Embracing Pain: Ronald Siegel’s prescription for psychophysiological disorders

I finally made time to finish reading Mindfulness and Psychotherapy, and I was particularly struck by the chapter on “Psychophysiological Disorders” written by Ronald D. Siegel. As a long-time student of Somatics, specifically Thomas Hanna’s Clinical Somatics, I have been intrigued by how repeated triggering of the stress response can lead to habitual patterns of muscle tension, which can in turn lead to a variety of problems and limitations in how our bodies function. (For those who are unfamiliar with the concept, “somatic” basically refers to our interior, directly-sensed experience of the body.) While Hanna acknowledged the psychological dimension of somatic issues in his writing and theories, his clinical method does not include an explicitly psychological dimension, and I personally have found this to be a limitation in the effectiveness of his program of somatic education. Siegel’s notions of the “chronic back pain cycle” and the “recovery cycle” dovetail nicely with Hanna’s sensory-motor perspective, bringing in a psychotherapeutic approach that can be applied to wide range of clinical issues.

Siegel points out some interesting parallels between the chronic back pain cycle (which he defines as “a cycle of psychological stress, muscle tension, and fear-based avoidance of activity”) and anxiety disorders:

They both result from overactivity of the fight-or-flight system. The also both involve future-oriented maladaptive fear responses, experiential avoidance, and false assumptions about the nature of the problem.

So, according to Siegel, both chronic back pain and chronic anxiety can often be exacerbated by (if not caused by) a fight-or-flight stress response system that has become stuck in overdrive. Whereas Somatics approaches the physical manifestations of stress, especially patterns of muscle tension, it does not directly deal with the psychological side of the coin, namely the fearful avoidance of experience and distorted thought patterns that so often keep the stress fires burning. Siegel’s approach uses mindfulness-based psychotherapy to address the problem on both a psychological and somatic level, but I wonder if the sensory-motor techniques of Somatics might be better suited to deal with the neuromuscular side of stress. I’ll have to read Siegel’s Back Sense and experiment with his principles and techniques to see if/how they might fit in with my current integral health regimen.

When I find the time, that is! For now, it’s time to get ready for the new semester and start diving into my counseling books. This coming week I start Counseling Theory & Technique and Group Work Theory & Technique. Looking forward to it!

Therapeutic Lifestyle Changes

Dr. Roger Walsh recently wrote a landmark article in the American Psychological Association’s flagship journal, American Psychologist. The article, Lifestyle and Mental Health, outlines eight major lifestyle factors that are woefully under-appreciated in the field of mental health, despite overwhelming evidence of their psychological (and physical and social) benefits.

Here’s the abstract:

Mental health professionals have significantly underestimated the importance of lifestyle factors (a) as contributors to and treatments for multiple psychopathologies, (b) for fostering individual and social well-being, and (c) for preserving and optimizing cognitive function. Consequently, therapeutic lifestyle changes (TLCs) are underutilized despite considerable evidence of their effectiveness in both clinical and normal populations. TLCs are sometimes as effective as either psychotherapy or pharmacotherapy and can offer significant therapeutic advantages. Important TLCs include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. This article reviews research on their effects and effectiveness; the principles, advantages, and challenges involved in implementing them; and the forces (economic, institutional, and professional) hindering their use. Where possible, therapeutic recommendations are distilled into easily communicable principles, because such ease of communication strongly influences whether therapists recommend and patients adopt interventions. Finally, the article explores the many implications of contemporary lifestyles and TLCs for individuals, society, and health professionals. In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical, and public health.

In my opinion, Walsh’s article has the potential to influence and unify the fields of mental health, public health, and medicine in much the same way as Dr. George Engel’s biopsychosocial challenge for biomedicine did back in 1977. The following is a list of resources related to Walsh’s article:

PDF of the article in American Psychologist

Lifestyle and Mental Health topic page on Dr. Walsh’s website

Dialogue between Roger Walsh and philosopher Ken Wilber (Part one)

Dialogue between Roger Walsh and Ken Wilber (Part two)

Full video presentation at University of California, Irvine

UC Irvine presentation in ten parts via YouTube:

(1) Impact of Lifestyle on Mental Health
(2) Exercise Benefits Body, Brain and Mind
(3) Eating for Mental Health: What Kind of Diet Is Best for Brain and Mind?
(4) Fish Oil and Vitamin D: Supplements That Benefit Body, Brain and Mind
(5) The Effects of Nature and Technology on Mental Health
(6) Relationships: The Most Powerful Factor Affecting Wellbeing
(7) Recreation and Mental Health: Good Times Make for Good Minds
(8) Relaxation and Stress Management:The Benefits of Letting Go and Letting Be
(9) Religion, Spirituality, and Mental Health
(10) Helper’s High—Feeling Good by Doing Good

There is also a documentary multimedia project in development, 8 Ways to Wellbeing, that will feature Walsh’s work on TLCs. Here’s the promotional video:

Reflections on radical acceptance

While I was jogging this morning a few thoughts floated through my mind related to the notion of radical acceptance. Whenever I start thinking about such things, it’s all too easy to get stuck in semantics, allowing the rules of grammar and the limitations of linear thinking to distract me from the heart of the matter. For instance, I often describe the state of radical acceptance as one characterized by a “letting things happen of their own accord” as opposed to “me making things happen or me resisting things as a willful agent.” Obviously, this sets up a dichotomy between me, on the one hand, and experience, on the other. Once the dichotomy is set up, I too often get lost in a confused attempt to philosophically reconcile to the two poles, forgetting that the dividing line between the two is non-existent, except as way of perceiving experience from a particular perspective, namely the perspective of ego identification, which implicitly entails a certain degree of disidentification with non-egoic dimensions of experience. From the perspective of ego identification, I have experiences; experiences happen to me.

When I move into a state of radical acceptance, I’m moving from a state of relative non-acceptance where I’m fighting against life, trying to deny what is, hoping to somehow transform it into what I want it to be. So, at first, the shift to acceptance feels as if there is an I who is allowing experience or life to happen without any interference or resistance from me. This dividing line between myself and the flow of life experience begins to blur as I move deeper into a state of acceptance, eventually bringing me to state of being where such distinctions no longer hold sway, no longer make sense, and no longer characterize how I feel. The “problem” of ego identification isn’t really solved. It just disappears (temporarily). The differentiation between myself and life ceases to seem relevant, if only for a moment.

Consider the following reflections (Yes, this is really what I thought about during my jog!):

You need to find your way to a soccer field that is located on the border of two towns. You pull out your trusty road map and make your way there. The lines on the map are useful for finding your way to the field, but once you get there, they are no longer relevant to your next objective, i.e. to play a game of soccer with your friends. The town line cutting the field in half helped you get there, but once you get onto the field it disappears from your mind, and now the only relevant lines are the ones marking the field. After the game, you might decide to have a picnic on the field, or maybe later that evening an outdoor concert will be held there. At that point, the markings on the field also become irrelevant. They, like the lines on the map, were useful conventions in a specific context, served a function in pursuit of a specific purpose, but during the concert they lose all relevance. I think ego identification is like lines on a map or lines on a field. The distinction between me and my experience has relevance and reality only from the perspective of ego identification, and that perspective is merely a convention, like lines on a map or a field, that is useful for certain objectives and not useful for others.

The problem with being stuck in a state of ego identification is that you get stuck with the sense of separation and disconnection from life that goes hand in hand with the state. Differentiating and separating out a me from the rest of life (not-me) is the action of attention that defines and generates the sense of being a self. When we are engaged in purposeful activities, when we’re “getting things done,” it’s probably useful to set down some imaginary lines to create an image of oneself as distinct from the flow of life. But when the job is done, the destination reached, it just confuses matters to keep generating those imaginary lines, as it would be confusing to play soccer on a field marked with lines not relevant to the rules of soccer — i.e. football yard markers, town borders, and/or concert rows. Radical acceptance, like other deployments of attention that might be considered meditative, can be strengthened through practice to the point where it becomes an enduring pattern, a healthy habit, an available perspective through which we can experience life in its seamless glory.

My intention as I began my jog this morning? To stay aware of bodily sensations and to avoid getting lost in thought! And just in case anybody’s wondering: Normally I get lost in far more mundane mental distractions, like fantasies of winning Olympic medals or snippets of random pop songs from the 80s.

The Embodiment of Freedom: An integral approach to optimal health and personal transformation (Part 5: The Technology of Alienation)

[See parts 1, 2, 3, and 4 of the series]

It is important not to mistake the distinction between alienation and authenticity as a condemnation of the particular techniques that have supported the success and progress of a scientifically and technologically driven modern world. These techniques are, in-and-of-themselves, of neutral value. It’s the ways in which we integrate various techniques into our lives (the technology) that can either lead us either toward disconnection and diminished awareness or into levels of greater conscious connection and deeper self awareness, and these ways of responding to the challenges of life are shaped very early.

Beginning with the ways parents hold and touch their children, infants are learning how “to be” physically in the world. As they learn to mimic adults’ behavior, children are further educated on how to move and how not to move. Despite the potential for differences in this early upbringing, most young children are energetic, highly mobile, flexible, and authentically expressive beings. As children enter school, however, these tendencies are actively shaped like never before. As most of us have been schooled, children are typically made to sit in rigid desks for long periods of time. They must learn to ignore their natural inclinations as to how to move their bodies physically and express themselves verbally, expressing themselves only when some authority deems it acceptable and only in ways that are deemed acceptable. A child’s experience of fatigue, hunger, and excitement are brought into alignment with the pre-determined structure of the school day. Even during set periods for “free” expression, children are taught the “right way” to do everything, from throwing a ball to drawing a picture. Since kids’ developing sense of self-esteem is so wedded to the positive reinforcement they get for doing things “right,” expressing oneself in idiosyncratic ways is often met with discouragement from authority and ridicule from peers.

While peer groups exert relentless pressure to conform to the status quo, in the classroom bad grades are meted out to those who fail to do things “correctly,” and sometimes even physical punishment awaits those who allow their restlessness and bodily tensions to sneak out into their behavior. This training prepares children for life after school, where the organic rhythms of the body are regulated to fit the needs of the typical work situation. Food is eaten during a set lunch hour, one goes to the bathroom during scheduled breaks, and the range of overall body movement conforms to the prescribed limits of the given work setting. Johnson, in his book Body, summarizes this whole pattern of body-shaping as follows:

From infancy through old age we are taught to conform our bodies to external shapes. We learn to perform physical activities in specifically prescribed ways. We are rewarded for keeping quiet and controlling our bodily impulses. The implied meaning of these recurrent nonverbal messages is consistent with the explicit teachings: our bodies, with their feelings, impulses, and perceptions, are not to be trusted, and must be subjected to external controls to keep them from leading us astray. They must be trained to support the status quo.

The technology of alienation encourages individuals to exist in a state of continual repression, a dissociated state which truncates one’s depth of awareness as well as one’s range of responsiveness. This state of disembodiment manifests not only in a diminished and deadened sense of self, but also necessarily disembodies one’s relationships to others. Since we experience all situations in our lives with, through, and as bodily beings, to be dulled to our own bodily senses and feelings is to be dulled to the feelingful aspects of any relationship or situation we find ourselves in.

The dimension of consciousness that an alienated individual loses touch with is what humanistic psychologist Sidney Jourard called “somatic perception.” Jourard pointed out that people respond to all situations on a bodily-felt level, and that by perceiving subtle changes in the state of one’s bodily being, one can sense when a situation either enhances or diminishes the quality of one’s life. It’s on this embodied level that a little girl can tell which of the smiling adults in a room actually doesn’t like her; that we just “know” something is troubling a loved one, no matter how hard they try to hide it; that we simply get good or bad “vibes” about a particular situation. As a person loses the capacity to discern how situations affect him or her as an embodied being, it becomes all too easy to continue ways of living and relating that are not in one’s best interests. As Jourard put it:

When we repress the experience of our bodies, we not only reduce our experience of being alive, but, in order to protect ourselves from threatening pleasure and pain, we actually create circumstances by which we become stupid, that is, uninformed, in a peculiar, somatic way.

Thus, to the degree one lacks embodiment, one is ignorant of how to live situations in an authentic way.

As Johnson reminds us, authenticity is a word of Greek origin that originally meant “to do something oneself, to have a sense that one’s actions and feelings are one’s own.” When a person has a well-developed capacity for somatic perception, one is better suited to be one’s own authority on how to live in growth enhancing ways. This “sensual authority,” as Johnson calls it, comes directly from one’s sense of embodiment, and is precisely what is stripped away via the technology of alienation. When access to somatic perception is dulled, people progressively lose the necessary depth of awareness to possess a clear sense of how to be and what to do in life. As Johnson describes it:

The technology of alienation accustoms us to sense a void between ‘I’ and my flesh, and between ‘I’ and ‘you’. Because we are led to feel that we are not in immediate contact with the palpable world, we sense that we need experts who understand that world enough to tell us what to do.

Alienated from our embodied experience of self and world, we give doctors authority over our bodies, psychologists authority over our minds, outside mediators authority over our interpersonal disputes, governments authority over our environmental policies and actions, and religious leaders authority over our spirits. The shift from alienation to authenticity requires that individuals develop their impoverished self-sensing capacities and that they learn to check the dictates of outside authorities against this growing base of awareness.

The Embodiment of Freedom: An integral approach to optimal health and personal transformation (Part 1: Introduction to the inquiry)

A view of the Organ Mountains from my neighborhood in Las Cruces, NM
We’ve all had moments when we feel particularly full of life, especially present to whatever we’re engaged in — times when we’re simply more on, more there, more tuned in to life than usual. I was in my mid-twenties when I started to realize that these experiences of wakeful presence and intense vitality were becoming few and far between in my life, scattered here and there amidst the languid grind of everyday existence. The more I inquired, the more it became increasingly clear that I was also progressively losing touch with the sense of wonder and possibility that I had come to know as the deepest, most precious part of myself. As the prize of maturity stood waiting for me to grasp hold, I was paralyzed by the fear that somehow this growing sense of disconnection and diminished vitality was simply the terrible and inevitable cost to be paid, the price of admission into the world of adulthood. Before too long, however, I’d be graced with another wide-awake moment and, for a time anyway, I would feel certain that there was a better way forward, a way of becoming more connected and more fully alive instead of less so as we get older.

Abraham Maslow used the term “peak experiences” to describe these windows of full-living, and my initial question regarding them was three-fold: What is the nature of such experiences; why are they becoming so few and far between in my life; and can I learn to live in such a way as to have more of them?

Over the years this initial inquiry has become a sustained, passionate pursuit of personal truth that has always been, at heart, toward a deceptively simple end: to be as fully myself as often as I can be. Along the way I have discovered a few things that I hope others will find to be interesting and useful. I also hope that writing my way through the process — of where I’ve been, where I am, and what may lie ahead — might open new avenues of inquiry and new territory to explore as I continue on this journey.

My intention is to update this series of posts regularly — at least once a week. In the next installment I’ll define in detail what I mean by the terms “integral” and “personal transformation”, and I’ll also lay out a broad outline of some of the territory I hope to explore.

Unwinding

I do a very idiosyncratic meditation practice of sorts that has evolved over many years — a little song and dance I call “unwinding.” Basically, I just lie on the floor, on my back, and do nothing. I inhibit any and all voluntary movements as I wait for anything that feels involuntary, any movement that feels as if it’s happening of its own accord. For the first several minutes I may only get a few twitches, but eventually, if I tune in enough, a whole series of movements will begin to emerge, and I follow them wherever they go, as long as the sense that it’s all “just happening” is driving the action. After a while, I might be bouncing all over the room, or end up on top of the refrigerator (this has actually happened!).

The sense I get during these movement meditations is that I’m literally unwinding various patterns of tension and inhibition, like the way a twisted rubber band will follow its way back to its slack form in precisely the reverse pattern with which it became twisted. At the end of this unwinding I feel incredibly clear and free, and I’m often showered with insights for hours.

Of course, it’s not always a super-intense experience, as the whole thing is about dropping into what’s actually going on in my body, not about trying to make something cool happen (although admittedly I’ve fallen into that trap many times). For whatever reason, I only do this practice every once in awhile, when I feel particularly compelled, which is usually when I’m particularly wound up. (Inconveniently, this has tended to be at like, three in the morning.) It’s only recently that I’ve explored this on a regular basis. That’s because it’s only recently that I’ve had the time to regularly indulge in such extended periods of purposeless. In so many ways, this “no job” period has been far more glorious than I imagined it would be. I know it won’t, can’t, and probably shouldn’t last forever, but I definitely can see myself getting in the habit of taking these extended “me retreats” more often in the future, should I continue to be so fortunate.

On the surface it might seem a bit self-indulgent to spend so much time navel-gazing, so to speak, but in my experience the benefits of such sustained inner focus usually extend far beyond my little Bob-o-sphere. Disconnection from my deepest intentions leads to disconnected experiences, disconnected actions, disconnected habits, disconnected relationships. Any investment I make in reconnection leads to, well… reconnection. It’s as simple as that. In short, the quality of my experiences–i.e. of my life–has always depended, in large measure anyway, on the quality of attention I’m able to bring to any given situation. Taking the time to truly unwind (as opposed to getting pleasantly distracted from being wound up) has consistently led to increased clarity of attention, refinement of sensitivity, deepening of self-awareness and, ultimately, a greater capacity for open-hearted communion with my fellow humans.

Or I’m just being self-indulgent. Either way, who doesn’t enjoy spending a quiet evening on top of the ol’ fridge?