The Alien View: Consilience in Physical Therapy

Barrett L. Dorko, P.T.


E.O. Wilson’s latest book, Consilience: The Unity of Knowledge (Vintage Books 1998) presents many ideas perfectly relevant to any thorough discussion of the deep model of human functioning. I wanted to say a few things here about what this might mean to therapy’s search for a greater understanding of painful problems.

Wilson defines Consilience in this way: “Consilience is the key to unification. I prefer this word over “coherence” because its rarity has preserved its precision, whereas coherence has several possible meanings, only one of which is consilience. William Whewell, in his 1840 synthesis The Philosophy of the Inductive Sciences, was the first to speak of consilience, literally a “jumping together” of knowledge by the linking of facts and fact-based theory across disciplines to create a common groundwork of explanation. He said, “The Consilience of Inductions takes place when an Induction, obtained from one class of facts, coincides with an Induction, obtained from another different class. This Consilience is a test of the truth of the Theory in which it occurs.”

“The strongest appeal of consilience is in the prospect of intellectual adventure and, given even modest success, the value of understanding the human condition with a higher degree of certainty.” (Note from Barrett: I really like Wilson’s concession to uncertainty here. He reminds us in this way that science is about making the best possible sense out of a given series of observations. It is not about “knowing” anything for sure every time you propose something.)

Later in the book Wilson writes about a typical colony of ants. He wrote an entire book entitled “The Ants” a few years ago, so I assume he’s an expert.

…Scores of biologists working independently established that ants organize their colonies with many chemical systems like those used to transmit alarm. Their bodies, we discovered, are walking batteries of glands filled with semiotic compounds. When ants dispense their pheromones, singly or in combination and in varying amounts, they say to other ants, in effect: danger, come quickly; or danger, disperse; or food, follow me; or there is a better nest site, follow me; or I am a nestmate, not an alien; or I am a larva; and on through a repertoire of ten to twenty messages, with the number differing according to caste (such as soldier or minor worker) and species. So pervasive and powerful are these codes of taste and smell that all together they bind ant colonies into a single operational unit. As a result each colony can be viewed as a superorganism, a congeries of conventional organisms acting like a single and much larger organism. The colony is a primitive semiotic web that crudely resembles a nerve net, a hundred-mouthed hydra writ large. Touch one ant, one strand of the net, and the displacement spreads out to engage the communal intelligence.” (Note from Barrett: I love this “crude nerve net analogy.)

Wilson points out that in the previous paragraph (and in a subsequent one where the molecular structure of various pheromones is discussed) “We have crossed four levels (in our understanding)-superorganism to organism to glands and sense organs to molecules.” He asks: “Is it possible to travel in the opposite direction, predicting the outcome without advance knowledge of the biology of ants?” He concludes that you can, at least with respect to some broad principles. He does however offer this observation about such thinking as well: “These predictions, or educated guesses if you prefer, qualify as consilience by synthesis. With some puzzling exceptions, they have been confirmed. But biologists cannot predict from physics and chemistry alone the exact structure of the pheromone molecules or the identity of the glands that manufacture them. For that matter, in advance of experiments, they cannot stipulate whether a given signal is used or not used by a particular species of ant. To attain that level of accuracy, to travel all the way from physics and chemistry near the entrance of the labyrinth to an end point in the social life of ants, we need detailed collateral knowledge of the evolutionary history of the species and of the environment in which it lives.” (Note from Barrett: This takes into account things like secondary gain which would be invisible to the deep model but essential for even more certain understanding of what we see and hear from the patient.)

If you’re still with me, this is what I’m proposing: Physical therapy procedures for painful problems have rarely contained a reasoning that “traveled in the opposite direction” as is so clearly explained by Wilson. Instead, they commonly employ a “from the outside in” method of thinking that ignores the full reality of painful sensation. Instead of considering the subtle brain chemistries that might contribute to something like central sensitization, they look at the muscular activity evident to palpation and make all kinds of assumptions about its meaning without actually considering the many contributions of the nervous system and its vast chemistry. Therapy without such careful and well informed thought is little more than personal training, and poorly done personal training at that. I think that this is how we’ve arrived where you see us today; clinics where people in pain have their exercises counted for them by somebody other than a PT, and no real time is ever spent in unique and personal caring for individual problems. Protocols developed for generic problems (there is hardly such a thing) for all “typical” patients (no such thing) drive the system.

A movement in our thinking toward Consilience would change this drastically, and that’s what I’m hoping we’ll see one day.

There’s a question I ask all my classes now, and I hope it haunts them: If an intelligent, alien life form were to carefully observe the human animal as Wilson suggests, much in the same way we have studied ants, would they be surprised to see patients in pain given strengthening exercises and little else for their problems?