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People with brains

By Timothy Cocks Philosophy of pain 11 Sep 2015

Nice research out of King’s College London this week, reported here:

Dynamically Tweaking Neurons

“Computers are often used as a metaphor for the brain, with logic boards and microprocessors representing neural circuits and neurons, respectively. While this analogy has served neuroscience well in the past, it is far from correct, according to the researchers from King’s. They suggest that the brain is a highly dynamic, self-organising system, in which internal and external influences continuously shape information processing ‘hardware’ by mechanisms not yet understood, and in a way not achieved by computers.” (emphasis added)

The timing is interesting, after a week in which some Twitter debate arose as to whether a ‘person’ was merely an illusion constructed by a brain, or whether a person had a brain (along with all the other organs and physical bits) and in this way existed as a living, sentient, acting, whole human being, in the world.

Falling into the latter camp, I was moved to share an excellent paper by Evan Thompson which discusses the enactive approach to mind and humans:

“According to the enactive approach, the human mind is embodied in our entire organism and embedded in the world, and hence is not reducible to structures inside the head…

The human brain is crucial for these three modes of activity, but it is also reciprocally shaped and structured by them at multiple levels throughout the lifespan

If each individual human mind emerges from these extended modes of activity, if it is accordingly embodied and embedded in them as a “dynamic singularity”—a knot or tangle of recurrent and re-entrant processes centered on the organism (Hurley 1998)—then the “astonishing hypothesis” of neuroreductionism—that you are “nothing but a pack of neurons” (Crick 1994, p. 2) or that “you are your synapses” (LeDoux 2002)—is both a category error and biologically unsound.

On the contrary, you are a living bodily subject of experience and an intersubjective mental being.” (emphasis added)

The idea that the brain is “a highly dynamic, self-organising system, in which internal and external influences continuously shape information processing ‘hardware’” as put forth by the King’s College researchers seems to dovetail nicely with the enactive view.

I’ll be writing about the paper that launched the original Twitter debate next week.

-Tim Cocks

 

 

comments

  1. Thank you for a beautiful thought provoking “being remodelling” piece. We are more than what we think we know we are……
    DB
    London😎

  2. I like Alva Noe’s phrase that” the world turns up for us”. I assume all therapists would embrace the enactive philosophy.However I am currently struggling through Bud Craig’s paradigm shifting “how do you feel”.Its a brilliant work of his lifetimes neuroanatomical findings.It states that emotions and pain are interoceptive autonomic functions (not ending in the somatosensory cortex but the insular and anterior cingulate,which was a bit of a revelation). It is a homeostatic mechanism ,there,fundamentally to conserve energy.
    This I feel puts us into the world of worker ants,being guided by our fundamental requirement of survival.

    1. Hi Graham
      Thanks for stopping by. I’ve long been a fan of Alva Noë’s work – I think his arguments are cogent and compelling, although I struggled with them to begin with.

      I’m only passing familiar with Bud Craig’s work, but i suspect that he might be quite ‘brain bound’. The obvious question in my mind that stems from his work is how does activity in the insular and ACC give rise to subjective experience (ie, the classic ‘hard problem’)?

      Taking this a step further, based on thinking from Kevin O’regan (a former collaborator of Noë’s) what is different about the activity in Insular and ACC compared with activity in the primary somatosensory cortex, or any other bit of cortex? And why/how does activity in one area give rise to subjective emotions/pain and in another the subjective experience of touch. This line of questioning leads to an infinite regress that is a huge challenge for theories like Craig’s!

      As Noë has suggested, maybe we are looking for consciousness (subjective experience) in the wrong place (the brain) and we need to get ‘out of our heads’ and look for consciousness in the dynamic interaction between the animal and its enacted world.

      As Noë and other philosophers of mind have pointed out, scientists, especially neuroscientists often work with implicit philosophical stances that are unquestioned – eg the brain is sufficient for consciousness, which has replaced Descartes’ ‘res cogitans’ – the thinking substance inside of us that does the thinking, with the brain, as the ‘thing’ inside of us that does the thinking. This still leads to a dualism and in no way address the hard problem. While Craig suggests that emotions and pain interoceptive autonomic functions with homeostatic mechanisms to conserve energy, Craig’s theory does not (and can not??) even begin to explain why these homeostatic functions are associated with ‘anything that it is to be like’ or subjective experience at all. Or, why some homeostatic mechanisms are apparently accompanied by subjective experience (pain) while others (responses to increasing arterial CO2) do not.

      I reckon we are at least a few steps up from worker ants!

      Thanks again
      Tim

  3. I admit I haven’t read Crick’s book, but this doesn’t sound like the “Astonishing Hypothesis” to me. According to Wikipedia, the AH is the claim that “a person’s mental activities are entirely due to the behavior of nerve cells, glial cells, and the atoms, ions, and molecules that make them up and influence them.”

    Thus is a more defensible claim than people are “nothing but a pack of neurons” which obviously isn’t literally true and must have been stated in some metaphorical way.

    And is it really “contrary” to the AH ( or anyone’s understanding) that a person is a “living bodily subject of experience and an intersubjective mental being.”? That is just a fancy way to say that people are conscious, alive and interact with their environment, which are trivial facts that everyone admits.

    And even if Thompson is right in his (extremely esoteric) criticisms of the mainstream approach to neuroscience, what practical implications does this have for people who treat pain? What pain states are better explained by Thompson’s model than, say, the neuromatrix? What novel predictions does this approach make and how would they be tested? How would a therapist who subscribes to enactivism treat patients differently than one who treats patients according to a “reductive” model like the neuromatrix.

    And one more question: would you say that Explain Pain and the Protectometer are more aligned with the conventional approach of Crick, or the radical approach of Thompson? I would say conventional (and that’s a good thing.)

    1. Hi Todd

      Thanks for your thoughts and comments.

      Francis Crick states that ‘The Astonishing Hypothesis is that “you,” your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behaviour of a vast assembly of nerve cells and their associated molecules. As Lewis Carroll’s Alice might have phrased it: “you’re nothing back a pack of neurons.” This hypothesis is so alien to the ideas of most people alive today that it can be called truly astonishing’ The Astonishing Hypothesis, Touchstone Edition 1995 pg 3.

      I admit, I haven’t read the Wikipedia entry, but someone adding “glia, atoms,molecules and ions” doesn’t seem to change Crick’s own chosen summary of his hypothesis that we are nothing but a pack of neurons.

      When Lewis Carroll’s Alice says “You’re nothing but a pack of cards” she quite literally means that the ‘people’ she was talking to were a pack of cards. I’ve always taken it that Crick was talking quite literally too.

      I would argue that Crick’s astonishing hypothesis is very much contrary to an enactive view of life and mind – in fact it is the very antithesis to an enactive approach. The AH is entirely brain bound – you are your brain and brains are necessary *and* sufficient for subjective experience. The enactive approach (or similar such as sensorimotor approaches (see Kevin O’Regan) or Alva Noë’s ‘actionist’ theories) suggest that brains are necessary but *not* sufficient, that consciousness cannot be found ‘in the brain’.

      Why are the facts that we are alive, conscious and interact with the environment trivial? Aren’t these amongst the biggest and most complex problems that we face in science?

      In regards to what practical difference an enactive approach makes for people who treat others experiencing pain – who can say? This ultimately is up to each individual. What difference does the neuromatrix theory make? Perhaps the answer is on the scale between all the difference in the world and none – it depends on the individual therapist. But might it make a difference if a therapist approaches a person as ‘just a pack of neurons’ compared to a whole person – an embodied agent embedded in the world? If we are ‘just a pack of neurons’ why not just remove those neurons ‘responsible’ for pain? Is it possible that the AH, historically implicit in the thinking of pain science for such a long time, has led to this erroneous thinking?

      How do you think the neuromatrix explains pain, let along chronic pain? If there is such a ‘thing’ as a “Body-Self Neuromatrix” that outputs things (pain perception, action and stress regulation programs) where does it output these ‘things’ to? Who or what is doing the perceiving of pain? If it isn’t the Body-Self Neuromatrix then we have another (albeit updated) dualism, do we not?

      This is not to suggest that the enactive approach fundamentally explains pain – I think the jury is still out on the whole consciousness thing. However the enactive approach encourages re-thinking of the nature of subjective experience which should change the way that science approaches the problem – rather than looking for pain in the brain, researchers might consider the broader dynamic interaction of the animal in its environment.

      I think that an enactive approach better predicts the effect of environment and context on subjective experience. Some very interesting work along these lines has been undertaken by Dr Abby Tabor – http://www.bodyinmind.org/wp-content/uploads/1-s2.0-S0304395913002509-main.pdf. I can see no way that the neuromatrix approach could predict or explain these findings. Abby’s PhD thesis extends this work even further, and there is at least one further paper in peer review for publication.

      Dr Mick Thacker has also recently written an editorial (not without some controversy as it turns out) that questions the ‘brain bound’ perspectives of looking for pain in the brain. It’s open access and worth a read – http://www.ingentaconnect.com/content/ppa/pr/2015/00002015/00000039/art00002

      “We are/should be a profession based on the three E’s of human existence – that is, we are embodied, embedded and enactive. This perspective sees the person for what they are, a sentient and salient agent that is both influenced by, and has
      an influence on their world and in so doing, perceives and acts as appropriately as possible to different situations and stimuli. These processes involve the whole person not just their brain.”

      Again, how a therapist would treat a patient differently with the above understanding compared to a reductive, neurocentric model is up to each individual therapist.

      I’ve seen a line of argument along the lines of “what clinical difference does this even make” in relation to Mick’s editorial and frankly, I really don’t get it. Beyond pain, questions of consciousness, subjective experience, and various approaches to mind, are fundamental to understanding humans and the kind of lives we live. If therapists think don’t this is relevant to clinical practice, then I’m simply astonished. I’m not suggesting that all Therapists have to go out and read Karl Friston’s theory of free energy or Jakob Hohwy’s papers on the Bayesian Brain, but Alva Noë’s ‘Out of our heads’ or Andy Clark’s ‘Being There’ are very accessible and not esoteric at all and might just lead to some questioning of underlying assumptions about humans, brains and pain.

      Finally, I would argue that Explain Pain and The Protectometer are moving and have moved (respectively) away from ‘brain bound’ perspectives. Not entirely so, but the Protectometer is collective, emergent, recognises the whole person, their thoughts, their biology, their environment and context – and fits, I think, rather nicely into an enactive account. There are hints too, in the work coming out of BiM (see Abby’s paper above), Lorimer’s own writings (http://www.bodyinmind.org/wp-content/uploads/tha10468_fm.pdf) and humbly, our own little blog, that things may be changing further still.

      Thanks again for some great questions.

      My best
      Tim

  4. Hi Tim, 

    Thanks very much for your detailed reply!

    I want to say that I apologize for the hostile tone of my original comment. Especially in light of recent conversational fails on similar subjects going on via Twitter and SS! Anyway, I find this subject interesting so I got a bit excited.

    Crick may have worded things a bit sloppy in his book, and yes there is something to the idea that cognition involves more than neurons and requires more anatomy than the brain. Certainly a lot of information processing happens in the periphery, and in interaction with the environment. But it seems to me a semantic issue (at least from the perspective of a therapist) whether you call this complex peripheral activity “input” to the brain, or embodied, extended or embedded cognition. And regardless of whether you think brain activity alone is sufficient for conscious experience, NOBODY fails to understand that people are alive, conscious and interact with the environment. That is the sense in which this observation from Thompson is trivial, especially when it is presented as a radical alternative to the mainstream.

    You asked: “What difference does the neuromatrix model make?”
       
    I’m surprised to hear this from a guy from NOI! I would answer that the neuromatrix model helps explain many phenomena that are otherwise very difficult to explain, including but not limited to: why tissue damage doesn’t equal pain; why phantom limb pain exists; various illusions like the rubber hand; why thoughts, emotions, sights and sounds affect pain; placebos; and the counterintuitive results of many of Moseley’s experiments.

    What phenomena can’t be explained by the neuromatrix, but are better explained by the idea that we are “embodied agent embedded in the world?” Isn’t this just a fancy way to say that we can make decisions, have bodies and live in a world? Again, these are facts that everyone knows and no one believes otherwise. Stating them with big words doesn’t explain anything we don’t already know.
     
    You asked: “If we are ‘just a pack of neurons’ why not just remove those neurons ‘responsible’ for pain?”

    Remove? The idea is to change their behavior and firing patterns. That is the neuromatrix approach, and in my mind a reasonable target for intervention. 

    You said: “If there is such a ‘thing’ as a “Body-Self Neuromatrix” that outputs things (pain perception, action and stress regulation programs) where does it output these ‘things’ to? Who or what is doing the perceiving of pain?”

    Who said the neuromatrix is a “thing?” My understanding is that it is a complex dynamic pattern that is constantly changing. Who said pain is a thing? It is a conscious experience. The word “output” is a metaphor. The point of the word is that pain is created by brain activity, not that it is a product or movie that goes somewhere in the brain to be viewed by a little man in a Cartesian theater.

    Thanks for the reference on the Taylor paper. After a brief read, I don’t understand why you see this as proving facts inconsistent with the neuromatrix approach. The idea that pain affects perception is a regular finding from researchers like Moseley and Hodges, each of whom use a neuromatrix framework to understand this relationship. 
     
    I read Thacker’s editorial and had some major disagreements. Here is the response I posted on Facebook.  

    “I love what Mick has to say about the role of the immune system and how it works with the nervous system. The idea of movement being an antigen is awesome. But I have never been a fan of how he applies his philosophical interest in radical embodied condition, or his calling out people for what he calls “mereological fallacies”, which I think is the inspiration for this article.

    I certainly agree with Thacker that telling a client “pain is in the brain” can be threatening, because it sounds like pain is in your head. Personally I never say that for exactly this reason. But the problem with this phrasing is easily understood through exactly the “brain centric” models that he criticizes. Under the neuromatrix model, hearing that “pain is in the brain” can be a threatening “input” that causes the brain to produce the “output” of pain. We don’t need a radical shift in philosophy (e.g. REC) to understand this point. 

    Here’s a crucial line in the paper that I disagree with:

    “Whilst I readily acknowledge that brains are necessary for the perception of pain, the important question is whether they are sufficient?”

    I don’t see that question as important at all to clinicians who never meet brains separate from bodies. Maybe to philosophers it is an interesting thought experiment. Would the brain survive in a vat without a body? If it could, wouldn’t the vat itself be the body? This is about as relevant to therapists as other philosophical problems like: Is the outside world real? Or can we ever gain true knowledge of the world?

    Thacker implies that if we don’t move away from brain-centric models for pain, we will somehow forget that our clients have bodies, or that they are even human beings – that a client is “a sentient and salient agent that is both influenced by, and has an influence on their world and in so doing, perceives and acts as appropriately as possible to different situations and stimuli.” 

    What? Does any therapist really forget that their clients’ are people who make choices and are influenced by their worlds? And the point about perception being influenced by many factors is exactly the kind of consideration the neuromatrix model asks therapists to be MORE aware of, not less.

    In short, I think the article fails to draw any connections between brain- centric models for pain and poor treatment decisions. Perhaps brain-centric thinking is impairing high level research or academic work in some way, but the article doesn’t appear to make that case.” 

    Sorry for the long post and for my rambling. If you read this far you are a champ! 

    1. Hey Todd

      Got to the end – twice. I’ve developed a deep interest in this area and greatly enjoy reading/thinking about other’s ideas – especially when they are in oppostion/contrast/conflict to my own, so I greatly appreciate you taking the time to reply with thought and substance.

      I didn’t get any hostility, just robust skepticism, which is what our aim for this blog has always been.

      As i read around the interwebs, on social media and blogs, and i read therapists suggesting that ‘we/you are our/your brains’ or that as therapists we somehow need to ‘hack the nervous systems’ of our clients, i do think that perhaps some of the focus on brains is leading therapists to forget that they are dealing with whole human beings – not just brain illusions or even “Apps”.

      Crick was a pretty amazing guy, brilliant and a sharp communicator. I doubt that he was sloppy in his book, but for me, he is just wrong.

      I beg to differ that “NOBODY fails to understand that people are alive, conscious and interact with the environment” in realtion to therapy. I’ve walked into enough clinics/medical centres around Australia that are boring, bland, and covered in posters that scream DIMs to make me question whether therapists really understand the potential impact of context and environment. Equally, the hours spent by patients undertaking meaningless movment (“exercise”) in impoverished contexts also make me question this.

      I think, if therapists are already approaching people as “sentient and salient agents that are both influenced by, and have an influence on their worlds – call this holistic (hate that word) biopsychosocial or anything else, then they are already taking a somewhat enactive approach and would reject the outright claim that we are our brains. So yes, the point becomes somewhat moot, other than to elicit some kind of reflection from therapists in regards to their assumptions and beliefs.

      My question “what difference does the neuromatrix model make?”, i think was poorly worded. My intention in asking that was to point out that the neuromatrix theory has made *all* the difference to certain therapists (and researchers) by changing their conceptualisation of pain. I would then further suggest that another change – one that embraces embodiment and enactive thinking (but see below) could equally make all the difference to a therapist. Or it might not.

      NOI is a broad church – we defintily don’t all agree on all things, but we don’t really ‘teach’ the neuromatrix, although EP and other books published by NOI certainly pay respect and homage, rightly so, to the thinking that led to the published work, including, but not limited to, Melzack’s neuromatrix.

      Having read everything i could on the neuromatrix, and then having read the work of Varela, Thopmson, Noë, O’Regan, Clark, Chalmers, Hurley, Hutto, Chemero, Hohwy and others (i don’t mean to name drop, only to point out that there is a really rich body of literature out there on this), I just don’t think that the neuromatrix has any explanatory power. It’s ‘sandwich’ model – input in, processing, output out is a very traditional view of brain ‘computation’ and doesn’t float my boat. The neuromatrix is a schematic that has been very quickly adapted, copied, reprinted and added to countless power point slides, but i fail to see what it explains- really explains. I don’t think it explains *why* thoughts, emotions, sights and sounds influence pain, it just posits that they do – as “input” into the tri-blade blender in the middle! The neuromatrix doesn’t seem to allow for the vital role of the conceptualisation of pain itself.

      I will take you task (in the most friendly and respectful manner;)) on your “Stating them with big words doesn’t explain anything we don’t already know.” comment – i don’t think this is what Thompson, or anyone else in the field is really doing, and i think it’s and unfair criticism. The language of philosophy of mind is unusal, dense and foreign, but is used very carefully and purposfully to try and minimise confusion around the often itangible concpets that are its subjects.

      On ther Thompson paper, I don;t want to hold this single paper up as a paradigm case of embodied/enactivism. It provided a nice summary of the view and hence my use of it, but it focuses on a fairly narrow case of enactivism. There are many others ( i hope to write about them in the future) that provide a broader base for the view.

      I was being a bit obtuse on purpose in asking why not remove those neurons “responsible for pain” and i understand your response in regards to changing behaviour and firing patterns, but here in lies one of the key issues – the “hard problem” – how/why is it that certain firing patterns give rise to subjective expereince at all? Why are certain firing patterns associated with “something it is like” to experience pain. I don;t think the neuromatrix come anywhere close to even acknowledging, let alone answering this question. Terrance Deacon argues (along with others) that in all of these brain based explanations the “little man” is slipped back in as an implicit assumption that there is someone “in there” doing the ouputing and the perceiving.

      Based on the neuromatrix, I can’t see how the ouput of the body self matrix of pain perception alters the subjective expereince of space. Action and perception are distinct and seperate in the neuromatrix, in embodied/enactive views they are not. I donlt recall Lorimer or Paul Hodges directly citing neuromatrix explanations for findings (certainly not Lorimer recently), but i stand ready to be corrected on this if, as the case may be, i am suffering confirmation bias. I do know, having had conversations with Lorimer, that he thinks the notion that pain has an effect *on* motor control or movement to be a bit daft – and rather that changes in movement are part of the overal response along with pain, not because of it.

      The sufficiency question on brains is at the heart of embodied thinking – brains are necessary but *not* sufficient for subjective expereince, which requires that the brain be embodied, in an animal embded in a world that is has enacted. The fact thattherapists never meet brains seperate from bodies, i think, is strong evidence that “you are nothing but a pack of neurons” is demonstrably false! In terms of embodiment vs ‘envatment’ – Cosmelli and Thompson wrote a paper just on this and suggest that the vat would of course have to be as sophisticated and integrated as our brains and bodies are – so no disagreement.

      For me, Mick is suggesting that we have an opportunity – to enrichen our views of humans and consciousness with some of the projects being undertaken in philosophy of mind (and also in artificial intelligence) and avoid a slippery slope of relpacing the erroneous “pain is in the tissues” with a heuristic of “pain is in the brain.”

      Reckon I’ve out-rambled you… so I’m gonna stop.

      Loving the thinking required to read and respond. As I’ve said before on this blog, I’m quite happy to discuss, even in the face of no one changing their position (I’m certainly not trying to convince or edumacate you), as i think that there is deep learning to be had.

      With deep thanks and respect, from one sentient and salient agent in the world to another,
      Tim

      PS- for whatever reason chrome’s spellchecker isn;t checking this, so apologies for a likely litany of spelling and grammatical errors.

  5. Hi All,

    I sympathize with the hyothesis that we are just a pack of neurons. But to be more accurate, I’d say “we are just the output of a bunch of neurons, and in that sense, not real”. It’s another way of saying “people or individuals don’t exist at the deepest level of reality”. I agree that Crick was being completely literal with this expression.

    The thought “I am sitting here” is just a thought. It has no reality beyond the firing of certain neurons. There’s no ‘I’ to be sitting here that’s separate to the thought of it happening. The only real fact is that there is a body sitting here. And yes the body breathes and circulates blood and interacts with the world, but so what? The I-thought can be switched off, and when it is, individuality literally disappears. All that’s left is the body, some mind functions, intellect and a few other thngs.

    Throughout history, various people have managed to inhibit that aspect of the mind which creates the sense of ‘me’ (and hence, individual ownership of the body). Thereafter, there’s just *life happening*,…. no me, no you, just one big unified *happening* which has absolutely no purpose. Only the self is desperate for purpose because it thinks that if it can achieve said prupose, it will appear more solid. The self is always seeking ways to bolster itself since it lives in fear of being uncovered for the illusion that it is.

    EG.

    1. Thanks EG
      Too exhasuted after my rant above to say anything more… But as we have come to realise, we are (happily i think) in disagreement on matters of reality and probabaly selfs – i suspect that you are much more comfortable with getting closer to a solipsistic postion than i aim
      My best
      Tim

  6. Hi Tim,

    Thanks for the well thought out reply and kind words. I appreciate the back and forth.

    You said:

    “I read therapists suggesting that ‘we/you are our/your brains’ or that as therapists we somehow need to ‘hack the nervous systems’ of our clients, i do think that perhaps some of the focus on brains is leading therapists to forget that they are dealing with whole human beings – not just brain illusions or even “Apps”.

    I disagree with Diane that “we are our brains” (if that is her position). And with Thacker in regard to “mereological fallacies.” But I think the whole debate is virtually meaningless on a practical level. Thacker seems to believe that thinking in a “brain bound” manner will somehow cause us to forget that clients are actually people. But Diane’s therapeutic style is exactly the opposite – she is an “interactor not operator” and emphasizes treating clients with high levels of respect, sensitivity and empathy. This is presumably the exact type of attitude Thacker would recommend. It’s a good example of the irrelevance of certain (but not all) philosophical stances for what actually happens in therapy.

    When people use phrases like “hack the nervous system” or install an “app” on the brain they’re using the computer metaphor to help understand pain perception. Metaphors can illuminate but they can also lead us astray, so we need to be aware of their limitations. Obviously brains are not digital or serial in their information processing, they are made of wetware not hardware, they are complex dynamic adaptive systems, etc. But nevertheless, the computer metaphor has been very useful to cognitive science, and it is a great way to understand the function of the nervous system. Maybe we will need to abandon it to go further, but many bright people like Gary Marcus, Dan Dennett and Steve Pinker disagree. In any event, I think it is misguided to imply that every instance of using the computer metaphor indicates some sort of fallacious thinking.

    You doubt Crick was sloppy in his writing? He must be a much better writer than Sapolsky then right?:)

    You said: “I beg to differ that “NOBODY fails to understand that people are alive, conscious and interact with the environment” in relation to therapy. I’ve walked into enough clinics/medical centres around Australia that are boring, bland, and covered in posters that scream DIMs to make me question whether therapists really understand the potential impact of context and environment.”

    Therapy is not boring because therapists fail to understand that people are alive. If you told boring therapists that their clients are alive they would say: Umm we know that. You could, as you point out, help them by giving them a better understanding of the “impact of context and the environment.” And this could be easily done with a conventional neuromatrix style or BPS model stating that environment is one of the inputs that affect pain. How would you explain this idea to them from the enactivist perspective? Maybe they would get some insight by doing a ton of work and reading books by Clark, Noe etc. But you are not expressing that insight by pointing out that clients are alive, conscious, have agency, and interact with the environment. Again we already know this.

    I need to go for now but I will address the rest of your post later. Thanks again for the conversation.

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