Tag: psychosomatic

Somatic climatology

In a previous post, I discussed John Sarno’s ideas on the psychological etiology of pain and other pathologies. In this context I would like to add some further hypotheses on how emotional repression affects the body and the felt sense.

The repression of emotions from consciousness does not merely prevent their expression in the neocortex. Emotions are naturally linked to the much more ancient endocrine system, which affects the body by means of hormones produced in the glands and vectored through the bloodstream and ultimately the extracellular matrix. The nervous and endocrine systems are interdependent, with response coordinated by the hypothalamus in the brain. The repression of emotions is a process which affects both the nervous system and certain key endocrine functions related to the evolutionarily adaptive response to the emotion in question. However, the body’s natural response to these locked emotions is not altogether disabled – they continue to produce effects in parts of the somatic and autonomic nervous systems as well as in parts of the endocrine system. The key point to understand is therefore that repression from consciousness is not equivalent to complete somatic disactivation. Repression by the ego is an imperfect dam, around which the stored emotions must find routes in order to maintain homeostasis. Because these routes do not provide for a full discharge of the emotions, however, the body is under constant tension.

We may consider that the primary emotional response is the alloplastic one – the one which is directed to changing the situation at the origin of the emotions being felt – and that it is this alloplastic response which is suppressed (if we are anything like our bonobo cousins, the repressed instinct may frequently be to have sex; this response does not change the external situation as such but rather its social expression, and could be termed mesoplastic or socioplastic). In its place, an autoplastic response is favored – the organism tries to change itself.

The inappropriate and sustained nervous and endocrine response to repressed emotions is what gives rise to the pathologies discussed, and it is important to realize that this is not just a “trick of the mind” but rather that it takes place on a biochemical level which, while not fully autonomous, enjoys a degree of autonomy from the conscious functions which we tend to think of when we use the term “mind”. In reality, of course, it is our terminology and its intrinsic duality which is at fault, because the bodymind operates as an integrated system in which certain material may be withheld from consciousness, but the vast majority is unavailable to consciousness in the first place.

The same objection has to be raised in respect of a focus on pathological syndromes only. In fact, the repressed response does not produce candidate pathologies only, but directly influences the biochemical environment of the body, proprioception, and our mental somatic map. It is not only pain, allergy or disturbed bowel function which may be provoked by emotional circumstances, but more generally also our level of somatic energy, our self-perception and our sense of wellness: aspects which we may think of as an innate part of our personality, but in reality are no more so than these other more obvious disturbances.

This raises, from my perspective, the interesting question of how an undisturbed individual would experience the body and embodiment. If it was not immediately obvious to me that my pain had emotional causes, it was even less obvious that the same was true for my general sense of self, for my general sense of inhabiting the body I inhabit. If this experience can also be altered by an awareness of its etiology, then interesting times lie ahead.

I wish all my readers a happy 2013!

John Sarno’s work on the etiology and treatment of psychosomatic disorders

I have been troubled all my adult life by disorders termed, which generally meant dismissed as, psychosomatic. These are disorders for which no physical etiology can be found, although they may have observable physical manifestations. From a psychological point of view, they have also recently been classified as somatoform disorders. As such, I was very interested to discover recently John Sarno‘s work on the subject.

Sarno’s basic premise is that just as emotional conflict can give rise to neuroses, so it also can give rise to pain and other physical conditions. This linkage may be direct, with Sarno positing that localized pain is a result of ischemia ordered by the central nervous system. Such emotional conflicts may also, via mechanisms which are presumably diverse, but which Sarno does not elucidate, result in afflictions to which non-psychological factors also contribute, whether in terms of their etiology or their clinical development. A key feature of Sarno’s posited diagnosis of tension myositis syndrome (TMS) is the variability in its lifetime expression. As such, it is an umbrella diagnosis or metadiagnosis for a variety of syndromes which have in common a non-progressive character. For a fuller discussion, read his 2006 book The Divided Mind.

I suffered in my early teens from clinical depression and situational urinary incontinence. By my mid-teens, this was replaced by muscular fasciculations, which I was convinced for a long time had to be a manifestation of a degenerative condition. Muscular function remained mechanically and electrically normal however, and much later this was officially classified as “benign fasciculation syndrome” (although it has receded, I am not fully free of it to this day). I went on at college to develop chronic fatigue syndrome, which at one point resulted in my being almost unable to walk. I also suffered at that time from migraines and back pain, and peri-orbital migraine was a regular occurrence for many years afterwards. During all this time, there have been no notable biochemical abnormalities observed.

Now I have not been monitoring bodily symptoms against my emotional state for many years and so I cannot provide a full account; it has changed immensely for the better, but I have still had my share of annoying things, in particular abdominal pains, and six or seven years ago Achilles tendinitis. Around May last year I developed plantar fasciitis on the left foot; it took a year to heel but then almost immediately the right foot developed the same symptoms. It has been quite debilitating as strenuous effort has tended to worsen it. All this led me to seek effective relief from the pain in various ways, a subject to which I will return.

Sarno’s notion, therefore, is very appealing. Indeed, given the importance of physical complaints, so called “hysterical conversion“, in the early development of psychoanalysis, it is not quite clear why attention has mostly been subsequently restricted to behavioral neuroses, especially outside of the Reichian tradition. Even if the mechanisms remain obscure, it is attractive to view psychosomatic disorders as somatic forms or expressions of neurosis.

However, I suspect the brain is less involved in mediating this relationship than we think. Sarno claims that the pain is directly generated by the brain as a diversion from unwanted emotions which threaten to break through into consciousness. I fancy this is otherwise: the brain is involved, certainly, in the repression of emotions, and by preventing their expression it prevents their discharge. The bodily symptoms, however, do not necessarily require neurological involvement and may arise on the basis of pure biochemistry. This is illustrated by research on the role of myofibroblasts in the mechanic regulation of connective tissue (see here). To me, the idea that the brain is busy, like some cranky old Wizard of Oz, devising ways to present consciousness with ever-new diversions seems crude, and it is not required to explain Sarno’s clinical outcomes. Variation in the site of pain may have simple biomechanical explanations.

So Sarno’s work is pathbreaking and liberating, definitively contributing to a shift in understanding of psychosomatic disorders, but it nonetheless needs to be taken with the necessary pinch of salt. Sarno offers, in The Divided Mind, no epidemiological data to back up his claim that the syndrome chosen by the brain is a matter of fashion (in a Kuhnian perspective, it is of course much more plausible that it is the diagnosis and corresponding collection of statistics which is driven by fashion, rather than the patient’s symptoms, especially since many of these diagnoses are evidently imprecise). He also offers no evidence to back up the conjecture that local ischemia explains the pain or that this is cerebrally induced (and if so, how). Indeed, the locus of pain is not discussed either, and some statements suggest Sarno does not have a deep understanding of myofascial biochemistry.

Sarno follows the usual path of airbrushing Reich out of the history of psychoanalysis, although it should be obvious that Reich was the first to look at the body and mind as a whole. However, his major error is to follow Freud’s mistrust of the id and misplaced trust in the superego. Freud, as we know, viewed repression as in many ways akin to a virtue upon which civilization depended. Sarno also paints a picture of the “childish, primitive” unconscious as the enemy within, even referring to it, with patent ideological bias, as the “dregs of evolution”, contrasting it to the “ethical and moral” conscious mind, a view hardly conducive to integration and well-being, and one which even Freud would have struggled to maintain (Nietzsche of course having demolished it comprehensively). His negative views of the moral quality of children are particularly depressing in their Calvinist overtones.

Several of Sarno’s statements in relation to brain neurology seem completely wrong: for example he attributes “rational, civilized” behavior to the neocortex, labeling it “that part of the human brain that has been added in the process of evolution”, even though the neocortex developed in the first mammals. The attempted equation between brain structures and Freud’s threefold division of the mind is presented as fact, whereas it is not a notion entertained by any mainstream psychoanalyst or neurologist. Indeed, Sarno oscillates gaily between the unconscious/preconscious/conscious model and the id/ego/superego model as if they were the same thing.

All this aside, this is a book which opened my mind to what now seems like an obvious fact but has long gone unnoticed, namely that the mind does not simply affect the body in vague, unspecified ways but perhaps in very specific ways where a direct link can be drawn between emotional circumstances and pain. It is pretty clear now to me what the circumstances were which led to both episodes of plantar fasciitis, and I am inclined to agree with Sarno that this knowledge is immensely emancipatory.

Five Rhythms

I have been dancing the movement practice called “Five Rhythms” on and off for a couple of years now, and am presently in the middle of a series of workshops which are subbranded “Heartbeat”. As far as I can gather from the founder’s website, which is not however very clear on this, this is intended to be the second of five “levels” in the Five Rhythms practice (the subsequent ones are “Cycles”, “Mirrors” and “the Silver Desert” respectively – the site is in Java so there are no hyperlinks to individual pages but look under “The Dancing Path” and “Becoming a Teacher”). (Roth also calls these the “first five levels”; afterwards there is still “Embodiment” and “Expression”). Our teacher says that Heartbeat is “the name for the emotional work in Five Rhythms dance”.

Whilst there is a lot of wisdom in some of what Roth says and has transmitted to other teachers, it is time for a working hypothesis of my own in relation to what this practice is and is not, the claims it makes and the place it might occupy in ones personal development practice portfolio.

I dance Five Rhythms and will probably go on doing so basically because I find it a very good integrative practice, as well as an enjoyable way to practice embodiment and embodied meditation. The wisdom of the body is there to be discovered in the practice. Five Rhythms is very popular in the tantra community for this reason.

However, whilst it does not appear to eschew portraying itself as such, which I find very regrettable, Five Rhythms is not a transformative or complete practice, and certainly not a rapid and/or deep one. In my opinion Roth, like so many others, has succumbed to commercial temptation and erected her system into a clumsy systematic “theology” of branded personal growth which is as unconvincing as it is inoperative and unnecessary. Just as access to the Godhead is mediated through layers of priesthood in the folk practice of the church (not in its mystical tradition), so layers of practice are interpolated between the practitioner and his or her full embodied expression in Roth’s schema, and the more there are, the more profitable it is. This is not a new strategy. It has been the strategy of religion through the ages.

I am not of course saying that there is no role for trajectories in such practices at all. But all they are is practices. They are not paths. Roth loses sight of this by pushing her initially perfectly valid observations and frameworks into overarching metaphors which are presented as a kind of key to unlock the secrets of the heart and of being human, but which are no such thing.

As any theory which is helpful enough in terms of what it is designed to explain, its reckless extension by analogy produces only increasing distorsion. Roth’s pentateuchal fetishism in these successive layers of practice reaches levels which evoke the spirit of Pythagorean mysticism. What is to be discovered is no longer innate but increasingly arcane. This strikes me as a dance of the mind, fully disconnected from reality, ungrounded and hopeless.

Let me illustrate. A (supposedly positive) review of Roth’s autobiographical handbook Sweat your Prayers on amazon.de states that as a result of movement work with Fritz Perls (the founder of Gestalt therapy), Roth “came to isolate five rhythms related to five archetypes or states of being“. Now, the description of these as “rhythms” is itself strange, as they of course are not; they are something more like “musical moods”. That there are exactly five such “moods” (flowing, staccato, chaos, lyrical and stillness) is hardly a taxonomy which exists naturally and objectively. Rather there is an infinitive variety of musical moods, which fade indistinctly into each other. Thus Roth has at the outset chosen what can only be reasonably considered a metaphor, and goes on to overapply this metaphor to everything that comes within her sight.

The same source goes on to say that “Roth claims that even terminally inhibited people can learn to enter these rhythms and sense how it feels to inhabit ‘mother, mistress, madonna, father, son and holy spirit.’ The three feminine archetypes follow a flowing rhythm, according to Roth, while the energy of the masculine archetypes corresponds to a staccato rhythm. Roth discovered that when the masculine and feminine fuse, a rhythm of fertile chaos results, as in acts of artistic creation or love. The resolution of chaos is the lightness and liberation of a lyrical rhythm, while stillness is the most profound rhythm of all.”

This is once again a fully extraordinary statement. Firstly, the identification of the Christian trinity as a trinitarian aspect of the masculine akin to the three feminine aspects embodied in the ancient European triple Goddess representation is to my knowledge unprecedented and very odd. Although there is a superficial similarity (the number three), the feminine trinity represents the three phases of the moon and of adult womanhood; the “masculine trinity” (the Christian one at least) represents no such thing. Furthermore, the Christian doctrine of the trinity as such is a late innovation which in no way can be or ever was designed to supplant the cult of the triple goddess. The subjugation of female by male deities had been complete millennia earlier. Thus the two have nothing whatsoever to do with each other.

The inherent counter-intuitive and speculative nature of the “discovery” of the fusion of masculine and feminine into “chaos” and the rest of the ontogenesis of the Rothian pentateuch (which looks like a discovery of three additional genders) I leave as an exercise to the reader…

In the workshops we have been invited to experience more exotic combinations of the “rhythms”. The “five” emotions (which is Roth’s own and certainly not a canonical list) of fear, anger, sadness, joy and compassion are paired with each of the “rhythms” in a way which is not really obvious, nor consistent with the characterization in Roth’s own book Maps to Ecstasy of some of these rhythms as “masculine” and others “feminine”, and the proposition of a fivefold classification of character (with no theoretical or experimental basis at all) corresponding to each of the five “rhythms”. In my view this is absolutely no reasonable basis for a scientific psychotherapy. It is basically, as another reviewer on Amazon characterized it, “cumbersome and tiresome psychobabble”.

We are then invited to experience one rhythm within another, the rhythm with and without the corresponding emotion, lightness within each of them … an utterly confusing attempt at embodied “visualizations” which sollicited the head far too much for a technique supposed to be centered in the body.

The workshops have primarily involved actual dance, but there have also been some exercises, mostly with no particular power to them compared to what I have found in pretty well every tantra workshop I have attended. I have found that in Five Rhythms it is very easy to avoid contact with the other dancers and this is what most people in fact do – contact is only fleeting and never to the point of discomfort which might prompt psychosomatic response. I see no real reason why the practice, relying as I said on “embodied visualizations”, should reorganize the psychic armoring. In my view this is a secondary phenomenon in the workshops which mainly draws on experiences outside of them. When a psychosomatic response does occur, it is not built upon to the benefit of the group – the workshop leader does nothing with it, certainly at group level.

This is why I characterize the practice as “integrative”. The best experiences I have had dancing Five Rhythms have been when I entered the room with a quantity of open psychic material, as a result of life events or of other workshops. I have felt it has an ability to “sew me back together”. But not to rip me apart. Of course to some degree it might if the very fact of engaging in such a practice is challenging for the practitioner. But this strikes me as a relatively low bar to clear. Most people will be well able to engage in the practice without troubling their resistances.

In short, I still like the practice notwithstanding its quasi-metaphysical psychobabble and I have certainly also drawn benefit from it, some of which I will hopefully describe in future posts. However, I think it would be far purer and more useful in a form freed from the oppression of the omnipresent pentateuchal metaphysic, and less comfortably solipsistic. There is a place, undeniably, for gentle approaches which are accessible to a wider audience, and for restorative methods, not only the deconstruction of defenses; but these approaches should be honest about what they can and cannot achieve.