Psychotherapy Out of Bounds

PSYCHOTHERAPY Out of Bounds, continued
A Realistic Tic
Perry was referred to Felicity for treatment of his severe spasmodic torticollis. That means that the muscles at the back of his neck and shoulder kept tensing suddenly, twisting his head sharply around to the right through almost 90 degrees of rotation and his chin was pulled down and his head tilted backwards. Some of the time, if he wanted to see where he was going, he would literally have to walk sideways. Besides, it was painful. His condition was sufficiently severe that his physician had said that if he could not soon get rid of the torticollis, they would have to cut the nerve feed to the affected muscles surgically so that he would be partially unable to turn his head in that direction any more. What a barbaric thought! I suppose that when you only have a hammer, everything you see looks like a nail.
Now Felicity knew about an instance in which treatment using EMG-feedback had made a case of torticollis worse. EMG stands for electromyograph, which is the recording device for measuring muscle potentials. That big word reduces to ‘electro’, meaning the measurement or recording of electrical potentials, from the ‘myo’ or muscle cells. The muscle cells are activated by the electrical potentials of the motor nerves which feed the muscles. These electrical potentials are recorded on a ‘graph’ to display changes in them. How do you like that for a complicated statement about something quite simple?
Fortunately, Felicity also knew the mistake that was made by the psychiatrist in using the EMG-feedback in that other case. A big complicated instrument called a polygraph (literally, a unit containing many channels for graphing from many electrode pick ups) had been set up to record several EMG channels. Electrodes, to pick up EMG signals from the muscles, had been stuck on the patient’s shoulders and upper back. The idea was to record the amount of tensing of the muscles involved in the torticollis over long intervals of time. The polygraph had been set up in advance with threshold filters, so that when a strong EMG signal was detected by the machine it could switch off something else – in this case a record player. When there was little or no activity recorded from the muscles, the record player would be switched on again. The recorded music was to serve as ‘feedback’ so that, as it was switched off and on by the polygraph relays, it would tell the patient how she was doing – hopefully to help her to learn how she could relax the muscles involved in her symptoms.
The idea was an elaborate one and not bad in its essential conception. But nobody listened to Felicity when he pointed out that a basic mistake was being made. The patient loved classical music. So did the psychiatrist. The psychiatrist assumed that the patient’s love of classical music would result in her receiving pleasure, and thus ‘reward’, while the music was on. This was the only instance in which Felicity’s general and uncouth view that music is just unwelcome noise was right. Many people would understand this idea if it referred to the gentle melodic refrains of contemporary music – which combines the mellifluent tones of jack hammers, pile drivers, dentists’ drills, cannon fire and ricocheting bullets, all recorded in a tin can, and played at peak volume for the benefit of the stone deaf. But few would accept the idea that Felicity’s views apply equally to classical music. But, whether pleasant or not, all music is noise and, especially if it is liked, it is arousing – it gets the person tense. So turning on the music when the patient was relaxed made her tense, and turning it off when she was tense was calming. It was her symptomatic tension which was being rewarded or reinforced, and so the method taught her to increase her symptoms and their strength.

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