M ssing L nks

As the years roll by, we accumulate a variety of techniques (“tools”) to apply in the clinic, but when the time to (maybe) utilize these “tools” comes there can arise dissonance in melting together rationales for which “tool” to pull from your “toolbox”. [I’m not a big fan of calling various treatment options “tools”, but let’s stick with it for now] How do we make sense of the different conceptual frameworks and rationales for application of any treatment options? Most of us would likely fall back into our old rut of “that’s what I always did before”. That old rut is immersed in the murky waters of psychological bias and fear of change.

Everyone needs a core set of beliefs to hold onto during challenging times. The thing is, I don’t think we employ these beliefs simply during challenging times, instead it becomes a daily habit. A comfortably familiar choreography of thoughts and actions free us from the thought of “I might be wrong” and the possibility of “I should change how I approach, think about, or perform X”. The question is: “How do we help ourselves get comfortable with assimilation of the new and the novel without feeling lost?”

Having a set of core concepts is essential to germinate a decision tree that can guide you through the decision-making process. The tree then develops branches based on various approaches and styles. As these branches grow, so do the biases and spells of indecision. These branches develop into silos of thinking that never (or rarely) seem to connect, resulting in aisles of thinking models that appear entirely independent. It suddenly seems Black & White, while the reality is that much of the magic happens in the Grey.

A system of connections might allay – and possibly solve – the problem of these monocultures of the mind. Our decision tree doesn’t have to grow branches entirely independent of each other, instead these branches could communicate to each other via context dependent “inter-branches”.

Charlie Munger says it best: (from http://hurricanecapital.wordpress.com/mental-models/)

l’ve long believed that a certain system which almost any intelligent person can learn – works way better than the systems that most people use. What you need is a latticework of mental models in your head. And, with that system, things gradually get to fit together in a way that enhances cognition. However, my particular approach seldom seems to get through, even to people of immense ability. Things usually die after going to the ‘Too-Hard’ pile.

Physical therapy has seen it’s share of explanatory models enjoy their moments in the spotlight, and I’m sure new models will develop in the years ahead claiming greater influence than the preceding models. While none of these models are complete, they do reflect elements of practicality and applicability. Problems arise when passions of the latest models grow into obsessive academic drumbeats. Suddenly all prior developments are overturned and the flag of the latest explanatory model is waived over the heap of “outdated” concepts.

Models are approximations of reality. Reality is far too complex to fit neatly into one model. Therefore, the linking of one model to another in a fashion that allows corroboration of findings and concepts might lead to a greater and deeper understanding than doggedly holding onto one approximation of reality. Whenever new explanatory models arise it seems as if prior models are declared patently false and any links are immediately dissolved (much to our detriment). We’ve effectively turned ourselves into the Man-with-a-Hammer Syndrome: “To the man with a hammer, every problem looks like a nail.”

So, how do we resolve these Missing Links and create a Latticework of Models with which to filter and distill the reality around us? From Munger’s 1994 Speech at USC Business School:

Well, the first rule is that you can’t really know anything if you just remember isolated facts and try and bang ‘em back. If the facts don’t hang together on a latticework of theory, you don’t have them in a usable form.

You’ve got to have models in your head. And you’ve got to array your experience both vicarious and direct on this latticework of models. You may have noticed students who just try to remember and pound back what is remembered. Well, they fail in school and in life. You’ve got to hang experience on a latticework of models in your head.

What are the models? Well, the first rule is that you’ve got to have multiple models because if you just have one or two that you’re using, the nature of human psychology is such that you’ll torture reality so that it fits your models, or at least you’ll think it does…

It’s like the old saying, “To the man with only a hammer, every problem looks like a nail.” And of course, that’s the way the chiropractor goes about practicing medicine. But that’s a perfectly disastrous way to think and a perfectly disastrous way to operate in the world. So you’ve got to have multiple models.

And the models have to come from multiple disciplines because all the wisdom of the world is not to be found in one little academic department. That’s why poetry professors, by and large, are so unwise in a worldly sense. They don’t have enough models in their heads. So you’ve got to have models across a fair array of disciplines.

You may say, “My God, this is already getting way too tough.” But, fortunately, it isn’t that tough because 80 or 90 important models will carry about 90% of the freight in making you a worldly wise person. And, of those, only a mere handful really carry very heavy freight.

Rather than clinging to the latest explanatory model with dear life, let’s leverage this model on the shoulders of previous models. Inoculate yourself from the “Man with a hammer” silliness by linking models together via a Latticework Approach. Connect the dots.

“We’re really good at taking a single sample and blowing it out of proportion. We need to get better at putting single samples into context.” – Carl Richards

The same can be said of applications of models. Let’s adapt that quote for the purposes of this post:

We’re really good at taking a single [model] and blowing it out of proportion. We need to get better at putting single [models] into context.

[Update] – Jason Silvernail just shared with me his article for The Journal of Manual & Manipulative Therapy titled “Manual Therapy: Process or Product?” It rhymes with the thrust of my post, and is well worth the read.



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