I do not think that the classic notions of the AT are sufficient to explain it's benefits.
The AT help students to improve the use of themselves. AT does not claim to help with pain - or any particular benefit. However, both scientific and anecdotal evidence suggests that students can expect less pain. But how is this? Why might they expect less pain?
I have suggested that AT teachers no longer use the word "pain". The word suggests that a bodily sensation can be separated from the rest (emotions, intellect, etc) of the person. Alexander was very clear that this can not be done. I have suggested that the state of extreme negative physical sensation + emotional distress + tortured thoughts should be called "suffering".
I believe that in addition to claims that AT student will have better use, that it is reasonable, based on science and anecdotal evidence, that the AT can help prevent 'suffering'.
How is this?
The AT teacher is trained to notice how people use their bodies, both with their hands and visually. When a student reports less suffering, and the teacher notices better use of their body, the AT teacher might jump to the conclusion that better use is the cause of less pain/suffering. Of course, it makes sense that better use would lead to less unnecessary tension, improved sensory appreciation, greater efficency, and new tools to organize oneself in order to abandon old patterns and learn new skills. So the case that the AT helps with 'suffering' by way of improved physical use really sounds compelling.
Yes, better use and less pain/'suffering' occur together. But correlation does not prove causality.
I propose that the AT helps with suffering by blocking the progression from stimulous to suffering.
As I have writting in my previous posts, specific steps need to be followed to get from sensation to suffering. These steps might be sensation, separation, aversion and then suffering.
I have claimed in my previous posts that the persistent and energetic direction of the primary control will block this process. Sensation, regardless of how sudden and severe, will not develop into suffering if one has sufficent direction. I have said this is a huge contribution that FM Alexander has given anyone who wishes to suffer less when confronting difficulties.
Zen Buddhists, who stress ending suffering, should take particular attention. Zen teaches the pracice of 'inhibition of end-gaining' or 'stopping' as the means to end suffering. This is fully supported by AT. But I am suggesting another pathway - which anyone can learn to employ.
What evidence do I have for the claim that AT students have less suffering primarily through blocking the development of suffering through direction as opposed to having less pain as the result of better physical use? The scientific evidence is very thin. But there is evidence to support my assertion.
Let us look at the best study on the AT and pain, the ATEAM study published in the British Medical Journal. The most sited primary outcome was an 86% reduction in days in pain compared with the control group. I imagine that most AT teachers would assume that this was due to improvement in physical use. The assumption is that those who learned the technique went about their lives reaching, bending, sitting, etc with greater ease and efficiency and as a result they had less pain.
With greater ease and efficiency there should come less disability. In the ATEAM study disability would seem a surrogate marker for improved use. One would assume about the same improvement in disability and with pain.
But this was not so. There was "only" a 42% reduction in Roland disability score. Still a huge benefit, but only about half of the benefit seen with days with pain: the pain benefit was double the improvement in disability.
This suggests a second mechanism of action that helps with pain. If better use/less disability accounted for only half the pain benifit, what other mechanism could be playing a role?
I propose that those who had studied the AT learned a valuable skill, and that is direction, specifically direction of the primary control. They still had some degree of sensation from their still somewhat disabled back. But with the tool of direction they prevented the sensation from progressing to suffering. Without suffering they reported less pain. And this pathway accounts for the other half of the pain reduction reported in the study.
I realize there are ways to criticise these statements and the evidence is thin.
However, based on the above, an AT teacher should consider telling prospective students that it is reasonable for them to expect less suffering through improving the use of themselves. AND, in addition, students will acquire tools to suffer less as life sends them the challenges that flesh is heir to. Students can acquire two highly effective pathways to maintain poise in the face of any noxious stimulous you might experience, and to prevent that stimulous from producing suffering.
Regarding the question of whether pain is a separate sensation... a vipassana (Buddhist) teacher, Shinzen Young, talks about an ability to make distinctions between sensations as a useful tool to reduce suffering. For instance, being aware of the physical pain as one thing, the thoughts as another thing, and the emotions as another thing. When they mix in the attention is when their power to create suffering intensifies.
ReplyDeleteMore fundamentally, does using the word "pain" to describe a physical sensation in some way detract from an ability to be aware of the whole of oneself? Let me make an analogy. Suppose we are looking at a color painting. It uses red, green, and other colors. The emotional power of the painting is in the whole thing. It is a unity. But to be able to say, "This spot is red, and this spot is blue" does not in any way reduce the power of the painting as a whole. In fact, it can enhance it. It is one aspect of mindfulness to be able to make distinctions between sensations.
In my previous comment, I think I misunderstood you. My apologies. You are talking about the sensations of pain as something separate from suffering.
ReplyDeleteAre you familiar with the neuromatrix theory of pain, orginated by Ronald Melzeck? I don;t know how close it comes to your distinction between 'pain' and 'suffering' but it does seem to be relevant. His basic argument, as I understand it, is that pain is a complex response of the brain that may only be indirectly linked to actual conditions in the body. It helps explains things like phantom pain, but it is also relevant to a richer understanding of how we experience what we call pain.
ReplyDeletehttp://ipcoregon.com/pdf/pain_and_the_neuromatrix_in_the_brain.pdf
Your idea that directing might not so much change objective bodily conditions as how the brain deals with it (I think that's what you are saying) is very interesting and stimulating. However, there are other, possibly simpler, explanations for why the ATEAM study should have shown roughly twice as much reduction in pain as disability (and I hadn't noticed this before - thanks). Direction changes use at a very subtle level. The disability index is a rather cruder measure than the pain one, so that the benefits of the AT lessons might be more easily picked up by the latter than the former. I'm inclined to the view that direction does actually change objective bodily conditions, just more subtly than we are used to measuring them. But, as you say, all this is a matter of opinion, and you raise a very stimulating question.