The Autonomic Nervous System:
Barometer of Emotional Intensity and Internal Conflict
A
lecture given for Confer, 27th March, 2001
The material for this lecture is part of a six evening seminar
‘The New Anatomy: Exploring the Mind in the Body’
run at Chiron February-March 2001.
As a body psychotherapist,
I come from a therapeutic tradition, whose basic premise is that
bodily processes are intrinsically involved in psychological processes,
and vice versa. In this field the autonomic nervous system has
long been recognised as a barometer of emotional intensity and
internal conflict. Body psychotherapy developed out of the work
of Wilhelm Reich, who was a student of Freud’s. Its basic
premise is that the mind and the body cannot be understood as
separate phenomena, and therefore need to be addressed together
in psychotherapy.
In body psychotherapy,
the Autonomic Nervous System has been known by the more archaic
term, the Vegetative Nervous System. Vegetative is derived from
the Latin vegetare which means to quicken, animate or bring life;
the autonomic nervous system governs the ‘involuntary’
visceral processes. I am going to be talking this a lot this evening
about variations in autonomic function, and its role as a homeostatic
regulator of emotional intensity. But its important to make the
point that the ANS function of maintaining parameters is essential
to life - a complete breakdown in functioning leads to death.
Between initial perturbance and imbalances, which go back to infancy,
and death there is usually a long intervening process of attempts
to re-organise and rebalance the psychophysiological system.
My proposal this evening
is that object relations are internalised in the body at every
level of function and structure, including as modifications to
the autonomic nervous system. I will be unpacking Reich’s
formulation that: the development of character is a progressive
unfolding, splitting and antithesis of vegetative (i.e., autonomic
functions). Although I’ll be drawing on some very recent
neuroscientific and metapsychological thinking, I want to give
credit to Reich’s insights which were so ahead of his time.
(see end for discussion of Reich in relation to Schore)
I am going to take
you from a basic picture of the functioning of the autonomic nervous
system, as you would find it outlined in any physiology textbook,
through a more developed holistic conception of it, to a model
which situates it directly within conscious and unconscious communications/exchanges
of object relations. As well as drawing on information from different
disciplines, we will be moving from a simple cause and effect
model of the nervous system to the more recent scientific perspective
of dynamic complexity. If we are to progress in our understanding
of the capacity of body and mind to function both as a unity and
as a split object/subject, we have to firmly put behind us a search
for ‘cause’, and even an explanation in terms of symbolic
language, and look instead at emergent properties of complex interactions
between systems (bodily, social, etc)
The Basic Physiology
The nervous system as a whole includes the Central Nervous System,
consisting of brain and spinal cord, and the Peripheral Nervous
System, whose nerve fibres connect all parts of the body with
the central nervous system. The Peripheral Nervous System is further
subdivided into two branches, the Somatic Nervous system and the
Autonomic Nervous System. All these nerves are outside the Central
Nervous System. The Somatic Nervous System controls musculoskeletal
movement, and conducts sensory messages from the body to the CNS.
(model is increasing decentralisation)
The Autonomic Nervous
System has two branches, the Sympathetic and the Parasympathetic,
which regulate the involuntary processes of the body, the viscera,
and sense organs, glands and blood vessels. In evolutionary terms
it is older than the CNS and its anatomical circuitry is broadly
dispersed, creating a general response, quite unlike the highly
specific pathways and response of the CNS. This generalised, widely
distributed structure enables it to mediate overall changes in
state; it is part of the limbic system which has also been known
as the mammalian or emotional brain.
It was called autonomic
because it was believed to function autonomously – we now
know that it is dynamically related to many other parts of the
brain especially the orbitofrontal cortex. Autonomic also means
self-regulating and this is a key principle of all body systems,
which depend of constant feedback in order to maintain homeostasis.
There are multiple feedback loops in the body which continually
send and receive information about what’s going on and the
ANS is part of this wider complex.
In standard physiology
the two parts of the ANS have been perceived as functioning reciprocally:
the sympathetic governing arousal, the fight or flight reaction
and the parasympathetic involving relaxation, recuperation and
digestion. The sympathetic nervous system is activated by any
stimulus over an individual’s threshold (and the threshold
can vary enormously), including feelings, and by noise, light,
drugs and chemicals (e.g. caffeine).In response to the stimulus
an immediate anticipatory state is generated by the release of
adrenaline. This causes the heart to beat more quickly and strongly,
increases blood supply to the muscles, raises blood pressure,
dilates the bronchii and increases the breathing rate, raises
the blood sugar level for increased energy, speeds up mental activity,
increases tension in the muscles, dilates pupils and increases
sweating. Non-emergency functions, such as digestion are lessened
or suspended. (priming phase – short-term) Walter Cannon
coined the phrase ‘fight or flight’ to describe the
function of the rapid mobilisation of resources.
The parasympathetic
nervous system comes into operation after the stimulus has been
responded to and action taken. It has the opposite effect to sympathetic
activity, allowing the body to wind down and re-balance. The activation
of the parasympathetic nervous system encourages relaxation of
muscles, slowing the heart rate and lowering the blood pressure.
It assists the breathing to return to its normal rate, digestive
juices flow, bladder and bowels are ready to function, the pupils
constrict and immune functions, such as the production of white
blood cells are re-commenced. The parasympathetic mode supports
rest and sleep. (the investment phase - long term). The standard
physiological model of the ANS is of reciprocal tension - with
the two parts keeping each mode in check – When the sympathetic
goes up, the parasympathetic goes down. A good example of optimal
autonomic balance can be seen in cats who respond alertly to certain
sounds or movements, but, as soon as the situation is assessed
as safe, return immediately to a relaxed state.
Lets just stop a minute
to become aware of our own autonomic state: tongue, heart rate,
peristalsis, skin – temp and moisture – warm &
dry; cold&wet; relaxation/tension. Attentiveness – alert
to broad awareness..
An understanding of
the autonomic nervous system in terms of ‘stress’
was popularised in the 1950’s in the work of Hans Seyle.
This marked the beginning of the extensive concern with stress
in psychological and medical thinking that is still around today.
Seyle identified the physiological responses to environmental,
lifestyle and personal change. He described a General Adaptation
Syndrome which consisted of 3 stages: first, the emergency or
alarm reaction which prepares the organism for immediate fight
or flight; then there is the resistance stage in which many of
the physiological changes associated with the alarm reaction are
reversed, and the organism has increased resistance to the stressor.
The final stage, exhaustion occurs when the body’s ability
to deal with stress runs out. It’s a concept that is still
useful and widely accepted. We notice that people can fight off
illness when there are demands that need to be met, such as work,
but that when they stop for a holiday, they succumb to illness.
The problem with the
ubiquitous use of the word stress, as Rollo May pointed out in
the revised edition of his classic work The Meaning of Anxiety,
is that it is used as a synonym for anxiety and they are not the
same thing. Anxiety is an intrapsychic phenomenon, which originates
in a repressed internal conflict, often a repression of instinctual
impulses that are actually bound up with survival. Stress, on
the other hand, is typically attributed to externals – stressful
working and living conditions. It puts the emphasis on what happens
to the person. It has an objective but not genuinely subjective
reference.
The emphasis on the
perception of danger in the name ‘fight or flight’,
which embeds its meaning in more primitive roots, is both a liberating
and limiting concept. Where it is useful is in helping us understand
that any situation that is subjectively perceived as a threat
to one’s integrity - from an insult, to threatened loss
of work – can trigger a fight/flight response. But it has
also detracted from an understanding that much subtler feelings
, combinations of feelings, and conflicting feelings correlate
with autonomic activity.
Emotional-Physiological
Cycles
In body psychotherapy, and more recently in neuroscience, sympathetic
activity, has been seen more broadly as an indicator of an impulse
or a feeling being stirred. The word sympathetic –sym pathos
means with feeling. It is most easily understood as an upsurge
– those feelings which are experienced as coming UP –
anger, fear, excitement, desire, hatred – and which if expressed
involve movement out, or towards, or in the case of fear, away
from, an object. Sympathetic physiology increases energy and readies
the body for action – so it is also about the need to do,
express, act.
Conversely the parasympathetic
action is a concomitant of coming DOWN – disappointment,
grief, shame, guilt, despair; and contentment, peacefulness, satisfaction
- feelings which involve a decrease in tension, withdrawal of
energy inward and tend more towards introspection. Laughter and
tears are both usually a sign of parasympathetic activity.
Reich pointed out that
pulsation, the movement of energy in and out – is a fundamental
quality of living organisms. It’s evident in our breathing,
heartbeat, and our need to take in and expel food. The autonomic
nervous system which governs these activities is a manager of
metabolic energy – increasing it when necessary, conserving
it the rest of the time. Sympathetic activity is catabolic –
it breaks down substances in the body to produce energy for activity.
Parasympathetic activity is anabolic – it builds up and
restores. The parasympathetic phase is vital to the maintenance
of long-term health. In optimal psychological and environmental
conditions the body swings into parasympathetic mode to repair
and maintain health.
It is well understood
and documented now that chronic sympathetic activation, which
can have many causes, undermines good health. A combination of
factors means that the predominance of the sympathetic mode is
the norm. Stimuli over a certain threshold of loudness, brightness,
speed affect the nervous system, as do stimulants in food, drink
and drugs. Culturally we’re into over rather than under-stimulation.
Further, an increase in acidity at cellular level predisposes
the body to sympathetic activity (and correspondingly alkalinity
links with the parasympathetic). And so, of course, vice versa:
if the body is in a constant state of sympathetic activation,
there is an over-acidity in the tissue, which has an effect on
health.
One way in which the
body protects itself from emotional intensity is the development
of chronic muscular tension, which dampens down both external
and internal stimuli. Reich called this character armour because
it establishes ongoing defences against internal conflict –
the location of the armour relates to specific developmental conflicts
around bonding, nurture, self-control, sexuality etc. Although
sympathetic activity increases muscular tension, individuals with
sustained high tension tend to have lower autonomic arousal than
those with less muscle tension. Muscle tension creates a buffer,
which reduces anxiety but at a cost – a loss of contact
with oneself and others. It can be a negative loop that leads
to loss of self-regulation.
Too much muscular tension
impairs health because it constricts and inhibits spontaneous
processes in general (i.e. including feelings and thoughts), such
as breathing, and the venous and lymphatic circulation, which
are responsible for clearing the body of toxins. (Interestingly
the word stress from the Latin stringere (to draw tight) is similar
in meaning to the Latin word angere (to press tightly) which is
at the root of our words anger, anguish and anxiety. This repressed
inner turmoil translates in the body as tension at every level
(visceral/muscular/autonomic etc), including hardening and narrowing
the arteries, as in angina, a medical condition which can precede
heart attack.)
On the other hand,
chronic parasympathetic activation, which correlates more with
psychological collapse and depression, is not healthy either.
Its characteristics are low blood pressure, sluggishness. The
organs and muscles lack tone – in other words there is not
sufficient tension.
Now I want to look
at the correlative psychological modes of the sympathetic and
parasympathetic activity. These are general qualities rather than
fixed attributes.
Sympathetic Parasympathetic
Activity Receptivity
Speed Slowness
Tension Relaxation
Focus Scope
Convergent thinking Divergent thinking
Extraversion Introversion
Goal-oriented Process-oriented
Agency Presence
Direction Elaboration
So these are all resources,
complementary modes, exquisitely differentiated states. Optimally
and in health these modes support each other, interact, balance
and modify the use of energy. Like a happy couple, they dance
together, supporting creativity, flexibility and well-being.
Reich perceived the
reciprocal action of sympathetic and parasympathetic as part of
a four-beat cycle: tension-charge-discharge -relaxation. This
is known as the vasomotoric (vaso – blood; motoric –
mvement) cycle, and is a holistic model embracing both psychological
and physiological function. One image I have of the sympathetic
is the coiling of a spring; the parasympathetic is the rebound
back to a resting state. The part in between – the spring
springing – is a crucial transition. In the coiled wire
this action is governed by physical laws – the extent of
its spring depends on fixed physical parameters. But in a human
process its much more complicated. Suppose the client has an impulse
to say something in a public setting which has a bit of charge
– they gather up the energy. They say it, the effects of
saying it sink in. That’s a cycle. Now suppose something
interrupts this – they dismiss the impulse almost as soon
as they’ve had it, or they allow the excitement and anxiety
to build, but then they bail out at the last minute, or they say
it and are so overwhelmed with having said it that they can’t
follow through or take in the response. Or, they say it, start
integrating, unwinding, but then are left with a remnant of anxiety
so they can’t completely let it go.
I’m sure all
these patterns will be familiar – the point I’m making
is that they have direct autonomic correlatives. In standard physiology
the autonomic nervous system is a closed system, where homeostatic
balance is maintained by innate self-regulation. The parasympathetic
will inhibit the sympathetic when it has reached a certain point,
and vice versa. Its what keeps us alive. But you will understand
that with emotional process it can get a lot more complex, and
small variations in function have a significant initially subtle
effect. This is because the body is also a relational body which
makes it an open system, subject to modification by the impact
of events and processes and the external environment.
Autonomic Splitting
In the example I’ve given, the inhibition at any point in
the cycle means that something is not integrated – its split
off. If the words are not said, the person will inevitably start
to wind down sooner or later – just because of the in-built
homeostatic regulation. The energy aimed for the speaking might
be turned into a self-attack, or maybe the person will think it
over and be a bit resigned. In this case the transition to the
parasympathetic may overlay ongoing sympathetic activity. And
this is a key thing to grasp. The internal psychological conflict
operates as an autonomic split. The parasympathetic can mask the
sympathetic, or the other way round. The two systems can be in
active conflict, or lacking reciprocal tension and therefore chaotic.
With the parasympathetic
masking the sympathetic, the person might leave the room and cry
hot angry tears and feel collapsed but be unable to receive support
because they are still angry. The inhibited anger/aggression isn’t
quite assimilated so that the parasympathetic mode of release
through tears and a more vulnerable state can only be partially
activated. Or the other way round, (sympathetic masking parasympathetic)
they might feel deflated inside, but rally themselves to get on
with it, thereby using a sympathetic mode to force the start of
a new cycle. Here the sympathetic might manifest as a slightly
compulsive quality of talking and acting – a bit speeded
up, overriding a deeper perceptible ‘flatness’.
Obviously it is quite
impossible for all impulses to be satisfied - the nature of life
essentially means that there is a huge over-presence of all thoughts
and impulses. And the way we deal with this is both positive and
constructive (acts of creativity), and negative and destructive.
Human beings have quite extraordinary and ingenious strategies
of transforming the abundance of life stimuli. That said I’m
going to focus this evening on how in particular the inhibition
of strong emotions has an effect on health.
The autonomic split
resulting from incomplete cycles may be a temporary compromise,
but often it’s a more fundamental physiological pattern
(I’m going to talk about its developmental origins in a
few minutes). The split off remnants remain in the body as generalised
or localised areas of muscular tension, pain, flaccidity or numbness.
They linger as particular controlled or constricted breathing
patterns; for example an in-breath stimulates the sympathetic.
It’s a spontaneous thing to do as we initiate, but if we
fear passivity we might force the in breath. The parasympathetic
is activated by an out-breath – again a natural way to end,
or a defensive way of trying to get rid of stimulus (for example,
the heavy sighs of someone who is repressing anger). Autonomic
splits can lead to hormonal or immunological imbalances (the hypothalamus,
which mediates autonomic action also effect the endocrine and
immune systems).
What I’m saying
is, an aspect of physiological functioning may become –
in Reich’s word - sequestrated. Sequestrated means to seclude,
set aside, to remove, render ineffective. Reich’s word emphasises
something temporary, lawful, purposeful. The splitting off –
paradoxically - maintains some kind of integrity. A part of the
body holds on to its original impulse. This brings me to another
way of translating autonomic - my favourite - from the Greek auto
- noumous : ‘the law of the self’. I believe that
the functioning – including the splitting - of the autonomic
nervous system is fundamentally bound up with preserving the dynamic
integrity of the self.
In health, physiological and psychological are relatively synchronous.
There is a congruence between the feeling psychologically perceived
and the feeling that is being embodied. Illness is always initially
an attempt by the organism to re-stabilise after some impingement.
It begins as a spontaneous response to a situation – maybe
a single event or a complex circumstance, with perhaps both external/internal
factors. (I include in this both something actual, like a virus,
and something subjective, like an unconscious fantasy)
Now before going further
with this more complex model of autonomic fragmentation, I want
to briefly go back to the characteristic defences and ego capacities
which correlate with these two modes. I want to emphasise that
these links I am making between autonomic states and defences
are not fixed, and cannot be diagnostically isolated but perceived
as part of an energetic pattern. They represent tendencies; autonomic
states, as I have suggested, can overlay each other and fluctuate
in ways that defy simplistic categorisation.
Sympathetic Parasympathetic
Flight Collapse
Aggression Passivity
Opposition/reaction formation Collusion/retroflection
Blame others Blame self
Hyperactivity Hyperreflective
(productivity without creativity) (creativity withoutproductivity)
Projection Introjection
Omnipotence Omniscience
Mania Depression
These defences arise
from the foreclosure of an emotional-physiological cycle. We understand
from Klein that these defences originate in the infant’s
vulnerability to and dependence on the environment. In adults
the same physiological patterns and defences may be employed as
habitual modes or under challenging circumstances, when the individual’s
capacity to act (sympathetic) or to digest feelings (parasympathetic)
is inhibited for any reason. We could say that these defensive
modes are signs of the organism moving into the margins of stress.
I want to make the point that while that these defences are still
healthy and functional while they are context appropriate. It
is only when the splits become chronically embedded in alterations
of the structure-function of the ANS that they are pathological.
I can think of a client
who, because of a complication in labour, had to go into hospital
although she had wanted to give birth at home. She had to deal
with her dependency on the medical staff and her hatred of what
they represented for her - a controlling, cold, mechanical mother.
Everyone in the hospital became seen as either good or bad –
she was able to trust absolutely in a few key figures and managed
to get rid of those she didn’t like, either by ignoring
them or by being overtly hostile. As soon as she had actually
given birth, this dramatic splitting subsided, because it had
fulfilled its temporary function – to postpone one emotional
cycle while a more urgent cycle was in progress. An important
part of her resolution of her experience in hospital was talking,
reflecting and writing about it. She called her birth story ‘Chiaroscuro’,
from the Italian for light/dark – ie. the good and the bad.
Self-Regulation: A
Developmental Perspective
In a fascinating and detailed study of the relationship between
attachment and neurological development, Allan Schore has helped
illuminate just how individual nuances in autonomic activity are
influenced by the infant’s ongoing relationship with the
mother. A baby’s capacity to act is incredibly limited by
its physiological and psychological immaturity – a baby
cannot, obviously, fight or flee something overwhelming. And the
something overwhelming might simply be its own need of food or
contact (Winnicott’s ‘clap of thunder’ captures
the experiential impact). It is dependent on mother or another
caregiver for emotional and environmental regulation. If the parent
can soothe and stimulate appropriately, these functions are internalised
as capacities in the nervous system.
In a newborn baby,
it is now suggested, the reciprocal tension of sympathetic and
parasympathetic are not well-developed. A good example of this
is colic which I did some research on a few years ago . Colic
is a very common but quite distressing phenomena where the baby
will have difficulty feeding and can cry every day for hours.
The digestion (parasympathetic) is disrupted because the baby
is over-stimulated (sympathetic). This over-stimulation may be
a result of many things – compression of the vagal nerve
– a crucial mediator of the parasympathetic nervous system
-during birth; an environment or life-style that is unsettling;
internal conflict in the mother etc (or of a combination of these).
One of the best ways of reducing colic is for the mother to keep
the baby in close physical contact – such as in a sling
– for long periods. Her body and her more mature nervous
system can help regulate the baby’s arousal.
As the baby develops,
the parasympathetic mode ( the soothing function) becomes more
an established and is more able to inhibit the sympathetic, in
other words to modify stimulation. The parasympathetic mode has
a role in impulse control. However it can be over-dominant. If
the parent greets a toddler’s excitement with harsh disapproval,
the toddler may respond to this withdrawal of contact with parasympathetic
over-activation – i.e. a collapse. The parent’s rejection
is experienced as a real down fall, a drop into shame, despondency
etc. Another toddler might respond by further demands or mischief,
which might successfully draw the parent back into relation, or
it might be met with a slap. From these two examples I hope it
becomes possible to imagine just how the interplay of the two
modes can reflect a containing parent, or in a more conflicted
or chaotic environment, the opposite. Constant opposition between
parent and child may become internalised as an antagonistic relationship
between the sympathetic and parasympathetic.
Deficits and failures
in the primary relationships are laid down as autonomic patterns,
which reflect the infant or child’s default style of coping
with its feelings. Styles of managing feelings are modelled explicitly
or implicitly in the way parents respond or react to events. Autonomic
identifications and polarisations become built in – for
example, a child may react like the over-excited mother (sympathetic);
or they may become the complementary object and be mother’s
‘rock’ steady, dependable, imperturbable (parasympathetic).
Of course, as with all object relations, the child will internalise
both, and what is lived out in their typical mode of being may
give way under stress to its opposite. (The terms ‘autonomic
identification and polarisations’ are mine; the examples
are my phenomenological extrapolations from Schore – his
own descriptions are purely technical.)
Repeated patterns of
interaction between parent and child have long term effects via
the ANS. The ANS manages quantity and distribution of energy in
the relationship between the organism and the environment. When
the response called up in the organism is overwhelming, the overload
can be managed in a variety of ways, intensification of autonomic
reaction, localisation of a charge within an organ or a muscle
group; usually all these means will be deployed to some degree,
with the correlative psychological defences. What happens next
is somehow more significant: the organism struggles to find equilibrium,
to assimilate, elaborate or bind the energy/feelings in the longer-term.
The psychologically and physically robust individual has the most
options for tolerating, adjusting to or acting upon the environment.
The more limited an individual’s options, the more likelihood
of chronic psycho-physiological compromise in the direction of
illness (visceral, tissue, muscle and skin armour limit the health-maintaining
functions of the organism); and behaviour including self-management
strategies like addictions.
I want to move on to
say something about trauma, which can be viewed specifically as
a breakdown in autonomic functioning. So far I have talked of
reciprocal function of parasympathetic and sympathetic, and of
splitting or antagonism between the two systems. In trauma, we
see another phenomenon. Instead of mutual inhibition, both sympathetic
and parasympathetic become more and more strongly activated. In
the face of a strong stimulus and a perception of no way out terror
is aroused and can end in paralysis, freezing, black out etc If
the danger cannot be met by fighting or running, or by expressing
vulnerability, co-operativeness or whatever (I’m thinking
of traumas as varied as rape, train crashes, fires, abduction
etc), the body, like the mouse caught by a cat, may involuntarily
play dead.
One of the defining
characteristics of post-traumatic stress is a chronic disorder
of the autonomic nervous system, manifest as a strong tendency
to startle, blackout, hyper-irritability, disrupted sleep etc.
A small but significant stimulus can trigger a panic attack. Where
the trauma goes back to infancy and is an intrinsic part of the
relationship with the caregiver, there is more likely to be severe
personality disorder.
Four types of Autonomic
Dysfunction
Characterologically and culturally, individuals will have predispositions
towards the sympathetic or the parasympathetic. For example, racial
groups originating near the tropics, needed to be more sympathetic
dominant, to respond to the challenges of that environment, in
which the capacity for flight was necessary. Further north, where
people migrated to settle and farm, a more parasympathetic dominant
tendency became embodied. Even farther north, where endurance
was the main survival quality there was an even stronger tendency
to parasympathetic predominance. Nowadays, with so much global
movement and multi-racial interweaving, such simple metabolic
biases no longer hold true. This reminds us of another way in
which we need to take on board complexity in the organism-environment.
(These patterns are recognised in Ayurvedic medicine, and have
been more recently popularised in the blood type diet)
By autonomic dysfunction
I really mean a chronic pattern of coping via psychological/physiological
defences. Essentially I am proposing four types of autonomic dysfunction,
which are reflected in all aspects of a person – from subtle
psychological and physiological processes to more extreme illnesses
and disorders. In doing so I’m aware of collapsing normal
distinctions between categories. This model is very speculative
but it does draw on a variety of sources, including the major
psychoanalytic theories of illness, recent neuroscience, holistic
therapies and body psychotherapy.
These autonomic splits
can exist in various combinations at various times and be more
or less creatively handled. In chronic and serious illness, an
equilibrium is established via some kind of compromise of an internal
conflict. Depending on the nature of the condition, the symptoms
may represent an appropriate adjustment, or a sustained defence
against the intensity of one or many feelings.
I want to make the
point that as well as being influenced by emotional factors, there
are of course genetic weaknesses and the impact of specific factors
in the physical environment which play a part. In fact what I
am proposing is an environmental-organismic model, rather than
an a purely psychological model. (see below for discussion of
terms organismic-environmental)
The first kind I’m
calling sequestration, using Reich’s term. This is where
a more or less isolated organ, muscle group or physiological function
becomes symptomatic. It’s a kind of damage limitation, and
its isolation in the body is also a form of representation. And
so a symptom emerges – a frozen shoulder, an ovarian cyst,
and a sore throat. In psychoanalytic literature this may be perceived
as a break down in symbolic thinking – the body becomes
the metaphor. Such a view is also well popularised in various
humanistic and New Age therapies where there is an emphasis on
discovering the message that the symptom is carrying. There are
many spectacular examples of symptoms clearing up when the message
has been received and understood. (see below in ‘Ways of
Working’ for further discussion of symbolisation).
A simple example of
symbolisation is the woman with a severe facial rash, who, it
eventually turns out, has been desperately putting a ‘brave
face’ on deep distress and anxiety. In a more complex introject,
I had a client with a frozen shoulder. There were obvious conflicts
around shouldering responsibility and feeling burdened which we
explored. Over a three month period I worked with increasing body
awareness, exploring the mobility of the shoulder, releasing the
tension in the neck through holding the head. But what became
increasingly evident to me was that the client was struggling
to avoid very painful feelings of exclusion and rejection. The
frozen shoulder was an introject of the ‘cold shoulder’
she felt she has been given in a current life situation, in her
early relationship with her mother, and in the transference with
me.
The second kind I’m
calling antagonism. Here there may be a war of attrition or a
full scale battle between the sympathetic and parasympathetic,
which correlates with a battle around drive and self-control.
Heart attacks may fit more into this pattern – the individual
pushes themselves to achieve, maintaining overdrive, controlling
anger, disappointment, frustration – pushing on, on, on
till the heart cannot cope. Heart attacks happen more often on
a Monday and cluster around 9am – the day and time when
most people go back to work after the weekend.
This antagonistic pattern
can also fuel addictions – most addictive substances either
stimulate, and wake you up, or they take you down and mellow you
out. We can start to use drugs of all kinds, including caffeine,
nicotine, alcohol, tranquillisers – to get ourselves into
the preferred autonomic state – it’s a sort of self-medication.
The third kind I’m
calling instability. Here the two parts of the autonomic nervous
system are failing to regulate each other, producing wild fluctuations
in mood and body symptoms. This client presents as hysterical
or hyperchondriac – symptoms move around, change, get very
intense but suddenly disappear. The key characteristic is instability.
Doctors may investigate and find nothing wrong, but the client
is tormented, and frightened of the body. I had a client with
a history of chronic abandonment. In our work together, I would
often sense that she had lost all connection with her legs. It
became clear that this was associated with abandonments of any
kind, where it seemed that ‘the carpet was pulled out from
under her feet’. She didn’t lose the capacity to walk
(a more extreme hysterical conversion), but to connect energetically
with her legs and the ground (i.e.. a matter of fact here and
now reality). Triggered by fear of abandonment, she was in some
respects ‘gone’. With my drawing attention to her
legs, and putting my hands on her feet, she was able to re-own
her legs (see below for discussion of motor-sensory integration.)
The fourth kind I’m
calling trauma. The two parts of the autonomic nervous system
escalate their functions. Here the symptoms are characteristic
of high stress – panic attacks, cold sweats, palpitations,
nightmares, outbreaks of violence, inability to cope, rapid changes
from hot to cold and back. Trauma, which makes the autonomic nervous
system highly unstable, can contribute to any of the above patterns.
In many cases, the traumatised client is more contained by illness
than not – hence the stubbornness of certain illnesses (i.e.
resistant to interpretation) which are apparently ‘psychosomatic’.
Illness can be a sign of health – the body is being allowed
to elaborate its terror, rather than held in a state of permanent
defence against spontaneous processes.
These splits could
be seen as a progression of disturbance – the ego is relatively
rigid in the first two examples, and more fragile in the second
two. In a very general way, we could say that in sequestration
and antagonism the individual makes use of their body; what is
feared is ‘excess’ i.e.. strong unmanageable feelings.
In instability and trauma the body is experienced as radically
unsafe; it is feared but not used. In the first two patterns,
the body is a controlling container; in the second the body becomes
the anti-container. These patterns repeat and embody object-relational
experience, as well as racial/gender/social patterns, possibly
encoded at a genetic level.
Sensory Motor Functions
and Splitting
Having outlined the link between autonomic and emotional development
as a relationship function, I want to go back briefly to physiology
to look in more detail at how these patterns become embedded.
There are multiple motor sensory loops in the body which send
and receive information. They influence all body functions –
for example, the immune system responds to changes in the body,
with appropriate immune reaction, such as the production of antibodies.
And this loop stimulates concurrent signals that influence the
individual’s behaviour – such as sending stimuli to
drink or rest. Contributory factors to many chronic illnesses
include the prolonged overriding of messages from the body to
stop and rest; and chronic dehydration because most people have
simply lost a healthy thirst reflex. In other words, there is
a split between spontaneous (instinctual) survival impulses on
the level of sleeping and drinking, and other influences (pressures
of modern life) which reinforce a dissociation from body signals.
To understand why this
happens we need to recognise that self-regulation in the widest
sense (including its autonomic/emotional aspects) is intrinsically
bound up with complex neural and chemical motor-sensory feedforward
and feedback loops. When we use our muscles, for example, there’s
not just an instruction from the brain, but feedback from proprioceptors
in the muscles and joints which monitor changes in tension, the
speed of change, changes of pressure in the tissue, the position
of joints in relation to each other etc. Although largely outside
awareness the proprioceptors provide a dense, dynamic 3-d map
of the body in space and in action. (See my article on the Motoric
Ego, also on this site) Similarly there are interoceptors in the
organs, complex chemical connections between all parts of the
body which relay a constantly updated picture of what’s
happening in the body.
The Autonomic Nervous
System and the Somatic Nervous System – the muscular system
– are regulated by sensory-motor loops. The sensory input
to the ANS concerns the exact nature of visceral activity, blood
composition etc; the motor output actively modifies the organs,
muscles, blood vessels etc. The pioneering neurologist Antonio
Damasio has emphasised that the brain is dependent on the body
for self-knowledge. Rather than language being the necessary feature
of self-knowledge, it is the critical multiple feedback loops
which inform the brain about activity in the body, which constitutes
the basis of all self-knowledge. He argues that the emergent properties
of complex activity in the body are emotional states. Feeling
feelings allows us to make sense of our environment and act appropriately.
(Note: self-knowledge is distinct from self-consciousness [the
capacity to reflect on oneself]. Self-knowledge supports appropriate
actions in a survival context, and provides the basis for more
sophisticated reflective activity. )
Putting together some
of the implications from Schore’s and Damasio’s work,
I would say that when the containing function of relationship
fails, there is a correlative breakdown of the sensory-motor loop.
The sensory component (including sensation and feeling) is split
from the motor function which is necessary for acting. Both feeling
and doing are life-saving functions – working together they
constitute experience.
Interestingly, Bion
defines ‘thinking’ in terms of the capacity to experience,
to make links, and he attributes this to being able to integrate
and assimilate sensory images (the alpha function). Intense feelings
always have a correlative motor –i.e. muscular – impulse
which includes all the primitive urges – to suck, to hit,
to reach, to cry, to tear, to cling. Bion argues that restraint
upon motor discharge is provided by means of the process of thinking.
I would qualify this by saying that motor restraint needs to be
accompanied by the sensory information of the act of restraint
in conjuction with the image of what is being desired. The linking
of the two constitutes thinking. By contrast, splitting the motor
and sensory function reduces the intensity and dilutes the conflict
to make the self in relation to object less overwhelming, less
threatening. The splitting may subsequently be followed by more
integrative reflective activity, or not, depending on the autonomic
capacity to contain the charge.
The motor-sensory split
will also be reflected in a sensory dysfunction – often
marked by numbness or pain; and motor dysfunction – typically
manifesting in rigidity/flaccidity of the muscle, or a compulsive
motor discharge (hyperactivity). An individual’s body will
be characterised by its own particular variations in muscle tone,
body awareness, differentiation of muscle groups, tissue textures
etc. The more ‘split’ the mental functioning, the
more splits are observable to the trained body psychotherapist.
The bringing together of sensory awareness and motility can increase
healthy integration and differentiation of functions,
The word proprioception
means ‘to receive oneself’, literally ‘to be
in touch with oneself’– it is the basis of physical
and emotional health. It is a condition of healthy embodiment
( by embodiment I mean congruence of physiological and psychological).
Alexithymia, the condition of being unaware of one’s feelings,
and therefore unable to articulate them or think about them, must
reflect an impairment of the integration of sensory information,
and has an established connection with psychosomatic illness.
A more extreme version of this, anosognosia (from the Greek nosos,
disease; and gnosis, knowledge) is clearly determined by damage
to specific parts of the brain. On the basis of his study of anosognosics,
Damasio has clearly linked the failure of areas of the brain to
integrate information from the body with the inability to feel
and to reason, despite no damage to the language centres of the
brain.
The contrary state
to fully functional proprioception– and the basis of ill-health,
I want to suggest - is omnipotence. By definition omnipotence
implies a dissociation from bodily functions – because bodily
capacities determine precisely the limits of what we can or can’t
do. The practicing phase is when the toddler has to repeatedly
discover the physical and emotional limits of his/her capacity.
The tears and tantrums of this age mark that constant painful
confrontation with the reality of their emotional and physical
capacity (including their capacity to contain impulses or feelings).
Such discharges are the child’s means of assimilating and
coming to terms with the painful reality, re-balancing autonomically.
Where tantrums and tears are met either with rebuff, punishment,
or a collapse in the parent’s boundary setting, there is
more likely to be a narcissistic split. The intensity in the body
has to be deeply controlled or dissociated from, either because
its prohibited or because of the fear engendered by not having
either internal or external boundaries to modify the sympathetic
over-charge.
Earlier on I linked
omnipotence with the sympathetic state – one of the characteristics
of high sympathetic arousal is that sense of ‘I can do anything’.
And in extremis, human beings can really push up against the limits
– sporting activity, the movement arts, moments of heroic
transcendence can give us the sense that we can be superhuman.
It can be an addictive state – the adrenaline addiction,
which fuels omnipotent fantasy. I think the changes in Western
life in the last three hundred years have accelerated and amplified
an innate human tendency towards omnipotence. Three hundred years
ago the sheer arduousness of life, the dependency on nature and
natural cycles, the limitation of medicine, the religious structure
which separated notions of man and god, kept us anchored in physicality,
and in the balance of sympathetic and parasympathetic.
Nowadays we can transcend
so many limits of physical reality, that it is becoming the hallmark
of our era – virtual reality. We are being speeded up with
cultural demands to do it better, quicker, bigger, to over come
previous limits. We are adapting to high speed – phone,
email, cars, planes – autonomically, but then when these
systems fail (computer crash, traffic jam), we have to very abruptly
shift down in gear and re-orient. No wonder there are outbreaks
of road rage ! For to cope effectively we need to be superbly
autonomically flexible to adjust to the variations in pace and
their implications. I suggest that as well as looking at individual
histories of illness, we need to understand many of the new illnesses,
especially the increasingly common autoimmune illnesses as a symptom
of a larger crisis and transition. There is a creativity in these
responses, as well as pain and suffering. Just as there are extraordinary
developments and achievements which are stemming from broad cultural
changes.
It’s very hard
to find a simple language to talk about complex processes and
not fall into the dualisms. Because it’s a system with two
branches, my talk has been structured around binary pairs, but
I hope it’s also clear that – via splitting –
the binary process becomes a complex analogic pattern. I don’t
really like words like bodymind or psyche soma – partly
because they are tautological, and also because of their associations
– bodymind sounds rather New Agey, and psychosomatic seems
to imply that there is a category of illnesses which can be separated
off from organic illness. I’m dubious about that. I’ve
gone with the word organism because it implies the functional
identity of mind and body – the disadvantage is that it
then disavows the pervasiveness of splitting as a fundamental
aspect of human function. On the other hand the word environment
fortuitously implies both the emotional environment – thanks
to Winnicott – and the physical, and economic, political
and social environment with which the individual is having to
contend. To give an example – hot flushes, hyperirritability,
difficulty sleeping, mood swings. These are the symptoms of menopause.
A woman’s experience of menopause - which is of course a
hormonal change but affects and is affected by the autonomic nervous
systems as well – will be influenced by her own social,
cultural and personal context, as well as her diet and lifestyle.
I want to conclude
this part by going back to the quote from Reich: “The development
of character is a progressive unfolding, splitting and antithesis
of simple vegetative (i.e. autonomic) functions”. Reich
thoroughly grasped the paradox of the body-mind relationship:
in ideal conditions, mind and body form a functional identity
(in which feeling and thinking are informed and enriched brain-body
processes); however, the vicissitudes of life engender deep and
multiple processes of splitting within the organism, to the point
where body systems and sub-systems act antithetically, i.e. in
conflict. Reich’s insight stemmed from his observation that
pulsation was the primary regulating mechanism of organisms. He
was not so interested in the intricate emotional regulation between
the infant and its caregiver. Allan Schore’s work, which
spans an incredible breadth of contemporary sciences, comes also
to the conclusion that self-regulation is fundamental, but he
integrates into this model the complexity of object relations.
I find that Reich’s phenomenological appreciation of psychological
process complements the scientific detail of Schore’s landmark
work, and Schore’s integrative vision broadens Reich’s
bold formulations.
Part two: the therapeutic implications - including the body in
psychotherapy.
(This was not part of the talk I actually gave on 26th March for
Confer, but it addresses some of the issues raised by the model
I am proposing)
A few notes…
* Object relations are embodied:
- chronically in changes in structure/function
- acutely as charge in the transference relationship
The therapist can work towards supporting emotional self–regulation
by providing boundaries, meeting the charge in the transference,
and increasing capacity for insight (itself a mini-cycle).
‘Charge’ relates to the intensity of a process, often
indicating unconscious transference feelings. It is perceivable
in the body in increase/ sudden decrease of tension, significant
gestures, micro-gestures, changes in skin colour and breathing
etc, as well as in language and attitude. It is palpable in the
countertransference. (The concept of charge has been developed
at The Chiron Centre for Body Psychotherapy, in the context of
integrating body psychotherapy with object relations)
• In contemporary
body psychotherapy, the body is seen as both ‘id’
ie. the
source of primitive impulses and ‘ego’, ie the more
or less conflicted container. We work to develop and establish
the containing function of the body in and via the transference
relationship. The individual’s relationship with their body
is itself a repetition of an earlier object relationship. (see
Totton, Soth)
• The conscious
embodiment of feelings in the transference relationship can act
cohesively and support autonomic re-balancing. ANS responsivity
and robustness in the therapist contains intensity in the client
(especially at high points of sympathetic and parasympathetic
activation).
• Surprise/shock/spontaneity
manifest directly in the ANS and mark the impact on the organism
of the environment and/or the unconscious. Intellectual activity
may be part of elaborating an autonomic process OR a defence against
the intensity of feelings, and shock/surprise/ spontaneity.
• Sensory-motor
integration & body awareness:
- sensory functions can be developed through sensing and exploring
imagery (including dreams)
- motor functions can be developed via exploring movement, gesture
and posture
e.g. In the client
with the frozen shoulder I might have arrived at the interpretation
of the introjected cold shoulder– which did have the effect
of shifting the symptom – just through reflection and my
own experience of the transference-countertransference. However,
the contribution of the bodywork was the deepening of the client’s
sense of her own inhibition and pain. Also, holding of her head
affected her at a level where she could experience her vulnerability
and need of contact, and therefore prepared the way (softened
the defences against) the interpretation of loss.
• Working with
physical symptoms:
- When did it/they
start?
-
- Be curious about all aspects of the symptom. Explore what gets
in the way of curiosity.
-
- The relationship of the client to the symptom parallels the
early object relationships. E.g. is the illness an ‘it’?
nothing to do with ‘me’? is it seen as persecutory?
Is it tended to over protectively, ignored, denied, abused, idealised?
Some illness can be treated as a vocation, as a calling from God.
-
- What is the symptom expressing in the transference?
-
- How is the symptom containing the wider environmental challenge
to the organism?
- How can the symptom
be more fully experienced?
A post-graduate course
on Working with Psychosomatic Symptoms will be run by Margaret
Landale at the Chiron Centre for Body Psychotherapy
Case study
Megan left her long-term partner eighteen months ago. For two
years preceding the final decision she had ongoing pain in her
kidneys, a constant dry mouth and a knot in her stomach. She had
been in turmoil daily with the question of whether to leave her
therapist or her partner, Jane. She took up running, which she
found relieved some of her symptoms. In the transference she had
a sullen but stifled hatred of her therapist. She set a date to
finish her therapy but changed her mind when, as she saw it, her
therapist really stood up to her. She described that decision
as being like a great ocean liner turning. Six months later she
left Jane – and experienced exhilaration and intense fear
which she compared to jumping off a cliff.
Over the next year,
as she struggled with housing and financial problems, and changes
at work, she experienced severe stress symptoms – frequent
sweating, palpitations, insomnia, but the old symptoms disappeared.
These bodily changes reflected the difference between a suppression
of the flight reflex which led to symptoms of kidney dysfunction
(pain, dryness), to the adrenaline being released to fulfil its
natural function of flight. Despite the stress symptoms, there
was an enormous overall improvement in her energy and health accompanied
by a deep shift in her resourcefulness. As she allowed herself
to depend more on her therapist, her process moved from ‘dry’
(sullen, stuck) to ‘wet’ (fluid, high emotional charge),
both physiologically and transferentially. She began to use her
therapy to contain intense feelings of panic, loss and rage, as
well as desire and hope.
Bibliography
Body Psychotherapy
Boadella, D. (1987) Lifestreams: An Introduction to Biosynthesis
(Routledge, London)
Boadella, D. (1997)‘ Awakening sensibility, recovering motility:
psycho-physical synthesis at the foundation of body psychotherapy:
the 100 year legacy of Pierre Janet (1859-1947) in International
Journal of Psychotherapy, vol 2, no.2
Boyesen, M.L. (1974)’Emotional Repression as a Somatic Compromise:
Stages in the Physiology of Neurosis’ Energy and Character,
vol 5, no 2
Eiden, Bernd (2000) ‘Reich’s Legacy’ & ‘The
Use of Touch’ in Recent Articles (Chiron Centre Publications,
London – http://www.chiron.org)
Reich, W. (1973) The Function of the Orgasm (Reprinted Souvenir
Press, 1983)
Reich, W. (1972) Character Analysis (Reprinted Farrar, Strauss
and Giroux, New York, 1990)
Rothschild, B (2000) The Body Remembers: The Psychophysiology
of Trauma and Trauma Treatment (Norton, London)
Soth, M. ‘Body/Mind Integration. AChP Newsletter, nos 17,18,19
Staunton , T (ed) (2001) Advances in Body Psychotherapy (Routledge)
Totton, N. (1998) The Water in the Glass: Body and Mind in Psychoanalysis
(Rebus
Press, London)
Anatomy & Physiology
Cohen, B.B. (1993) Sensing, Feeling and Action (Contact Editions)
Hartley, L (1994) The Wisdom of the Body Moving (N.Atlantic Books)
Juhan, D. (1987) Job’s Body: A Handbook for Bodyworkers
(Station Hill)
Kapit, W. (1987) The Physiology Colouring Book (Harper Collines,
New York)
Neuroscience & Psychoanalysis
Damasio, A. (1999) The Feeling of What Happens: Body, Emotion
and the Making of Consciousness (Heineman, London)
Damasio, A. (1994) Descartes Error: Emotion, Reason, and the Human
Brain (Putnam, London)
Freud, S. (1950[1895]) A Project for a Scientific Psychology SE.1
Grinberg, L (1977) New Introduction to the work of Bion (Aronsom,
New Jersey)
May, R. (1977) The Meaning of Anxiety (Simon and Schuster)
Moore, M. S, (1998) ‘How can we remember but be unable to
recall? The complex functions of multi-modular memory’ in
ed. Sinason, V. Memory in Dispute (Karnac)
Schore, A (1994) Affect Regulation and the Origin of the Self
(Lawrence Erlbaum, Hove)
Solms, M. & Kaplan-Solms, K. (2000) Clinical Studies in Neuro
Psychoanalysis (Karnac, London)
Psychosomatics
Broom, Brian (1997) Somatic Illness and the Patient’s Other
Story (Free Association)
Mindell, A (1982) Dreambody (Sigo Press)
Whitmont, E.C. (1993) The Alchemy of Healing: Psyche and Soma
(N. Atlantic Books)
Scientific background: Chaos & Complexity Theory
Capra, F. (1996) The Web of Life: A New Understanding
of Living Systems (Anchor Books, New York)
Coveney, P & Highfield, R (1995) Frontiers of Complexity (Faber,
London)
top
previous
page
|
