This paper appeared in the August 2006 ‘Journal of Holistic Healthcare’. This is the journal of the British Holistic Medical Association, a body open to anyone interested in a more holistic approach to healthcare and life in general.
Abstract
Though the mind-body connection is increasingly recognized as a therapeutic resource, therapies that tap into it can trigger psychological dynamics of resistance. These dynamics affect both the individual who tries to implement mind-body healthcare, and the practitioner who is enabling it. The suggestion of this paper is that mind-body healthcare requires a substantial transformation in an individuals worldview and sense of identity. Consequently it may be better understood as a dramatic transformational process involving psychological death and birth, rather than the simple acquisition of some self-care techniques. Therefore practitioners may require particular skills when they seek to guide their clients.
***
One morning in the Autumn of 2005, I was clearing up breakfast dishes in the kitchen when I heard my wife, Sabrina Dearborn, gasp and then laugh. I turned to see what was happening. Her hands were holding her lower stomach and she looked pleasantly astonished. I asked her what was going on. She explained.
For three years she had been suffering from a stomach ulcer and had tried various mainstream and complimentary approaches to curing it. Early on in the process she had become aware of the possible psychological sources of the ulcer and had spoken several times about her stressful mood and attitude, which possibly triggered the production of the acidic endocrinal conditions that fed the ulcer and caused her pain. Her laughter, she said, was due to the fact that in that precise moment she had witnessed herself changing mood, going into a negative thought pattern and simultaneously her ulcer had begun to hurt. The connection between her thought process and her pain was explicit and, most crucially, recognized.
Her amusement came from three sources: the blatant experiential obviousness of the mind-body pattern negative thoughts = stomach acid; the promise, now that she fully understood it, that she could possibly self-manage and cure the ulcer; and the knowledge that the illness and her witnessing the pattern which triggered its exacerbation, were now leading her into a character change that would be good for her. There was insight and there was hope.
This is similar to what is perhaps the best known story in mind-body medicine, described in Anatomy of an Illness, when Norman Cousins, who had ankylosing spondylitis, realised that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain free sleep.(1)
There is an interesting and poignant paradox here, of which holistic practitioners are aware. In this paradox there is the suffering and pain of the actual illness. But along with it is the delight at the nature and process of self-managed healing. Illness presents itself here not just as an intrusion, but also as a gateway to some enlightenment and personal development. This is part of the tragic-comedy of the human condition.
Perhaps at the top of the holistic practitioners caduceus, it would be appropriate to place a mask from Greek theatre, one half sad and the other happy.
***
To be aware of the mind-body connection is, however not enough. For many inexperienced years I expected people to practice self-management simply because it was logical and worked, but I have become more realistic. More often than not there is a disconnect between intellectually understanding the mind-body methodology and implications, and actually implementing them. For one aspect of the mind, it all makes perfect sense. But for the mind as a whole, for the psychological persona, the information does not compute. People are presented with a strategy that will cure them, but they are psychologically unable to integrate the logical consequences that they should employ the strategy.
This sabotaging mechanism is, in my experience, as much at work in practitioners as it is in clients. And, of course, it is also writ large in our culture as a whole, as the medical establishment and intellectual hegemony grindingly wrestle with the implications of integrative healthcare.
This lack of congruence between theory and practice, between knowing something and actualizing it, was very obvious when we conducted the cortisol experiment described in the paper which follows in this journal.(2) In this experiment, using saliva samples, cortisol levels were measured before and after a body-centered meditation strategy.(3) In general, the results are favorable towards the technique, showing that the intervention reduces cortisol levels. In terms of progressing the mind-body healthcare project this result is useful. For me, however, leading the intervention, something else very interesting was also taking place. Not reported, but alongside the cortisol testing, one of the papers co-authors, Val Bullen, was monitoring other changes. Two of these stand out.
At the beginning and at the end of each session, she asked students to measure how tall they were. Many of them experienced increased height as a result of the intervention. There was excitement around this. The release of stress, students of the spine will immediately recognize, allows the spine to open up and expand into its natural space. For people with many different kinds of challenge, this is significant. As witness to this scene, I was waiting for the coin to drop, for the realization that this was directly relevant to how they conducted their own lives and healthcare. There was excitement, but no jaw-dropping ah-ha, eureka moments. There was the usual disconnect.
There were two women there with whom I also spoke, who suffered from eczema, but experienced relief from its symptoms during and immediately after using the strategy. Not only did the sensations of irritation subside, but the presentation of the eczema on their faces disappeared. Again, there were the obvious implications for self-management and again there was a disconnect. The thirsty horse is led to water but does not drink.
After the cortisol experiment was complete I reflected on the whole event and my heart was particularly touched by the eczema incident. I wondered whether their inability to appreciate the significance of the process was my fault. Perhaps I should have been more explicit and more enthusiastic. Perhaps I should have performed a celebratory war dance, drumming, rattling and chanting with the full passion of my heart: Let the experience in! Its real! You yes you! can control your body chemistry! I should have danced this communication with all the fury of a tribal healer. O troubled hearts, you can indeed heal yourselves! You can increase your height! You can cure your eczema! But I did not. I behaved in a manner that was appropriate to our culture and presented myself professionally.
***
The psychological dynamics that impinge upon autonomous mind-body healthcare need to be carefully addressed. As practitioners if we do not engage with them we are obviously less than holistic and, strategically, if we do not find a way of coherently understanding and managing them, we may sabotage the integration of mind-body healthcare into general practice.
Let us first be clear about the intellectual argument, lest we think that the tendency to resist mind-body management is due to its theoretical lack of coherence and rigour. In fact, the argument is already won. From Pavlov’s dog onwards the case is proven. There is no doubt that the workings of the mind directly affect the endocrine system. The sound of the bell, associated with food, is sufficient to stimulate digestive juices. There is, of course, no real food, only the neural association. Many neural suggestions fearful, pleasurable, erotic and so on trigger endocrinal responses.
In terms of scientific rigour, the proposition that the endocrinal system responds to mental stimuli, regardless of whether the stimuli are real or imagined, is coherent, repeatable and testable. The growing field of PNI and its laboratory experiments, such as the one described in the paper mentioned above provide measured evidence of the mind-body effect and the efficacy of the many strategies.(4) As a result of these strategies there are specific and measurable results: slowing of heart beat, reduced blood pressure, appropriate carbon dioxide emissions, reduced cortisol and adrenalin, increased endorphins, relaxed tissue, reduced pain, boosted immune system and so on.(5) To the degree also that good science builds upon a previous body of knowledge, the traditional healthcare systems of, for example, Ayurveda and Taoism, provide further substantiating evidence.
There is also a clear commonality at the core of all mind-body strategies. Whatever the specific technique there is the common element of using focused mental attention. This focus can then be directed towards a variety of subjects: a mantra or affirmation, a healing image or prayer, music or sound, the movement of the breath in different areas of the body, the kinaesthetic sensation of particular body parts and areas of tissue, and the mood of the mind as it focuses within the body. All of this is to state that the actual strategies themselves are specific and coherent, with little room for ambiguity and, thence, avoidance.
Having asserted the theoretical integrity and methodological coherence of mind-body medicine, we can go on to look at the real reasons why people may not adopt its usage the psychological resistance.
***
The psychological resistance has its source, I suggest, in at least five dynamics:
Cognitive dissonance
Difficulties in learning
Paradigm shift
Threat to personal identity
Birth of new consciousness
Cognitive dissonance occurs when information received by the mind does not fit any previous frameworks of cognition and comprehension.(6) Well-known examples of this include US military intelligence, which could not accept reports that the Japanese were planning to attack Pearl Harbor, and African jungle pigmies, who on first seeing an elephant through a telescope. assumed it was an insect at the end of the tube. The new information is perceived but not cognized. The whole notion of mind-body self-management when presented to a client is also usually new and it requires a transformation in the usual frame of reference for understanding illness. The usual paradigm of illness is that it is purely something nasty that is done to us and for which we then go to an expert for help. This cognitive framework is well established and mind-body medicine inverts this to suggest that illness is something we may do to ourselves and the healing of which is, to a degree, in our own hands. The neural framework for cognizing and integrating this information does not exist.
Learning difficulties. Anyone who has experienced learning a completely new skill or set of concepts is familiar with the time and effort required to grasp them. There is an uncomfortable period before the new framework has integrated and landed, during which all the effort seems wasted. There is little immediate gratification. Moreover, with mind-body strategies, as with other self-management approaches, while it may be easy to practice the strategies carried along by a group dynamic, it is difficult to sustain the practice on ones own. The normal and usual difficulties in incorporating a new realm of knowledge are exacerbated by a sense of failure and disappointment.
Paradigm Shift. By its very nature of being embedded in culture, society and psychology, a prevailing paradigm resists a new one.(7) Self-esteem, status, and social and financial stability are usually embedded in a prevailing worldview. The established healthcare paradigm, like paradigms in general, is reluctant to give up its leadership and influence. The financial and social investments are obvious, as are those of status. It has also been extremely successful. To shift this established worldview affects millions of people and billions of pounds of resources. Resistance is natural.
Threat to personal identity. This dynamic is, I suggest, the most powerful psychological factor in resisting self-managed healthcare. Self-managed healthcare is more than a concept, more than a pill, more than a visitor to a practitioner. It is a new action and a new behavior. This new behavior, by its very nature, signifies the appearance of a new self a self that behaves in this new way. This new self is, in certain ways, diametrically polarized against the old self and its activities directly oppose the old behavior and old attitudes. This old self is being asked to give way, to transform, to die. This is threatening.
Old behaviors, many of them originating in childhood, many of them compulsive and acted out daily, if not hourly, have furrowed deep neural grooves. They are embedded psychological traits. Transforming them can be an excruciating struggle, equal to those encountered when withdrawing from addictive substances. Thirty years of self-judgment or stoicism, for example, rarely give way gracefully to a more balanced style. These behaviors are firmly cemented into a habitual neural-endocrinal and psychological state.
An individuals sense of identity is that which gives coherence, sense and safety to their location in society and culture. Whatever the school of psychology from behavioral through psychoanalytic to transpersonal there is a common understanding that human beings, especially as infants, are insecure creatures who identify with and internalize the behavior and attitudes of the significant people around them. Once this internalization has occurred, it provides both a sense of personal coherence and the mode for being securely within their group.
This glue that normally binds people into their everyday sense of identity their culture, gender, sexuality, religion, nationality, career, politics is so powerful that people aggressively defend it, attack competitors and will die for it. In many situations, the psychological identity’s instinct to survive is more forceful than the biological instinct. From suicidal political and religious activists through to the men and women who sing marching into war, there is ample evidence that people would often rather die than surrender their cultural personality.(8)
The transition, therefore, in healthcare towards self-management, can entail a battle royal with entrenched psychological resistance, to the point of self-destruction. To this we can add the normal infantile need, when in distress or pain, for healing and comfort rather than a shift into a mature self-responsibility. The personal history of childhood wounding and disempowerment may, understandably, fuel dogged inertia.
But there is even more to this great human drama. The very nature of mind-body methodology implies that there is the birth of new consciousness. In mind-body strategies people are transferring the control centre of their behavior, away from habitual attitudes and ways of thinking, to a new, witnessing, self-responsible persona and consciousness. There is here the birth of a new self.
In meditation and mindfulness traditions, there is this concept of waking up to reality. In this new consciousness – that of being the witnessing self, and able to choose attitudes and behaviors the individual finds himself being born again as a new type of creature. He perceives now that the human being whom he thought he was, is in fact, to a degree, a psychosocial automaton, a creature embedded in conditioned responses. Prior to this awakening, his sense of persona was formed in reaction to ongoing psychosocial constellations of circumstance. This is indeed a transformation, a death and rebirth. And like all birth, time is needed for development and integration. It is not a simple matter of waking up and then being awake forever. There is endless forgetting and falling back into the unconsciousness of just being a conditioned human creature. There is also the whole delicate business of integrating everything one was into the new state.(9)
***
When therefore, as practitioners of integrated health, we suggest that our companions engage in mind-body self-management, we need to acknowledge the far deeper process we are seeking to initiate. Most sensitively, we need to be present to the poignancy and paradox of the situation. There is discomfort, pain and anxiety, and yet there is the promise of creative transformation and emergence. This is a difficult balance to maintain. The extremes of clinical frigidity and new age you-create-your-own-reality cruelty are obviously to be avoided.
But the practitioner is not alone in seeking to enable self-managed mind-body healthcare. The individual seeking health, as well as possessing all the sabotaging psychological dynamics, is also dynamised by a will to survive and a will to develop. Just as there is a natural healing dynamic in nature wounds heal, flesh repairs so too the psyche itself seeks to emerge, heal and integrate. This is latent in human psychological development. Given the appropriate circumstances people grow.
And often, as we have been noting, it is illness itself, in its janus-faced paradoxical nature, that acts as midwife to the new persona and consciousness. Pain, fear, disorientation and relentless discomfort all create such constraints and disorientation on the psychosocial self that consciousness, looking for meaning and expression, emerges instinctively into this new persona and dimension. Perhaps there is nowhere else to go. Indeed in many books on death and dying, there are descriptions of that most poignant of events, when a person recognises that their illness is fatal, but nevertheless has emerged into such a new and balanced identity that they feel and assess themselves as healed. Their body has not been healed, but their consciousness has. This is what Stephen Levine has described as healing into death.(10)
Thus illness and trauma, even when fatal and painful, may deliver new consciousness.
***
In conclusion, at the very least we can be aware of the difficulties and paradoxes in using mind-body techniques for self-healing. The resistance we meet in our clients is no different from that which we ourselves experience. The benefits are equally great.
There are so many implications in all this for holistic practitioners. What is certainly needed in the integrative healing community is an explicit and ongoing discussion around how we can best serve the project of enabling self-managed mind-body healthcare. Clinical diagnosis and treatment are very different from acting as midwife to the birth of new consciousness. If we encourage self-management, then we need to do so in a way that is informed, congruent, grounded, authentic and well practiced. Appropriate relational and communications skills are needed. The intellectual and clinical skills need to be balanced with those the heart. The art of healing the body expands to a more holistic understanding that the growth of consciousness is also within our domain.
I know full well that these are deep issues continually to be explored and reflected upon. Nevertheless, in ending, I cannot resist suggesting that when appropriate we need sometimes to drop our professional demeanor and bedside manner, and be more enthusiastically encouraging not only to our clients but also to ourselves. Two images come to mind.
The first is of an eccentric rowing coach on a bicycle, madly clattering along the riverside, megaphone to face, hurling instructions and encouragement, devoid of all sense of self or dignity.
The second, to return to an earlier thought, is that of the shamanic healer, dancing, singing and rattling, ecstatic, celebratory and willing the birth of new consciousness, the transformation of the heart.
NOTES
1. Norman Cousins, Anatomy of an Illness as perceived by the patient, Norton, New York, 1979.
2. Bullen V, Fredhoi C, Bloom W, Povey J, Hucklebridge F, Evans P and Clow A,
Salivary cortisol, stress and arousal following a 5-week training programme in kinesthetic guided meditation to undergraduate students, Journal Of Holistic Medicine, Volume 3, Issue 3, August, 2006.
3. William Bloom, The Endorphin Effect, Piatkus, London, 2001.
4. Bullen V & co, op cit
5. Jorge H. Daruna, Introduction to Psychoneuroimmunology, Elsevier, Burlington, 2004; Manfred Schedlowski and Uwe Tewes (eds), Psychoneuroimmunology : An Interdisciplinary Introduction, Springer, New York, 1999; Philip Evans, Mind, Immunity and Health: The Science of Psychoneuroimmunology, Free Association Books, 2000, London.
6. Leon Festinger, A Theory of Cognitive Dissonance, Stanford University Press, Stanford CA, 1957.
7. Thomas S. Kuhn, The Structure of Scientific Revolutions, University Of Chicago Press, 3rd edition, 1996.
8. The whole business of how psychological identity is structured and then defends and enhances itself, is fully discussed in William Bloom, Personal Identity, National Identity and International Relations, Cambridge University Press, Cambridge, 1990.
9. This is discussed in all spiritual teachings that address issues such as the dark night of the soul. For a contemporary description, see Jack Kornfield, After the Ecstasy, the Laundry, Random House, New York, 2000.
10. Stephen Levine, Healing into Life and Death, Anchor Press, New York, 1989.