Tag: stress

The neuroscience of fear

Continuing my interest in the neuroscience of emotion, I recently finished reading neuroscientist Joseph LeDoux’s book “The Emotional Brain”(*). This is a quick review and synopsis, in particular of those points relevant to psychotherapy.

LeDoux is one of the best known figures in the field, alongside Antonio Damasio, whose work I have also delved into, but found rather indigestible. Although I found Ledoux more readable than Damasio, I have two major gripes with the book. The main one is the title: there is not a lot in the book about emotions in general; Ledoux rapidly zeroes in on the single emotion of fear, which is his area of specialism. On this subject he is relatively enlightening, but it wasn’t what I expected or hoped for. In addition, some of the statements he does make about emotions in general, even if they may apply to fear are not obviously true of all emotions.

Additionally, the blurb suggests a book which is highly readable, but I did not find this to be really the case. It’s fairly readable, but has a tendency, especially in the later chapters, to get lost in detail. I would say it is not ideally pitched to the non-specialist reader (though likely at the same time to be oversimplified for a specialist), and does not belong to the best in science writing. Having been written in 1998, it is of course also somewhat dated by now, though I have not come across anything more recent.

LeDoux argues convincingly – but it is not very surprising – that there is no single “emotional system” in the brain, but we have to look at each emotion separately. As i said, he focuses on fear, which presumably is one of the easier emotions to study because it has a much longer evolutionary history than some of the “higher” emotions like love and joy which seem more particularly to relate to human experience. It is quite hard to read any conclusions across from fear to these other emotions.

LeDoux argues that we typically have little reliable insight into the factors which trigger our emotions, but a great tendency to make up stories about them and to believe in these stories. Indeed, we are unreliable in our reports of our emotional states as such. Emotions, unlike cognition, are intrinsically linked to the body and prompt bodily response; they evolved as “behavioral and physiological specializations” (p.40). The characteristic “feel” of emotions  reflect their different physiological signatures.

Emotions operate below the level of consciousness. This is illustrated by the phenomenon of “emotional priming” whereby the response to an explicit stimulus is influenced by a preceding stimulus the duration of which is too short for it to be captured in conscious memory (p.59). Mere exposure is sufficient; there is no need for any logical connection between the two stimuli.

The study of fear has, of course, a particular relevance to psychotherapy and some of LeDoux’s arguments bear consideration in this context, as he himself notes, though does little to develop. LeDoux argues that fear, and comparable emotions, are registered in the amygdala from where they govern programmed physiological reactions; at the same time there is a feedback loop to cognition which passes via the hippocampus. This latter circuit is obviously much more developed in humans than in lower mammals, but in all species it is notably asymmetric: the hippocampus, which is where new memories are created, has the equivalent of a broadband connection to the medial prefrontal cortex, but the available bandwidth is much less in the opposite direction. This, LeDoux argues, makes it difficult to reprogram the association made in the hippocampus between certain remembered events and the fear response. This sounds plausible, and may reflect experimental observations on the persistence of conditioned fear responses in rodents as well as the observed difficulties of therapy, but it is no more than suggestive of the conclusion which LeDoux draws.

Fear conditioning is the process which “turns meaningless stimuli into warning signs” (p.141). Some stimuli are preprogrammed: “laboratory-bred rats who have never seen a cat will freeze if they encounter one” (p.143). But most, of course, are learned. The simultaneous presence of two stimuli of which only one, the “unconditioned stimulus” (US) is intrinsically unpleasant is sufficient to form a link between them, on the basis of which the second or conditioned stimulus (CS) is subsequently sufficient to evoke the fear response, regardless of its intrinsic link to the US. This link is highly persistent and may indeed be impossible to forget completely even if, subsequently, no link between the stimuli is observed for a protracted period. The best that can be done is to extinguish it by presenting the CS repeatedly in the absence of the US, but there is always the risk of recurrence if relevant circumstances, such as re-exposure to the unconditioned stimulus, or simply a high level of ambient unrelated stress, arise. A CS may be almost anything: a place, a gesture, an expression, a tone of voice… Of course, the atomicity of these candidate stimuli is hard to determine : is being in exactly the same place necessary to evoke the conditioned response, or is it sufficient that a place bear some resemblance and, if so, in what respects?

In stressful situations, memory formation by the hippocampus is impaired. This would imply that traumatic events might not leave a memory trace, but still result in fear conditioning. In such cases, there may be no way to “reverse-engineer” the event out of the conditioned reaction. This has the clear implication that going after memories of traumatic events may be a fruitless strategy, and that resolution of trauma might happen without those underlying events ever being recalled, even if they occurred past the stage of childhood amnesia. However, the stress hormone cortisol has the opposite effect on the amygdala. Thus it is “completely possible that one might have poor conscious memory of a traumatic experience, but at the same time form very powerful implicit, unconscious emotional memories” (p.245). At the same time, recreating the emotional state conditioned does facilitate recall of explicit memories (p.212).

LeDoux’s analysis of conditioning and memory therefore sheds some light on problems encountered in therapy and on effective therapeutic strategies. I learnt something from  this book, but I suspect that a general book on recent contributions of neuroscience to psychotherapy might have gotten me more rapidly to my goal.

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(*) References are to the 1999 paperback edition published by Orion books.

Healing the body

In this post, I want to review two books with a common theme: Bruce Lipton’s 2005 The Biology of Belief and Lissa Rankin’s more recent Mind over Medicine.

Lipton, in his book, sets about demolishing what he himself admits is a straw man: the notion that genes determine disease and its progression. In his view, genes only provide a blueprint for building proteins, and it is the cellular receptor proteins on the membrane which drive gene expression in response to their environment. Few genes are self-expressing.

This hardly seems controversial. Nevertheless, the book is, even if it is not its main intent, a good and very readable laymen’s introduction to the molecular biology of the cell, and worth reading for that reason alone.

The “belief” in the title refers essentially to the ability of the brain to command, whether consciously or unconsciously, the production of neurotransmitters and other signalling proteins which then tell cells what to do. This view, as Lipton acknowledges, is based on the ideas of Candace Pert, whose work Molecules of Emotion I reviewed earlier. Interestingly, Lipton reports that this signalling intelligence was first developed in unicellular amoeba communities, where the signalling compounds are released into the environment and operate between distinct individuals. Multicellular organisms came only later, and took over this system of signalling to regulate the behavior of the community of cells which had now come to be permanently associated in a single individual. Thus cellular intelligence underpins the intelligence of more complex organisms.

Despite its expositional merits, however, Lipton’s book does not get us much closer to an understanding of the actual mechanisms behind the control of cell behavior. For the most part, he relies on somewhat forced analogies from quantum physics, the pertinence of which is far from established. Whilst he seems authoritative in matters of cell biology, what he says about quantum physics is frequently wrong and sometimes breathtakingly so. Essentially his main argument is the same one picked up on by Rankin, which may well be valid but is nevertheless lacking in detail, namely that the body’s self-healing mechanisms are activated by relaxation and disactivated by stress, i.e. by the activation of the hypothalamus-pituitary-adrenal (HPA) axis.

These self-healing mechanisms may be astonishing, and may depend to a significant degree on the variables the authors cite, but they remain quite mysterious in their details. One possibility one might have hoped Lipton would explore, but which he does not, is that there is a macro equivalent of the cellular apoptosis mechanism which leads entire organisms to self-destruct when signals in their environment communicate to them that they no longer play a role in the community. This may be a gross simplification but it would fit with Lipton’s overarching metaphor whereby the human body is, in many ways, merely the cell writ large.

Lipton also prefigures Rankin by taking to task the medical community for overuse of prescription medicines without a proper understanding of their systemic functioning. However he does not, and cannot, establish any principles to determine whether or not the use of pharmaceuticals is appropriate in individual instances and whether the other healing resources of the body have been sufficiently activated and explored. As such, the criticism, even if one may have sympathy for it, seems superficial.

If Lipton’s book is written from the perspective of a medical researcher, Rankin comes at the subject as a practising doctor disillusioned at the lack of holistic attention to health which characterizes the Western medical community. Failure to grasp the holistic nature of the body’s self-healing mechanisms means that many people get poor medical advice and care. Rankin is at her best campaigning for a much greater awareness on the part of medical caregivers of how healing actually takes place (though in this respect she seems to draw heavily on the admirable precedent of Bernie Siegel).

Much of Rankin’s argument centers on the unnoticed efficacy of placebos, a notion she draws from Lipton without, it seems to me, adequate attribution; indeed even some of the examples she cites already appear in The Biology of Belief. Rankin claims to have researched the placebo effect extensively, but at least sometimes she appears to permit misconception of the originality of her research. (A recent article in Scientific American is worth a look for anyone who doubts the strength of the placebo effect).

There are a number of important principles stressed in Rankin’s book which are often absent from other self-help guides directed towards recovering and maintaining health and which are welcome. Her insistence on finding meaning in life as a key contributing factor to wellness rings true, as does her defense of the power of affirmations given the need to override the negative messages which we are usually passing on to our bodies. She is also right in pointing to the value of community, although she passes lightly over important shortcomings of institutions like family and church the drawbacks of which may very well, in many instances, outweigh the benefits, and which are certainly some way short of the ideal. These institutions have quite likely been at the root of many of the health problems people experience. Moreover, even if community may be as important as diet and lifestyle, the recommendation to seek it out is difficult to operationalize if one does not have a healthy form of it to begin with. Rankin probably should also be commended for pointing to the importance of sexual life, but again, there is no clue in the pages of the book as to what might constitute a healthy configuration or even that this is a legitimate and important question to ask.

Unfortunately, for all its admirable qualities, Rankin’s book appears to take far too lightly the difficulty of modifying ones beliefs and actions in order to obtain better health outcomes, a mistake that Lipton avoids, since he is well aware that most of the body’s beliefs are encoded in subconscious scripts. The “diagnosis and prescription” part of the book is the least satisfying one, often asking the reader to answer in a few sentences what many seekers have needed decades to unearth and understand. In this sense, Rankin’s book looks like a typical US cultural artefact which uncritically endorses the errors of the positive thinking fraternity, discussed by me here.

This is disappointing, because Rankin is a much better self-publicist than Lipton and has acquired a significant new media voice which could have been used to promote deeper healing modalities than those she herself is able to offer. This unfortunately means she gives the impression of overextending herself where greater humility might have been in order, and accordingly coming across as superficial. Parts of her own “prescription” for herself read like an awkward list of endorsements of particular personalities, and there is no indication why they should be of value to someone else; they appear to be simply plucked from the air. Making a diagnosis of the factors in ones life which promote illness and writing a prescription to deal with them – even if one accepts this way of speaking – remains a major task and a daunting endeavor.

These criticisms aside, it is clear from both books that a major shift in social consciousness around health and healing is underway and increasingly forcing its way into the mainstream. For those who continue to place undue faith in the mechanistic and simplistic ideas which have hitherto underpinned Western allopathic medicine, either or both books will be very helpful antidotes. We may be still a long way off adequately describing how the body’s self-healing mechanisms work, but there seems no doubt at all that they make a key contribution to health outcomes and, if only for this reason, should be nurtured. In reality, of course, the quest for optimal health only dictates what the spiritual path anyway demands on other counts: a conscious uncovering of reality, and the courage to listen to what we already know.

Trauma releasing exercises

I am just back from the three-day introductory training in David Berceli‘s Trauma Releasing Exercises (TRE). These exercises and Berceli’s work are well worth knowing. Surprisingly enough, there is no Wikipedia article on Berceli and his work. The article on post-traumatic stress disorder (PTSD) does not mention it either, nor somatic approaches to PTSD at all, even though these have been about for a long time and must in any case be more effective than the “recognized” approaches, CBT (cognitive behavioral therapy), EMDR (eye movement desensitization and reprocessing) and medication.

Berceli (as far as I can see) takes his basic model of the somatic effects of trauma from the work of Peter Levine; in any case the models are very similar. To summarize, the basic idea is that the human animal has (for some reason; we shall come onto this) suppressed a natural response to coping with stress, which needs to be reactivated for healing to occur. However, the two differ considerably in terms of methodology. Levine’s approach, known as Somatic Experiencing (SE), which is quite widely practised in Europe (though not a lot in Belgium), requires exploration of the trauma and the felt sense of the body in response to it. As such, it borrows from Gendlin’s ideas on Focusing and more generally is, it seems to me, within the intellectual tradition of Gestalt therapy. By way of contrast, Berceli’s approach, like most somatic psychotherapy, is more purely process-oriented. As such, it does not require or even directly encourage exploration of the traumatizing events, and particularly not by the therapist; rather, the focus is on what the body is doing in the here and now and on the ways in which the body’s natural attempts to self-regulate are hindered or can be supported. The independence of method from the client’s personal history offers some considerable advantages, since it makes possible group work and relies less on the skills of the therapist.

Berceli’s therapeutic method borrows from Bioenergetics (I may update this article when I have read his books, so check back), rather in the tradition of Alexander Lowen. Its aim is therefore to produce involuntary trembling in the body. Unlike Lowen, there is no element of talk therapy within the method, though Berceli does say that his method can be integrated within others, so leaves the door open to syncretic approaches. Significantly, however, the trembling is reinterpreted compared to the Reichian tradition, to which Lowen remained loyal. Rather than being glossed as the release of sexual/life energy held in stasis by the body, it is interpreted as the reactivation of the post-freezing response of animals described by Levine: “When it is out of danger, the animal will literally ‘shake off’ the residual effects of the immobility response and gain full control of its body. It will then return to its normal life as if nothing had happened“.[1]

Why is this response suppressed in humans? For this, Berceli seems to have no deeper or more convincing answer than does Levine: “Most human cultures tend to judge this instinctive surrender in the face of overwhelming threat as a weakness tantamount to cowardice. However, underneath this judgment lies a deep human fear of immobility. We avoid it because it is a state very similar to death. This avoidance is understandable, but we pay dearly for it.“[1] In other words, the response is suppressed by the ego under the weight of social stigma attached to it. Neither Levine, nor Berceli, as far as I can see, has (or even looks for) any evidence of this claimed stigmatization. Many bodily functions may be disrupted by trauma, but this does not mean that those functions themselves are necessarily stigmatized. Thus this appears to me not very convincing, and basically it eschews a psychoanalytic explanation of ego defenses and their role in the developmental process. There are lots of criticisms which can be easily leveled not only at the model, but also at how the practice relates to it. Most basically, the question arises as to why the practice does not endeavor to, nor succeeds, in simply reestablishing this response and allowing it subsequently to play whatever role it needs to play in the individual’s further experience. Rather it is recommended to continue the practice on an ongoing basis. It therefore does not constitute a “cure” for PTSD, but a door into another dimension of experience. Berceli explicitly encourages such an understanding, and views his work as transformative on a global scale. This is laudable and I thoroughly support it because I believe he is on to something; but it is not convincing theoretically.

The great advantage of Berceli’s exercises over classical bioenergetics (and over Reich’s simplified anatomical model of the biological basis of character formation) is that it is more anatomically informed, and results in exercises which are shorter and easier to carry out. This makes it more suitable for the problem it is intended to address, since persons suffering the physical developmental impact of childhood trauma are often limited in their range of motion. These exercises should absolutely be considered for use in all those contexts where people currently employ Lowen’s exercises (though not his whole framework of Bioenergetic Analysis, which he himself acknowledged did not have the clinical success he hoped for) and its derivates, such as Osho’s active meditations. Because Berceli’s exercises directly solicit and progressively release tensions in the hip adductors, iliopsoas and muscles of the pelvic floor, that is, in all of the major muscles primarily involved in the orgastic response, and they are more easily taught and experienced than existing alternatives, they seem to me the basis for a more effective practice which clients will better be able to follow and stick to (they of course do not substitute for other exercises used in group therapy the purpose of which is rather to generate than to release tensions, which will then be released in other ways).

The other great advantage is that the method can be employed in a very wide range of contexts, from schools to palliative care, contexts in which bioenergetics or anything else “explicitly” psychotherapeutic would have no chance of penetrating. It does not need and does not really have a unifying discourse, which minimizes resistance. People are willing to try it out who would never go near (or for that matter be able to afford) a psychotherapist, and stick with it because, after all, it is only their body doing what it wants to do, and it is hard to be against that.

On the other hand it would at least seem not to be a complete system for spiritual liberation in the sense we derive ultimately from Reich. Berceli applies his technique way beyond the boundaries of PTSD, presumably because people have reported positive effects in those contexts, and has some awareness of the endemic and embedded nature of societal trauma, but the need for wide appeal seems to prevent him from going deeply into underlying societal issues in the radical tradition of much psychoanalytic thought. I am not saying this is a bad choice. Perhaps it is an excellent one. But ultimately, personally and at societal level, one does need to go there. Refusing to do so will always limit the benefits that can be attained.

What Berceli’s discourse seems to me to lack is an understanding that the disruption of the trauma response is ultimately due to the fact that social experience, being so far from the natural state of man, continually regenerates trauma. On top of distorting ego development, social experience also acts in the present. Our shared cognitive models of the world and the human need for relationship continually pull us back to a depressed, unhealthy state, and would do so even if all “residues” of specific trauma were somehow dissolved. We touch here on the manner in which Berceli’s approach is most fundamentally incomplete. It is essentially solipsistic, and presupposes, ultimately as a matter of ideology, the ability of the individual body to regenerate in the absence of regeneration of the collective body and the social tissues, which although they are just as ossified as the somatic tissues, are not directly brought into vibration by the practice. This cannot work. An interpersonal dimension of therapy and practice is absolutely indispensable if we are to begin to reprogram the social mechanisms which propagate and perpetuate trauma.

So I guess that makes me a big fan and a big critic at the same time. However I will do and use the exercises and I recommend them to you to.

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[1] See http://www.traumahealing.com/somatic-experiencing/art_chapter1.html