Monday, October 1, 2012

Learner therapist (24)……A little rewiring!!

Learner therapist (24)……A little rewiring!!

Torrey Orton

Oct. 01, 2012


Rewiring, or experience-dependent brain plasticity

The experience

Ten days ago I tripped on the 6 inch front step at the Fertility Control Clinic as I turned from a delivery guy holding a 2 litre milk container and a ½ kg. loaf of bread in my left hand and the day's newspaper in my right. Refusing to let go of the goods, I fell forward catching myself with my full hands. This went fine on the left with the cushion of the milk and bread (which came out of it unscathed) but my right thumb was severely scrunched, still bluish five days later though somewhat less swollen (it still had a bit of bee sting-like puffiness).

I had made two mistakes: starting to move before I had the stuff safely in my grip and preferring the goods over my safety (a bad application of the good training which makes me agile with packages) as I started to fall. This mistake is similar to one 10 years ago when I passed out in a local street, realising just before I did that I was going to do so (that fainting feeling you may have heard about if not experienced) and wondering to myself where I could sit down. By the end of that wonder I was out cold with major skull fracture and headed for a visit to the ER. Should have just sat down on the spot and saved the concussion. Wondering instead about where to sit was habitual action taking over – the latter a pattern dominated by my sense of public propriety not of safety, to my surprise after the fact. What a dumb thing to do.

Rewiring, type one

My present re-wiring focusses around various highly repeated everyday activities like tying shoes, buttoning shirts, writing by hand, opening doors, opening keyed locks, shaking hands and a host of fine-tuning applications which require thumb to index manipulation of objects (winding a traditional watch, opening cardboard milk boxes and chip packages for example). I now know why European door handles are superior to our globular ones. They do not require thumbs.

As the days have passed since the accident, I try the more difficult right-handed tasks like unlocking our keyed front door with a thumbed grip to test the pain involved. Same with shirt buttoning and pants zipping (you can do a calculation of the daily number of events for a man from this list).

Then, there's the clumsiness factor. Winding my watch left handed was impossible from the first night. As a result of my clumsiness, coupled with incapacity (try turning a firmly closed screw top on an unopened, pressurized jar without a fully working thumb), I developed work-arounds like avoiding some tasks requiring a normal right thumb. One set of these was various ways of achieving a near thumb effectiveness between the four fingers of the same hand. For example, turning a door key by gripping it between index and middle fingers. Testing when the lock is sticky! Fall back position: use my left hand.

Do not mistake this for a merely behavioural activity. I have to decide each time what to do…to press on with the left hand cuff button or leave it undone because my thumb's too stiff that morning. Notice, I might get away with buttoning a shirt left handed after a while, but left cuff left handed – not likely in this life. Similarly with fly zipping, door handle turning, sock-pulling (on, up or off). Sometimes I can go for the left hand (door opening especially).

These are all internal negotiations. Over the time since injury I notice that I'm increasingly approaching repeat usages with a pre-emptive awareness – that something (maybe) to be worked around is coming up and I should get ready for it, consider an alternative 'technology' to the old right hand thumb driven one.

Rewiring, type two

As for combination internal and external negotiations of my world, there's the socio-cultural domain of hand-shaking. Shaking hands is a core part of my professional life, done with every patient (until now!) at start and finish of sessions. I find myself breaking this golden rule to avoid the explanatory caution at first encounter (that my thumb has to be protected from shocks) or the experience of a partially withheld shake by someone who knows and unconsciously expects my normally firm, full grip. This simple matter invokes a series of barely registered reflections like:

  • I shouldn't impose my unavoidable shortcoming on the others.
  • The injury draws attention to me rather than where I want it – on them.
  • It's too clumsy (that word now describing interpersonal perceptions and intentions) to mention or do, so don't do it at all.
  • Oh, I forgot to offer my hand…
  • Try the left-handed shake!!
  • ….

Rewiring unstrung

Then, there's accidental re-wounding, the reopening of old wounds perhaps. I did this, too, a few days back by theatre parking under pressure (self-induced more than situational), missing the bay on the first go and retracing my path three meters to have a more direct go, turning the wheel with intense focus and caught my already offended thumb on the wheel's cross strut. Just a little rap, but right on the most injured 2 mm of the first joint which roused that unrelenting, rolling pain which you have to wait three minutes to subside. A morphine worthy event if it had continued.

On the other hand, a nothing event compared to real long term trauma, but instructive for another take on what sustains trauma: accident as much as intent – or, rather, in this case overwhelming of my self-protective intent (stop pain) by my personal achievement intent (get the car in the spot meeting some timeliness and beauty of execution criteria both of which are automatic and were functionally irrelevant at the time)!!

Plasticity is one thing, competence another?

Is it any wonder that all really "hard-wired" habits, those acquired over years in the crucibles of life - family, schools and clubs – are resistant to change even with serious application of focus and energy?? They are really complicated, complex and multi-domainal; they touch most aspects of the patient's life. They are constantly reinforced in everyday relationships which reproduce even the merest inkling of the originally compromising formative experience(s).

A thorough description of the detailed actions of thought and feeling required to relearn to button a shirt effectively (a measure of time, completeness and pain factors all occurring intertwined, not in sequence) could take a page or more. Those of you who recall the history of attempts to completely analyse the process of learning to ride a bicycle may remember that the researchers gave up after they got to around 350 pages of documentation. For an alternative access to these phenomena, watch your child learning such things for the first time, to the point they can successfully dress themselves in one of their normal dress styles. Analysis won't help you or them, but application will and does lead to learning, eventually.

Incongruously, this may be why successful survivals of long term abuse(s) have trouble getting their whole lives together, especially in the relationship domain. But then, who doesn't have this trouble ? I still haven't managed a Windsor knot after all these years, or to successfully avoid self-damage in the pursuit of truth, beauty or justice. I did wind my watch right-handed after one day by finding a purchase on the stem which just hurt a bit, valuing the propriety of wearing my watch over pain reduction. On the other hand buttoning my top shirt button under a tie is still off limits 12 days later.



  1. One description of "presence" is to notice things we usually don't.
    Putting aside the mechanics, and brain placiticity etc., I wonder what you have experienced while grappling to wind your watch clumsily. Were you more present than usual? I bet you had a lot less in your mind about the past or planning for the future, you were most likely highly absorbed in those moments of struggling to wind your watch; or buttoning your top shirt button, .... Be great if you can post on that too.

    1. H - I've thought about this since your request and can't see quite what I should add that would get the aspect you are looking some help here would be good, since I'm open to trying...just need direction