Curiosity in the Context of Pain: Part 2 #BTCP

What do physiotherapists think of when they think about curiosity? Why would physiotherapists care or even need to think exclusively about the word? It can be argued that Physiotherapy is a profession that has harnessed curiosity since its genesis in the late 19^th century. Curiosity itself has been compared to the inherent behaviour of hunger. Like hunger, curiosity rises and falls depending on context (Lau et al., 2018). Curiosity would most definitely have had a role to play when four London-based nurses and midwives formed the Society of Trained Masseuses in 1894, which later became the Chartered Society of Physiotherapy in 1917 (Nicholls, 2017).

In Part 1, I briefly discussed curiosity and it’s style - the acquisition of knowledge.  I explored curiosity in the context of physiotherapy, less so in the context of pain. Ultimately, there was a reason for this. Understanding physiotherapy’s origins and its relationship with curiosity provided the heuristics for its approach to physical rehabilitation. Modern critiques would suggest that the affinity with the biomedical / biomechanical model at the time the profession was formed, was an important step for the profession towards securing its future (Nicholls, 2017). However, with such a strong, and rather narrow-minded attachment to biomedicalism, it has been commented upon that physiotherapy is in a very weak position to be able to evolve into anything more than the fateful proposals made by the 4 British nurses and midwives in 1894 (Nicholls, 2017).  Ultimately, the guillotine, albeit slowly (and has now rapidly picked up pace) had begun to fall once physiotherapy was founded.

Returning to the previous example comparing curiosity and hunger, if curiosity rises and falls in relation to the acquisition of knowledge then undeniably it is valuable to humans. It is valuable to physiotherapy for its legitimisation. In this sense it is teleological. Curiosity as an acquisition of knowledge delivers outcomes, it delivers diagnostic clarity, and refines our reasoning processes. Our lives as clinicians get better, as do patient’s lives, when they get better. In the context of injury and pain, the gap of uncertainty between what we know and what we want to know reduces as we acquire information.

The information gap theory proposed by George Loewenstein in 1994 (Loewenstein, 1994) bears a strong inclination towards the success of the profession at a disciplinary and legitimacy level, and at a clinical level through the processes of critical thinking and reasoning. The contentious issue for curiosity in physiotherapy is that it has only ever served a biomedical / biomechanical view of the body. On a superficial level one might view this as a curiosity about the body. It is a perspective that reduces people to atomised physical matter. In contrast at a deeper level one might view the body from a position of curiosity with; that is a connectional force rather than an acquisitional one.

So how does a physiotherapist embrace a connectional curiosity? How do they identify the differences between acquisitional and connectional curiosity?

Work by Zurn et al., (2021) propose that where curiosity is described as an acquisition of knowledge, a question lingers regarding the constituent parts of knowledge. They write,  “An acquisition (or collection) of informational bits does not constitute knowledge.’ (pg.3.) and that ‘Knowledge requires an understanding of the relations between bits of information: relations of cause, of correlation, and of consequence, to name a few.’ (Pg.3.)

Zurn and colleagues are inquiring about how and in what ways can humans reconcile curiosity from the acquisitional with the connectional? Rather than an extinguishing of curiosity when information gaps are “supposedly” closed, projections remain open, silent, sparked into life when curiosity is ignited once more.

Interestingly, this bears parallels with how we currently view pain. There is a perpetuating imbalance between how clinicians and people living with pain engage in reconciling what pain is. Frustratingly, for people living with pain, a clinician explaining what pain is to the person living with pain could be received as condescending. Pain is not mere pain biology. Yet a large part of what physiotherapy emphasises is the biological nature of pain. Anyone who has experienced pain whether acute or chronic has likely never thought or attempted to reconcile the biological mechanisms involved in the sensation or experience that is called pain. Similarly, we don’t think about the biological mechanisms that are involved in our heartbeat, or the biological mechanisms involved in our kidney’s filtering our blood. The uniqueness and enigmatic process of our bodies don’t require our conscious attention, so why would we think the biological mechanisms of pain requires this amount of attention? This is not to say that living with a persistent ache or pain doesn’t bear questions from the sufferer, such as, “why is this not settling down?” It also isn’t suggesting that biological processes are not involved, it would be naïve to think this since we are biological organisms.

The objectification of bodies to atomised physical matter does not explain the humanness of what it is like to experience pain, much like any experience we have. We all know what it’s like to taste a really rich and decadent chocolate cake, sometimes we are unable to explain what we experience. If we atomize this experience to biology and chemistry we lose that sense of something we experience, it becomes sterile and meaningless. An objectification is a curiosity about rather than a curiosity with.

In this sense, Curiosity about the biology of pain risks a unidirectional explanation of pain from clinician to the person with pain. Is there a curiosity about the biological mechanisms of pain FROM the person living with pain? Only then can we have a curiosity with the person living with pain. Acquisitional curiosity can be self-serving, connectional curiosity builds relations. Unless there is a sense of interest from the recipient to find out about the biological mechanisms of pain, do we risk delegitimizing the person with pain by perpetuating the curiosity about the internal mechanisms and processes of pain? A Curiosity about from the physiotherapists perspective risks assumptions about what people with pain want to know. Many questions float in the ether that are commonly unanswered, specifically questions about the person with pain rather than the body in pain.

Imparting knowledge of pain biology to the person with pain without establishing a curiosity with, satiates our information gap. Contrastingly, the person with pain is left attempting to reconcile information that constitutes 6 years of university training. A curiosity with fundamentally connects. It is the catalyst to building and rehabilitating networks between the human and the outside world. It is transgressive. It is not biology that makes pain real, it is the ensemble of all things that make us human that makes pain real.

It is here we will pause for reflection and finish part two. In part three, I will explore a model of curiosity and attempt a playful experiment of applying it to pain management.

Thanks for having a read

TNP

References

Lau, J. K. L., Ozono, H., Kuratomi, K., Komiya, A., & Murayama, K. (2018). Hunger for Knowledge: How the Irresistible Lure of Curiosity is Generated in the Brain. BioRxiv, 473975. https://www.biorxiv.org/content/10.1101/473975v1.abstracthttps://www.biorxiv.org/content/early/2018/11/22/473975https://www.biorxiv.org/content/10.1101/473975v1.abstracthttps://www.biorxiv.org/content/early/2018/11/22/473975

Loewenstein, G. (1994). The psychology of curiosity: A review and reinterpretation. Psychological Bulletin, 116(1), 75–98. https://doi.org/10.1037/0033-2909.116.1.75

Nicholls, D. A. (2017). The end of physiotherapy. In The End of Physiotherapy. https://doi.org/10.4324/9781315561868

Zurn, P., Zhou, D., Lydon-staley, D. M., & Bassett, D. S. (2021). Edgework : Viewing curiosity as fundamentally relational. PsyArXiv, 1–20.

 [PL1]This needs refining and reviewing and some references