30 Oct The Mind-Body Connection working with Bodily Experiences
Although humans share and utilize the same subcortical systems as other mammals as part of their emotional lives, higher brain functions filtered through the neo- cortex help to mediate and transform their emotional lives that begin as emotional bodily based responses. Thus, judgment, prioritizing, and other executive functions are brought to bear upon subcortical emo- tional responses, thereby adding complexi- ties and nuances. We are not only biology; rather we are both biology and lived experi- ence (Damasio, 1994). Mainstream psycho- therapy and psychoanalysis have privileged experience (nurture) and minimized biology (nature).
Willa, (from Chapter 2 of my book Infant Research & Neuroscience at Work in Psycho- therapy: Expanding the Clinical Repertoire), is a good example of the body serving as the pathway for accessing emotions and subse- quently feelings. Just as her body posture served as the pathway to understanding a central component of her relational experi- ence, working with her bodily experiences helped her to find language for her intense emotional experiences.
As we explored her social shyness, Willa was unable to describe her feelings or emo- tional reactions. In fact, this was true in any situation. As I switched my focus and asked her to attend to her body, she became aware that she experiences uneasiness as a “heavy pain in my chest” and that “my stomach feels like a bunch of little knots all squeezed together.” Willa showed me the pain in her chest by repeatedly thumping that area. These physical manifestations spoke to me in a visceral way. Willa eventually learned to translate these physical experiences into feelings of fear. Once she moved from her body to a feeling state described in lan- guage, we were able to connect the emotion of fear to the repetitive template of needing to hide when in the company of a significant other.
There is a preponderance and conver- gence of evidence from neuroscience, psychology, and experimental psychology that emotions are bodily based experiences, in that there is a strong physiological component, often occurring outside of reflective awareness, to emotional reactions.
The next section summarizes some of the leading points of view from neuroscience and psychology. This is not meant to be a comprehensive review, but is sufficient for a clinician to better integrate and use the emotions held in the body of both patient and therapist to expand the clinical dialogue. I describe the neuroscientist Antonio Damasio’s Somatic Marker hypothesis and then move to the psychologists Sylvan Tomkins and Paul Ekman. Both Tomkins and Ekman defined basic emotions that they believe are universal and exist across cultures. Ekman than went on and correlated these basic emotions with specific facial, musculature configurations that serve as powerful, nonconscious communications between individuals and between an individual and its important groups. This latter perspective is especially relevant to a two-person psychology.
Damasio’s Somatic Marker Hypothesis
Since most neuroscientists agree that body-based experiences are central to emotions and subsequent feelings, I’ll focus on only one theory: Antonio Damasio’s somatic marker theory, as described in his book Descartes’ Error (1994). Damasio calls our bodily experience of emotions or bodily states somatic markers. These bodily states bias and inform conscious decision making. The cognitive mechanisms use the body’s readings for prioritizing, assessing, judging, and ultimately taking action: Should I approach or avoid this situation? Secondary cognitive processes have their own somatic markers that help to order and prioritize potential activity and bring nuance to any situation. Is the matter urgent? If so, how urgent? Will I feel better doing it now or should I wait until later? Cognitive process- es, like emotional processes, are shaped by prior experience. The point is that the body holds numerous biases prior to any conscious or felt experience that informs conscious judgment and decision making. They tilt us in particular directions.
The body and brain interact through two routes of interconnection. The first includes the sensory and motor peripheral nerves, which carry signals from every part of the body to the brain and from the brain to every part of the body. The second is the bloodstream, which carries signals such as neurotransmitters and neuromodulators throughout the body. These two intercon- nected “highways” of the brain function as an ensemble that interacts with the envi- ronment. While interacting with the envi- ronment, the bodily experiences along both highways have already begun to tilt toward action in a particular direction (approach or avoid) before there is any conscious aware- ness of a feeling or any felt requirement to make a decision.
Damasio (1994), building on work with others in his laboratory, conducted several experiments to show that emotional/bod- ily reactions function as somatic markers that guide fundamental decision-making processes. Patients with ventromedial prefrontal damage were chosen for this experiment because it is believed that the ventromedial area of the brain is involved in creating emotional (salience) associa- tions between visceral bodily feedback and external events. The results of the patients with ventromedial brain damage were compared with the results of normal subjects (i.e., those without any brain damage).
Damasio (1994) in a series of studies with Daniel Tranel, a psychophysiologist and experimental neuropsychologist, first determined that those with ventromedial damage had emotional/bodily reactions. Using a skin-response conductance test (the polygraph or lie detector), Damasio tested those with frontal lobe damage using a startle stimulus and determined that those individuals have the capacity for skin conductance responses. Damasio then tested both the control group and the patients with frontal lobe damage for skin conductance responses to disturbing events. Both groups were hooked up to skin conductance response monitors and shown a series of pictures. Some pictures were bland and others showed horrifying and/or disturbing images, designed to ac- tivate an emotional response. The results were unequivocal. All people in the control group (normals) and people with brain damage to parts of the brain other than the ventromedial area registered an emotional reaction at the moment of viewing the dis- turbing pictures. Those with prefrontal lobe damage did not register any skin conduct- ance response to the disturbing pictures. However, later when asked to describe what they had seen, they noted the horrifying pictures. This response demonstrated that the disturbing images had registered with them, but they did not appear to have a concomitant emotional reaction.
As the subjects began their play, the control group of normals sampled the vari- ous decks, bit by bit, and eventually began to form hunches that led them to approach the decks that did not have large penal- ties, but resulted in a small and steady gain. Alternatively, the people with prefrontal lesions kept going for the high-paying decks with high penalties. Ultimately, they lost everything. It seems as though they never learned from their previous experiences. Damasio hypothesized that those with frontal lobe damage do not register the emotional reaction correlated with the experience of punishment and/or reward. Thus, they don’t have the “somatic mark- ers” that help them make good decisions.
it continuously receives stimuli from the internal and external environments.
Some emotions are species-wide and innate. Different species are primed to fear particular things so that they can avoid natural predators or be drawn to some- thing necessary for survival. For example, several species of birds run (flight) or freeze in response to a large horizontal shape. The horizontal shape is resonant with the shape of a hawk’s spread wings, the natural predator of these birds (Tinbergen, 1951). Monkeys are naturally fearful of an S shape, the shape of a moving snake, their natural predator. Alternatively, mammals are primed to pursue things that bring reward and satisfaction; for example, pheromones send out subtle sexual odors that attract the opposite sex. Each zebra has a pattern of stripes that is unique, similar to human fingerprints; baby zebras recognize their mothers’ signature stripes and thereby can stay close and safe (Rustin & Sekaer, 2004).
Humans have basic emotions that serve to help them meet their need for physiological, social, and psychological survival as they function in this complex world (Panksepp, 1998). These primary emotions serve as an automatic appraisal system that is influenced by both our evolutionary and personal pasts. These emotions prime us, through a set of immediate physiological changes (somatic markers), for a particular situation (Ekman, 2003; Tomkins & Karon, 1962). An example of an evolutionary fear common to most humans was described by Charles Darwin (Darwin, C., 1872/1998) almost 150 years ago in The Expression of the Emotions in Man and Animals. Humans, for the most part, are innately primed to fear snakes. Darwin described putting his face close to the glass (in a safe setting) in front of a puff-adder snake with the intention of not backing away if the snake attempted to strike at him. But as soon as the snake “struck,” Darwin’s resolve crum- bled. He automatically jumped a yard or two backward, even though he knew he was protected from the snake by the glass. His will and reason meant little in the face of the automatic subcortical system that anticipated danger.
Prior to the advent of high-tech imaging machinery, research psychologists devel- oped theories about emotions that were then tested experimentally. Silvan Tomkins (Tomkins & Karon, 1962), a pioneer in affect theory, defined nine primary affects (what Tomkins called affects, neuroscientists more usually lean toward the term emotions). Tomkin’s originally identified 8 basic affects (with disgust and dismell as separate) as biologically programmed emotions. The ninth one (shame) he believed developed later. Eventually, he grouped disgust and dismell together. Despite the difference in terms, most theorists today subscribe to some version or combination of these basic emotions originally defined by Tomkins. Panksepp organizes his emotional systems somewhat differently, but his systems seem to cover the same primary emotions with different clustering. Despite differences in language and organizational coding, each emotional system seems to have its own neural and physiological mechanisms that function in ways to provide solutions for survival and/or advancement.
Survival might mean:
How do I obtain what I need for my physiological existence?
How do I keep myself safe?
How do I protect my territory?
Advancement might mean:
How do I make sure I have the necessary social contacts for emotional support?
I use the emotional systems defined by Tomkins and Karon (1962) and later refined by Ekman (2003). Tomkins believed that humans are equipped with innate affective responses. Tomkins (1962, 1963) was using affects to describe the biological compo- nents of emotion. These innate responses bias him to stay safe, avoid death, to desire sexual experiences, to seek novelty and avoid boredom, to want to communicate
to remain in close proximity with others of his species and to resist the experience of shame (as cited in Demos, 1995). Each of these primary emotions facilitates meeting of our basic needs for survival and/or en- hancement. Tomkins describes emotions in terms of their usual intensity and their more extreme form.
Both Tomkins and Ekman focused on the importance of the face as the locus for communication of emotions in important interchanges. In addition to serving the individual’s need, emotions exist in order to communicate meaning to others. The snarl of anger or the facial agony of distress communicates a lot to the observer. It asks for a response. Furthermore, as emotions morph into the experience of feelings, they provide the bridge between rational and nonrational processes. In the following list, I use Ekman’s grouping derived from Tom- kins. The basic emotions and their defini- tions follow:
2. Disgust/dismell primes the organism to avoid something that is dangerous or toxic.
3. Distress/anguish communicates pain and attempts to solicit comfort from the environment.
4. Fear/terror alerts the organism to danger and prepares the body for fight, flight, or freeze.
5. Shame/humiliation protects the organism, primarily humans, from unbear- able social pain.
6. Startle/surprise pertains to level of intensity. It is similar to interest, but has greater intensity in positive and negative directions. For example, seeing a dreaded person unexpectedly startles, and the emo- tion then turns to fear. In the positive direc- tion, surprise turns to excitement.
7. Enjoyment/joy primes the organism to continue rewarding experiences. In a healthy trajectory, this includes experi- ences that further the physiological and emotional growth of the individual and the species.
8. Interest/excitement provides the or- ganism with the impetus to seek out expe- riences and find things in the environment that it needs for continued survival, growth, and development.
• Imagining an emotional situation
• Talking about an emotional situation
• Empathy for others
• Instruction by others about what to feel emotionally
• Violation of social norms
Each of these appraisal systems may also have bodily equivalents, but according to Ekman they may not be as strong as the facial musculature equivalents.
Emotions and Facial Musculature
Ekman’s facial coding system evolved from his work with the sequestered tribal people of Papua, New Guinea. They spoke no English, and many of his subjects had never heard radio or seen television. Using a set of facial photographs taken of a different remote tribe, Ekman noticed there wasn’t
a single facial expression he did not recog- nize. Editing out the social context, he then showed the photographs to Silvan Tomkins, who was also able to immediately identify each emotion and describe the underlying facial musculature. Armed with these pho- tographs, Ekman returned to Papua, New Guinea, and designed an experiment that involved a very simple story told in the na- tive language of the Papuan people. Three photographs of the face, each one depict- ing a different emotion, accompanied each story. As the simple story was read in the native language, the subject was asked to point to one of the photographs that con- veyed what the main character in the story felt. For, example, the lady goes to the house and learns that her friend has passed away. The subject invariably selected the face portraying sadness and agony. Or, the lady in the house is alone with no weapon or stick. The lady sees a wild pig approaching her door. The subject invariably selected the photograph of fear and/or surprise. Af- ter testing nearly 300 subjects, Ekman was able to statistically verify the uniformity of selection for happiness, disgust, anger, and sadness. Only fear and surprise could not be clearly distinguished from each other (surprise often morphs into fear; alterna- tively, one might hypothesize that our first response to fear may be surprise). But, at least these two emotions were consistently linked to the same stories. The experiment was repeated and verified using another secluded tribal people, the Dani, in West Irian (part of Indonesia). Ekman took this verification to support his theory that facial expressions and the underlying facial musculature convey a universal language that communicates emotional meaning to others, regardless of native tongue or country of origin.
Ekman’s work … confirms that the brain and body are inextricably interwoven and that both contribute to our ongoing human efforts to construct meaning and to interact meaningfully with our immediate environment.
Ekman’s work on the correlation of facial musculature and emotions confirms that the brain and body are inextricably interwoven and that both contribute to our ongoing human efforts to construct mean- ing and to interact meaningfully with our immediate environment. Of note, the em- phasis on facial musculature adds another dimension to the importance of face-to- face play between infants and mothers. Regina Pally (2011) suggests that the baby “reads” the emotion in the mother’s face by experiencing it in his or her own facial mus- culature, thereby experiencing the emotion in him or herself. One might hypothesize that a baby with a depressed (sad) mother actually experiences, through her own facial musculature, the same sadness when she is with her mother. In adult psycho- therapy, Pally (2001) suggests that there might be different brain systems that read and interact with these nonconscious com- munications that are expressed through the subtle facial musculature. Patient and therapist in face-to-face interactions are implicitly reading and communicating to each other.
Andrew:Embodied Relational Conflict
Andrew, a 30-year-old professional, came for therapy for treatment of his fibromyalgia. He had made many attempts to heal his symptoms, but he remained chronically symptomatic. Andrew heard of my somatic orientation to psychotherapy and hoped that I could help to alleviate the chronic symptoms of his fibromyalgia: pain, fatigue, cognitive disorganization, and de- pression that accompanied all of the above. Fibromyalgia is a poorly understood disease. Although considered a legitimate disease, it is nevertheless considered by many in the medical community to be purely psycho- somatic. To date, little has been successful in treating the pain, discomfort, and other symptoms that patients suffer.
“I don’t know what I feel,” he said, and he seemed confused when I tried to elicit other bodily areas of experience. Over time, it became clear that for Andrew, the only way of feeling his body was through pain.
Using the principle of starting with where the patient is psychically, I inquired about the parts of his body that were in pain, and asked him to describe the pain in as much detail as possible. I used this detailed ques- tioning to get a better picture of his self experience. In describing his pain, he used words such as squeezed, pushed, pressed, poked, and prodded. From his associations to these harsh words and the images they evoke, Andrew’s body slowly revealed his relational history. Beyond the pain, it was difficult for Andrew to come up with much experientially. When I asked him about parts of his body that were not overtly in pain,
he had no answer. Because Andrew had so little awareness of his body, I started with the basics in order to help orient him to his body. I asked him about his awareness of his heartbeat, his breathing, and his tempera- ture. This was difficult for me. I experienced the work as painstakingly slow and very constrained, and Andrew expressed frustra- tion at this line of questioning. Awareness of his body did not come easily to him.
As we explored the “right answer” theme, details about Andrew’s early rela- tionships began to emerge. Andrew, the youngest of four boys, grew up in a highly ambitious family. All four sons were ex- pected to meet high intellectual, athletic, and social expectations. Whereas the three older boys seemed to comply easily with these expectations, Andrew felt pressed, pushed, prodded, and squeezed to conform and measure up. He was relentlessly com- pared with his highly successful brothers, and he always felt that he came up short. The competitive sparring in the family was often in the form of debate and intellectual dominance. Andrew felt unsuccessful or overwhelmed in this environment and was often ridiculed by his family. He was filled with shame. As this relational configura- tion emerged, I acknowledged that I did indeed want something from him, but what I wanted was to share in an exploration of his inner world and his self experience. Despite this explanation and reassurance, Andrew was convinced that I knew some- thing that he was supposed to figure out; he was panicked and frozen because he kept coming up blank. Thus frozen was expressed in his body: It was devoid of any and all feelings because he expressed his fear through freezing.
Not surprisingly, I often experienced myself in a power struggle with Andrew. He had a way of changing, in some nu- anced way, everything I said. If I said “You seem sad,” he might say, “Well, I’m not sad, I’m frustrated” or “It’s not really difficult, it’s more exhausting.” This reflexive “no” was constant enough that I made a connection to the struggle in his body over releasing tension in the muscles. I pointed out that there seems to be a parallel. I interpreted to him that he feared having his experience co-opted, and thus he tries to take control by stating it exactly in his own words.
In this way, he maintains control. Andrew developed a feeling of strength and power in being able to thwart and control the healing process. He longed for his suffering to be seen and attended to, yet he also derived some satisfaction in being able to say “You can’t help me.” This ambivalence toward being helped served other functions as well. It served to contain his fears of letting go and getting to know his body (his self) out of fear of further wounding.
As we explored Andrew’s issues around control, he revealed that he had been pushed rather relentlessly to succeed in many areas by his very controlling, anxious mother. She placed a high premium on looking attractive, on social status, and on professional success. Andrew often did not measure up to her high standards, and his mother freely showed her disapproval and frustration. In relation to these demands Andrew developed all sorts of somatic com- plaints—headaches, body aches, chronic sicknessall of which were dismissed as essentially unimportant or, at worst, fabri- cated. He received very little understand- ing, empathy, or support. In fact, his physi- cal symptoms seem to have frustrated his mother and stimulated her anxiety. When I expressed empathy for his pain and distress, he rejected these words. It was as if he had internalized his mother’s attitudes toward soothing and comfort and couldn’t let himself recieve it.
By helping Andrew connect to himself through his body, many aspects of his self experience changed. Primarily he gained access to his psychic pain and sadness. This affective/emotional experience was an experience that existed separate and apart from the pain in his body through the fibromyalgia. He is now more willing to share these painful, vulnerable feelings with me and with intimate others. I would parallel this softness with relaxation and greater flexibility of his muscles. He yields emotionally and physically.
I believe that exploring somatic realities with Andrew afforded entrance into his self experience in a way that working solely with the narrative, on the explicit level of discourse, might not have allowed. Because fibromyalgia is a condition that ex- presses itself somatically, it proved fruitful and therapeutic to bypass the more usual psychodynamic, narrative work and go directly to the source of the pain: his body.I was able to use the body to help Andrew interpret its messages in a language that he both spoke and understood. It gave him access to himself in a way that words alone did not seem able to provide.
Because he is less preoccupied with his pain, there is more “space” for him to inhabit his body in a more complete and engaged way. He seems more energetic, and he no longer takes antidepressant medication.
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Dynamic Psychosocialsomatic Psychotheyapy (DPP)
Dynamic Psychosocialsomatic Psychotherapy (DPP) is a highly structured, once to twice weekly-modified psychodynamic treatment based on the psychoanalytic model of object relations. This approach is also informed by the latest in neuroscience, interpersonal neurobiology and attachment theory. As with traditional psychodynamic psychotherapy relationship takes a central role within the treatment and the exploration of internal relational dyads. Our approach differs in that also central to the treatment is the focus on the transference and countertransference, an awareness of shifting bodily states in the present moment and a focus on the client’s external relationships, emotional life and lifestyle.
Dynamic Psychosocialsomatic Psychotherapy (DPP) is an integrative treatment approach for working with complex trauma, borderline personality organization and dissociation. This treatment approach attempts to address the root causes of trauma-based presentations and fragmentation, seeking to help the client heal early experiences of abandonment, neglect, trauma, and attachment loss, that otherwise tend to play out repetitively and cyclically throughout the lifespan in relationship struggles, illness and addictions. Clients enter a highly structured treatment plan, which is created by client and therapist in the contract setting stage. The Treatment plan is contracted for a fixed period of time and at least one individual or group session weekly.
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Further Reading :
The Power of Group Psychotherapy
Nutrition & Conscious Lifestyle at Plant Based Academy
Functional Health – The Mind/Body Connection
Working with Transference
Cancer treatment at Life Change Health Institute
Attachment and attachmnet disorders
Healthy Sexuality at Embodied Tantra Ireland