Knowing How & Know-how
I have characterized pre-empirical functioning at the first tier of consciousness in terms of the indescribable “knowing how” that we take for granted as “muscle memory.” We know how to do the things we do even if we are unable to explain exactly how we do them. The things we do, however, involve tasks that are more complex than muscle movements alone. They take place routinely in the smoothly coordinated performance of physical tasks that require continuous monitoring and guidance without second-tier involvement. This is the difference between merely knowing how to physically carry out a task and having the know-how that comes from a well-established core of experience at the first tier.
Suppose my wife comes to me with the doorknob we ordered and wants me to install it. I reply, “I can do that.” In a different setting, the eighth grade math teacher at my school reports that her class is out of control and wants my assistance. I reply, “I can do that.” These represent two very different kinds of doing and knowing how.
I have talked about how much I rely on the experience base I established from years of practice as a clinical neuropsychologist in developing the ideas and insights for this book. That experience base includes knowing how to carry out the physical movements involved in administering and scoring cognitive tests. More critically, it also depends upon the countless observations I make during the course of giving those tests and the interactions with my patients that lead me to adjust what I am doing and question what I am observing. This flow of ideas and insights guides me throughout the evaluation and enables me to construct a comprehensive framework for interpreting the results. My experience base provides a critical source of know-how that I draw upon repeatedly.
The experience base that a skilled professional develops extends far beyond the sensory guided movements needed to physically execute the required movement sequences. Visceral processes guide both the direction taken and the force applied in that direction. This internal guidance leads me toward the best responses at the right time throughout a clinical evaluation. Mirroring guides us through situations that require carefully nuanced interactions with others. I establish and modulate rapport with my patients so that I can enlist them as active participants in the diagnostic task.
We are aware of the sensory inputs that literally sculpt our movements; we consciously recognize their role in shaping the actions we are taking. We are less likely to observe the visceral forces that impact the fine-tuned adjustments we continuously make to what we are doing. We consciously experience ourselves doing what feels right. Since visceral processes guide only the force and direction of what we are doing, they are only indirectly revealed in the actions we initiate. We are even less likely to be aware of mirroring that guides our actions in relation to others. We only know when our connections are working well and when they are not.
I do not know how these pre-empirical processes infuse their magic into my clinical evaluations, but I know that they do. They are integral parts of the know-how that I bring to my work. It is a similarly rich experience base that the jazz bassist brings to his trio, a master chef demonstrates in her kitchen and a drug counselor draws upon in counseling her group. It challenges the meaning of what we usually think of as muscle memory and reveals the degree to which the physical core of experience at the first tier informs everything we do.
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