boils down to the question of whether consciousness (mind) is a physical phenomenon or a non-physical one. The position that consciousness is a physical phenomenon is known as materialism and the position that it isn’t is called dualism. Almost all modern-day scientists are, at least on the surface, fierce materialists. Indeed, in scientific circles these days the word “dualist” is so unacceptable that it tends to be reserved as a last-ditch imprecation, to be hurled only when all else has failed to dispose of an opponent’s argument.

                                    Susan Pockett   (The Nature of Consciousness:  a hypothesis)

Why are manual therapists talking about consciousness?

Well, it might seem a rather philosophical topic for people who spend their days ostensibly massaging muscles and prescribing exercises for thoracic mobility, but we are really dealing much more broadly with people’s experience of pain and their body.  With the biopsychosocial movement,  there has been more and more interest in the science of pain.  Neuroscience has become much more developed and advanced, and if you follow it far enough, it strangely starts to turn into philosophy all on its own.  

Lorimer Moseley, in a piece promisingly titled “Conciousness Solved”, posits that

we would be better placed to solve the pain problem if we first solved the consciousness problem

to which the obvious response is “Good luck, mate!”.  And indeed, having been unpersuaded by four distinguished neuroscientists who claim to have cracked it to some extent, he ends up concluding, like most other people, that 

we still have absolutely no idea how consciousness emerges from all these physiological processes

It’s not only the NOI group and BodyinMind, though.  Hilary Abbey at UCO has been teaching Acceptance and Commitment Therapy for quite a while in the OsteoMAP programme.  “Mindfulness” has finally overtaken Pilates to occupy the number one spot in the ‘thing most of my patients seem to think they should be doing’ chart.  Matt Wallden and Paul Chek recently published an article called The Ghost in the Machine, on similar subjects, in the Journal of Bodywork and Movement Therapies.  (It attracted a heavyweight reply from the likes of Thomson, Draper-Rodi, Abbey, Tyreman and Vogel, no less).  

It makes total sense that consciousness is “our department”.  Our work involves us grappling for much of the time with how to understand and improve the way people “feel”; we are at the very coalface of the study of ‘mindbody’ phenomena.

Roger Kerry, preparing to wow and amaze us with his incredible robot films

Moving towards a unified theory of consciousness for manual therapists

As there is no agreed model of consciousness, it sounds like Roger was suggesting we could collectively, as manual therapists, just pick one off the peg, if we wanted.  Apparently psychologists do this.  It sounds good but it might be a bit like…..oh, I don’t know…. off the top of my head…..like the entire UK voting population deciding on their preferred model of our relationship with the European Union.  (Hahahollowhaha).  There seems to be something called embodied cognition or embodiment floating around, and also something called predictive processing.  I am familiar with the words but not yet familiar with the meaning behind them. but they seem to be gaining traction as something we should all know about, and they might be worth looking at if we are picking a working model.  They might even help shift me away from my own embarrassingly archaic dualist position.  The last time I really looked at current issues in consciousness was over 10 years ago, and things have evidently moved on. But I think it’s fair to say that whatever our personal beliefs, this was a fascinating talk on a dynamic subject in manual therapy right now, and as we and our work evolves, so will our notion of the meaning of pain and our understanding of consciousness.

I hope I’ve given you some idea of the deep and meaningful pondering afoot in the world of manual therapy.  We might not come to any conclusions but it’s sure fun trying

Thanks to Le Pub Scientifique for a very stimulating evening, and for introducing me to a really great pub.