More Brain Lies

[Follow up to this post]

I had a friend who once dated a 44 year old woman with the abs of a young Britney Spears.  She hated her body.  At first I was confused by this.  How could you not love having a stomach like that?  Eventually I realized that I had the causality reversed.  She was stuck on “hates her body” and that gave her the energy to starve and work out until she had that perfect stomach.

Similarly, anyone who has $100,000,000 and thinks they need more.  No, they don’t.  But if they were capable of feeling satisfied with the amount of money they had, they would have stopped at $10,000,000.  Or $1,000,000.  Or couch surfing and dumpster diving.

The particularly deficiency in my social circle is “I’m not good enough/smart enough/productive enough”.  As Justis Devan points out, this is a among a group that by and large makes six figures and a lot of whom are directly working on important things.  I have a friend who feels bad for not being Elon Musk.

Now, people are not always wrong that something is holding them back from being everything they could be, and to be frustrated by it.  But sometimes it helps to take the gap between is and ought as a sign of how high your standards are, rather than how bad you are at a thing.

Your Brain is an Unreliable Narrator

Recently I went down a tube slide at a water park.  Tube slide means you go down on an innertube, which you adhere to with only your hands.  After 30 minutes of waiting in line watching people bank on the slide I am convinced that letting go means I fly into the air and die.  So you’d think I would grip the tube really really tightly.  But when I finally got on, I found I couldn’t.  No matter how hard I tried, my grip felt weak and tenuous.

One possibility is that my wrists have a death wish.  Another is that my brain was trying to keep me alive, and attempted to increase my grip strength by lying to me about it.  After all, when my wrists felt weak I gripped the handles tighter.  And empirically, I did not fly off the tube and die.

I think a similar thing happens when I rock climb.  When I started bouldering (climbing without a rope), I always felt like I was about to lose my grip, and afterwords my forearms were absolutely throbbing.  When I switched to top roping (climbing attached to a rope, limiting the distance you can fall), that eased up a lot.  Although I still get very strong “you can’t do this, you should get down” signals, and then go on to climb several more routes, indicating I did in fact have the strength available to climb the first thing.

I think this is what Todd Hargrove was describing in A Guide To Better Movement– the information your unconscious brain feeds your conscious brain is not unbiased, it is motivated, primarily by a desire to be safe.  If you have other motivations, such as climbing to the top of a fake rock being awesome, you may need to correct- but gently enough that your unconscious brain doesn’t simply further bias itself in response.

I experienced a similar thing with stretching.  When I tried to stretch I would hit what felt like a physical limit, but the muscle didn’t feel stretched afterwords and I never got any more flexible.  I tried doing the same stretches on a muscle relaxant (which I occasionally take for my jaw pain), and without any effort or thought dropped much deeper into the stretches.  I was able to remember these new limits passed when the the medication wore off (probably thanks in part to doing the Guide to Better Movement exercises for weeks beforehand), and most retained the gains.

I am extremely curious where else my brain is underestimating me.

Review: The Life Changing Magic of Tidying Up and Spark Joy (Mari Kondo)

I read these books not because I planned on following them literally, but because I was moving and I wanted to bias myself towards getting rid of stuff rather than keeping stuff.  This was a good plan that I recommend to anyone with similar goals.  Having a little voice in the back of your head saying “If it doesn’t spark joy you are morally obligated to throw it out” is a great counterpoint to your inner hoarder.  Now on to the epistemics.

These books are weirdly calming, because they’re so confidently wrong.  There’s no hedging, no complications, no conception that other people might operate differently than her, just her opinion/the right way to do things, which are one and the same.  I spend all day around people with very complicated models they are very tentative about, and it was relaxing to see someone fully commit to something.  Plus if something is almost true, it’s stressful to disagree with it.  If it’s so clearly wrong and not considering other options, disagreeing feels easy.

Kondo actually walks back a lot of the wrongness in the second book.  For example, she acknowledges that there are practical things you need to keep even if they don’t fill you with delight.

I think I also enjoyed the books because Mari Kondo and I have the same ultimate goal: human flourishing.  She has fixated on tidyness as the base of the pyramid that ends in utopia, and she’s doing what she can to make that happen.  Aside from her initial assumption that tidyness will fix everything wrong with your life, I agree with all of her logical steps.

Epistemic Spot Check Changes

Previously I checked books pretty much as I went along.  Doing otherwise felt like the check was playacting; if knowing wasn’t going to affect my behavior towards the book it was rigor theater, not genuinely caring about a book’s factual accuracy.  I’m backing off on that.  It prevents a book from gathering any momentum and it’s too easy to turn into cheap shots. Instead, for the mental health books, my default is going to be read the introduction and at least one other chapter, marking what I want to verify as I go, and circle back at the end of the second chapter to fact check.  This will give the books a little time to breathe and for me to evaluate their model.  It’s also way easier for me.

The exception  will be books where I get a stuck feeling and need to look something up to continue, or where I get nerd sniped.

Econtalk on Generic Medications

I’m pretty educated on the pharmaceutical industry for someone who doesn’t work anywhere near it, and last week’s Econtalk taught me a lot.  Here’s a teaser.

Developers of new medication are granted a limited term to sell that medication without competition, which generally makes the price higher.  This is useful because it creates an incentive for inventing new drugs.  But it’s costly, because the incentive is money consumers wouldn’t otherwise spend.  Sometimes companies claim patent protection for bullshit patents, just like the software industry.  Challenging these patents is costly; to incentivize generic manufacturers to do so, the government grants them a limited monopoly if a they win.  For six months only they and the inventor can sell the product.

Only the count starts when the second manufacturer brings their version to market, not when they win the case.  If they don’t release a product no one else can either, even if the drug moves off patent in the meantime.  Unsurprisingly, pharmaceutical research companies began paying off generic manufacturers to essentially win lawsuits and then never release a generic, thus extending their monopoly past the patent expiration.

Courts have mostly struck that down at this point, and companies have moved to either more subtle rent seeking (“how about we just pay you to manufacture the drug for us?”) or more antagonistic actions…

Dd you know that you can’t have a generic for a name-brand drug that’s no longer on the market?  I mean, you can, but doctors don’t write prescriptions for generics, they write it for the name brand and the pharmacist gives you the cheapest substitute.  But they can only do that if the name brand is theoretically available.  If a company, say, tweaks the formula in an absolutely irrelevant way and files a new patent on that, they can completely forestall generic competition until the new patent runs out.

Big pharma, I’m on your side.  I defend your monopoly profits more than almost anyone.  But you need to cut this shit out.

Epistemic Spot Check: A Guide To Better Movement (Todd Hargrove)

Edit 7/20/17: See comments from the author about this review.  In particular, he believes I overstated his claims, sometimes by a lot.

 

This is part of an ongoing series assessing where the epistemic bar should be for self-help books.

Introduction

Thesis: increasing your physical capabilities is more often a matter of teaching your neurological system than it is anything to do with your body directly.  This includes things that really really look like they’re about physical constraints, like strength and flexibility.  You can treat injuries and pain and improve performance by working on the nervous system alone.  More surprising, treating these physical issues will have spillover effects, improving your mental and emotional health. A Guide To Better Movement provides both specific exercises for treating those issues and general principles that can be applied to any movement art or therapy.

The first chapter of this book failed spot checking pretty hard.  If I hadn’t had a very strong recommendation from a friend (“I didn’t take pain medication after two shoulder surgeries” strong), I would have tossed it aside.  But I’m glad I kept going, because it turned out to be quite valuable (this is what triggered that meta post on epistemic spot checking).  In accordance with the previous announcement on epistemic spot checking, I’m presenting the checks of chapter one (which failed, badly), and chapter six (which contains the best explanation of pain psychology I’ve ever seen), and a review of model quality.  I’m very eager for feedback on how this works for people.

Chapter 1: Intro (of the book)

Claim: “Although we might imagine we are lengthening muscle by stretching, it is more likely that increased range of motion is caused by changes in the nervous system’s tolerance to stretch, rather than actual length changes in muscles. ” (p. 5). 

Overstated, weak.  (PDF).  The paper’s claims to apply this up to 8 weeks, no further.  Additionally, the paper draws most (all?) of its data from two studies and it doesn’t give the sample size of either.

Claim:  “Research shows the forces required to deform mature connective tissue are probably impossible to create with hands, elbows or foam rollers.” (p. 5). 

Misleading. (Abstract).  Where by “research” the Hargrove means “mathematical model extrapolated from a single subject”.

Claim:  “in hockey players, strong adductors are far more protective against groin strain than flexible adductors, which offer no benefit” (p. 14).

Misleading. (Abstract) Sample size is small, and the study was of the relative strength of adductor to abductor, not absolute strength.

Claim: “Flexibility in the muscles of the posterior chain correlates with slower running and poor running economy.” (p. 14).

Accurate citation, weak study.  (Abstract) Sample size: 8.  Eight.  And it’s correlational.

[A number of interesting ideas whose citations are in books and thus inaccessible to me]

Claim:  “…most studies looking at measurable differences in posture between individuals find that such differences do not predict differences in chronic pain levels.”  (p. 31). 

Accurate citation.  (Abstract).  It’s a metastudy and I didn’t track down any of the 54 studies included, but the results are definitely quoted accurately.

 

Chapter 6: Pain

Claim: “Neuromatrix” approach to pain means the pattern of brain activity that create pain, and that pain is an output of brain activity, not an input (p93).

True, although the ability to correctly use definitions is not very impressive.

Claim: “If you think a particular stimulus will cause pain, then pain is more likely.  Cancer patients will feel more pain if they believe the pain heralds the return of cancer, rather than being a natural part of the healing process.” (p93).

Correctly cited, small sample size. (Source 1, source 2, TEDx Talk).

ClaimPsychological states associated with mood disorders (depression, anxiety, learned helplessness, etc) are associated with pain (p94).

True, (source), although it doesn’t look like the study is trying to establish causality.

ClaimMany pain-free people have the kinds of injuries doctors blame pain on (p95).

True, many sources, all with small sample sizes.  (source 1, source 2, source 3, source 4, source 5)

Claim: On taking some cure for pain, relief kicks in before the chemical has a chance to do any work (p98)

True.  His source for this was a little opaque but I’ve seen this fact validated many other places.

Claim: we know you can have pain without stimulus because you can have arm pain without an arm (p102).

True, phantom limb pain is well established.

Claim: some people feel a heart attack as arm pain because the nerves are very close to each other and the heart basically never hurts, so the brain “corrects” the signal to originating in the arm (p102).

First part: True.  Explanation: unsupported.  The explanation certainly makes sense, but he provides no citations and I can’t find any other source on it.

Claim: Inflammation lowers the firing threshold of nociceptors (aka sensitization) (p102).

True (source).

Claim: nociception is processed by the dorsal horn in the spine.  The dorsal horn can also become sensitized, firing with less stimulus than it otherwise would.  Constant activation is one of the things that increases sensitivity, which is one mechanism for chronic pain (p103).

True (source).

Claim: people with chronic pain often have poor “body maps”, meaning that their mental model of where they are in space is inaccurate and they have less resolution when assessing where a given sensation is coming from (p107).

Accurate citation (source).  This is a combination of literature review and reporting of novel results.  The novel results had a sample of five.

Claim: The hidden hand in the rubber hand illusion experiences a drop in temperature (p109).

Accurate citation, tiny sample size (source).  This paper, which is cited by the book’s citation, contains six experiments with sample sizes of fifteen or less.  I am torn between dismissing this because cool results with tiny sample sizes are usually bullshit, and accepting it because it is super cool.

Claim: “a hand that has been disowned through use of the rubber hand illusion will suffer more inflammation in response to a physical insult than a normal hand.” (p. 109).

Almost accurate citation (source).  The study was about histamine injection, not injury per se.   Insult technically covers both, but I would have preferred a more precise phrasing.  Also, sample size 34.

Claim: People with chronic back pain have trouble perceiving the outline of their back (p. 109). 

Accurate citation, sample size six (pdf).

Claim:  “Watching the movements in a mirror makes the movements less painful [for people with lower back pain].” (p. 111). Better Movement. Kindle Edition.

Accurate citation, small sample size (source).

Model Quality

Reminder: the model is that pain and exhaustion are a product of your brain processing a variety of information.  The prediction is that improving the quality of processing via the principles explained in the book can reduce pain and increase your physical capabilities.

Simplicity: Good.  This is not actually simple model, it requires a ton of explanation to a layman.  But most of its assumptions come from neurology as a whole; the leap from “more or less accepted facts about neurology” to this model is quite small.

Explanation Quality: Fantastic.  I’ve done some reading on pain psychology, much of which is consistent with Guide…, but Guide… has by far the best explanation I’ve read.

Explicit Predictions: Good, kept from greatness only by the fact that brains and bodies are both very complicated and there’s only so much even a very good model can do.

Useful Predictions: Okay. The testable prediction for the home-reader is that following the exercises in the back of the book, or going to a Feldenkrais class, will treat chronic pain, and increase flexibility and strength.  Since the book itself admits that a lot of things offer short term relief but don’t address the real problem, helping immediately doesn’t prove very much.

Acknowledging Limitations: low. (Note: author disputes this, and it’s entirely possible he did and I forgot).  GTBM doesn’t have the grandiose vision of some cure-all books, and repeatedly reminds you that your brain being involved doesn’t mean your brain is in control.  But there’s no sentence along the lines of “if this doesn’t work there’s a mechanical problem and you should see a doctor.”

Measurability: low.  This book expects you to put in a lot of time before seeing results, and does not make a specific prediction of the form they will come in.  Worse, I don’t think you can skip straight to the exercises.  If I hadn’t read the entire preceding book I wouldn’t have approached them in the correct spirit of attention and curiosity.

Hmmm, if I’d assigned a gestalt rating it would have been higher than what I now think is merited based on the subscores.  I deliberately wrote this mostly before trying the exercises, so I can’t give an effectiveness score.  If you do decide to try it, please let me know how it goes so I can further calibrate my reviews to actual effectiveness.

 

You might like this book if…

…you suffer from chronic pain or musculoskeletal issues, or find the mind-body connection fascinating.

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