other dreams

I have, in the latest book, got to The Obligatory Page And A Half On Descartes, but this one makes a point of describing it as a "reductionistic approach".

The Thing Is, of course, that much like the Bohr model (for all that's 250 years younger, give or take), for many and indeed quite plausibly most purposes, The Cartesian Model Of Pain is, for most people and for most purposes, good enough: if you've got to GCSE level then you'll have met the Bohr model; if you get to A-level, you'll start learning about atomic orbitals; and then by the time I was starting my PhD I had to throw out the approximation of atomic nuclei as volumeless points (the reason you get measurable and interpretable stable isotope fractionations of thallium is -- mostly! -- down to the nuclear field shift effect).

Similarly, most of the time you don't actually need to know anything beyond the lie-to-children first-approximation of "if you're experiencing pain, that means something is damaging you, so work out what it is and stop doing that". The Bohr model is good enough for a general understanding of atomic bonds and chemical reactions; specificity theory is good enough for day-to-day encounters with acute pain.

The problem with specificity theory isn't actually that it's wrong (although it is); it's that it gets misapplied in cases where Something More Complicated is going on in ways that obscure even the possibility of Something More Complicated. The problem, as far as I'm concerned, is that it doesn't get presented with the footnote of "this isn't the whole story, and for understanding anything beyond very short-term acute pain you need to go into considerably more detail". But most people aren't in more complex pain than that! Estimates run at ~20% of the population living with chronic pain, but even if we accept the 43% that sometimes gets quoted about the UK, most people do not live with chronic pain.

There's probably an analogy here with the "Migraine Is Not Just A Bad Headache" line (and indeed I'm getting increasingly irritated with all of these books discussing migraine as though the problem is solely and entirely the pain, as opposed to, you know, the rest of the disabling neurological symptoms) but I'm upping my amitriptyline again and it's past my bedtime so I'm not going to work all the details of that out now, but, like, Pain Is Not Just A Tissue Damage, style of thing.

Anyway. The point is that I still haven't actually read Descartes (I've got the posthumously published and much more posthumously translated Treatise on Man in PDF, I just haven't got to it yet) and nonetheless I am bristling at people describing him as reductionist (derogatory). Just. We aren't going to do better if we also persist in wilful misunderstandings and misrepresentations for the sake of slagging off someone who has been dead for three hundred and seventy-five years instead of recognising the actual value inherent in "good enough for most people most of the time", and how that value complicates attempts at more nuance! How about we actually acknowledge the reasons the idea is so compelling, huh, and discuss the circumstances under which the approximation holds versus breaks down? How about that for an idea.

Sarah Russell of The Ostomy Studio, the person who made such an enormous difference to my general State Of Being just over a year ago via the medium of a private Pilates lesson pre-surgery, has just announced publication of the new Exercise and Physical Activity after Stoma Surgery best practice guidelines that she's been working on for literal years along with some amazing collaborators!

The principles here are the bedrock for the private lesson I had before surgery, and are also what I used as my foundation for rehab despite not after all needing to work with a stoma; I've not read them in full, but if you know folk they might be of interest to then please do pass the link on <3