If you were asked to point to your mind, you would most likely point to your head, thinking that where your brain is. However, you would be wrong to think that your mind is limited to your brain alone. The mind exists throughout the physical body, mediated by the neurons and biochemicals of the central nervous system and the hormones of the endocrine system. The mind receives its impressions of the world primarily through the sensory system of the physical body (ie., the five senses of sight, hearing, taste, smell, and touch) and interprets these perceptions through the brain. Conscious thought is just one aspect of the mind, facilitated by higher brain functions. The unconscious mind exists in the lower brain functions, and is expressed in dreams, automatic reflexes, conditioned responses, somatic memories, and in physical symptoms and behaviors.
Western or allopathic medicine inherited the Greek Gnostic philosophy and practice of drawing a separation between the physical and spiritual aspects of human experience. This distinction remains with us today, in the arbitrary and stigmatized distinction between medical and mental disorders, and the exclusion of psychiatry and psychology from full participation in medical care and insurance coverage. Once you understand that we do not have a single feeling, thought, or behavior that is not mediated by the physical body, you can no longer make this division. Life is foremost a somatic experience. When we speak of individual pathology, a "Mind/Body Split" occurs in various ways:
"Mind/Body Splits" are both a symptom of disorganized experience, and a cause of further dysfunction. Some typical symptoms of "Mind/Body Splits" are depression from internalized anger and helplessness; anxiety from the pressure of unresolved conflicts or negative emotions demanding attention; and numerous physical complaints. Because "Mind/Body Splits" cut us off from the internal resources of either the body or the mind, different aspects of our Selves cannot communicate and work together in the healing process.
Mind/Body Medicine recognizes the complex interrelationship between the mind and the body, maximizing the functioning of both for their mutual benefit. It is also called "Integrative Medicine" as it heals the "Mind/Body Split" and is especially useful when working with medical conditions and illnesses.
In general, Mind/Body Medicine focuses on eliciting the body's inherent Relaxation Response, as the natural antidote to the Stress Response, in the process of healing.
Mind/Body Medicine uses a variety of techniques to bridge the Mind/Body Split when working with medical disorders:
Numerous studies demonstrate that participating in Mind/Body Medicine can enhance medical treatment and improve outcomes. For example:
Absolutely. Sometimes talking and insight do not produce the changes we are looking for. Most talk-therapy is left-brain centered, and depends on an accessible or conscious narrative (the client's story) for progress. However, sometimes a narrative is not available; the story may be partly or entirely unconscious. In these cases, it is necessary to engage the right brain in the treatment process. Several techniques of somatic psychotherapy such as EMDR and guided imagery, focus on right brain processing.
Contrary to popular culture, psychosomatic disorders are neither "imaginary" nor "all in your head." The term "psychosomatic" comes from the Greek "psyche" for "mind" and "soma" for "body" and refers to the complex relationship between the mind and body as it affects our health and well-being. Psychosomatic disorders are medical conditions that are related to emotional states or conflicts, both conscious and unconscious. When all medical causes of a physical complaint have been explored and ruled out, we have to consider other origins, such as the mind, and the individual's total experience in their environment.
Classically, psychosomatic disorders are viewed as arising from unresolved emotional conflicts that are internalized and expressed physically. Frequently the emotional state is expressed in a "body language metaphor", such as being around someone who is "a pain in the neck" leads to headaches; "I can't stomach him" leads to gut tension and digestive problems; not speaking up for oneself is expressed as tight jaw muscles, teeth grinding, and tongue biting.
Most often, psychosomatic disorders are actually the result of stress responses. When we experience stress, our body reacts with "the Stress Response," releasing stress hormones that create the physical changes necessary for defensive action. When stress is chronic, without sufficient relief and time for recovery, body systems bear the tension and begin to dysfunction. One very common example of this internalized stress response is seen in digestive problems: over or undereating, eating in a hurry, and poor food choices are all responses to stress. Over time, the gut responds to the stress with increasing dysregulation, leading to indigestion, bouts of diarrhea and constipation, intestinal spasms, poor gut environment and ulcers. When the individual's stress response is adequately treated, the physical symptoms improve or disappear.
Mind/Body Medicine and Somatic Psychotherapy can be very helpful in recovering from psychosomatic disorders by helping you:
One very useful way to understand anxiety is to see it as the tension between suppressed emotions that are trying to rise to our awareness, and the unconscious effort we expend to keep these emotions down, away from our awareness. The troubling emotions do not have to be especially painful for us to suppress them; even mildly uncomfortable feelings are easy to suppress if we are too busy or lack the capacity to deal with them. Some typical examples of suppressed emotions are:
Even though anxiety is called a mental disorder, the tension between the rising emotions and the force to keep them down can be felt physically. Anxiety appears in folks in a variety of ways, usually in odd behaviors and physical complaints. Some of the most common symptoms of anxiety are:
Panic attacks are probably the form of anxiety that we hear about the most. Because they can seem so dramatic and scary, panic attacks grab our attention most easily. The signs of panic include short rapid breath; rapid heartbeat; cold clammy hands; sweat; muscle tension; fears of suffocation or passing out. It is not uncommon to feel that one might die from the difficulty breathing, but panic attacks are rarely life threatening.
What makes anxiety symptoms hard to notice and treat is that they most often appear entirely disconnected from the actual cause or trigger. We tend to adapt to the discomfort over time, and do not seek help until our coping mechanisms break down. A good first step to discovering the root of the anxiety is to notice the earliest low level signs of tension in your body and ask yourself: "If I could feel my emotions, what would they be now?" Often we need help from someone else to help us see what we cannot recognize on our own.
Treating anxiety with somatic psychotherapy can be done with:
Putting it very simply, there are two kinds of depression: one is the kind caused by painful life circumstances, losses and relationships; the other is caused by fundamental dysfunction in the biochemistry of the brain, usually because of hereditary factors, or, in women, hormonal shifts, such as peri-menopause, menopause, pregnancy or childbirth. The first kind of depression may be caused by any of a number of losses (financial, health, relationship) that we feel inadequate to deal with successfully, or relationship conflicts which we feel helpless to resolve, so we internalize the conflict instead. Additionally, we may become depressed by being around other depressed people, like spouses, partners, and family members. Young children are especially vulnerable to identifying with depression in their parents, and can grow up with an "emotional low water mark" that they can never exceed to feel good.
Depression may be difficult to acknowledge because of the social stigma associated with mental illness and because the initial symptoms are often physical, not emotional. Whichever kind of depression you may be experiencing, any depression is actually a brain disorder characterized by changes in thoughts, behaviors, and feelings that last for two or more weeks.
If you think you are depressed, the sooner you seek help, the better, as untreated depressions worsen and increase the risk of recurrence. If most of your symptoms are physical or behavioral, or you are feeling suicidal, you should begin by calling your medical doctor or a psychiatrist as soon as possible. Otherwise, you can begin with a good psychotherapist for an evaluation to see if medication and a referral to a psychiatrist are warranted.
There are many effective treatments for depression. Somatic Psychotherapy and Mind/Body Medicine can help by:
Bipolar Disorder is a mental illness characterized by mood swings between the poles of depression and mania. In addition to recurring lows of depression, folks with Bipolar Disorder also experience high periods, called manias. Either state can last from a few days to weeks and months.
Bipolar Disorder can be hard to recognize and diagnose for a few reasons: in the beginning of the illness, most individuals may experience several periods of depression before the manic periods emerge; when the either the depressions or the manias are severe and uncomfortable, some people try to relieve their symptoms with alcohol or other drugs, which may mask the symptoms or induce further mood swings; and some people find the hypomanic period to be a creative or productive time that feels "normal" compared to depression.
Most commonly, Bipolar Disorder is missed because not all manias are pleasant or euphoric, and folks don't realize that their mood shift is manic. In fact, manias can be characterized by extensive periods of euphoria; expansive and grandiose thinking; or irritability, anger and rage.
Some other signs of mania include:
To further complicate matters, some moods are "mixed" states, with signs of both depression and mania, such as agitation and exhaustion.
Because there are many fine points to consider, the diagnosis of Bipolar Disorder is best made by a mental health professional, and treatment should include a whole "team:" you, your doctor, a psychotherapist, and your support system. Unlike many ailments, episodes of Bipolar Disorder cannot be "toughed out." While a particular episode may end and mood may shift, the cycle of disease continues. Treatment of the disorder always requires a doctor's care for medication management to decrease the frequency and severity of the mood cycles.
Even though Bipolar Disorder is caused by a biochemical dysfunction in the brain, life stressors and circumstances can trigger shifts. Psychotherapy and Mind/Body medicine can help by:
When we hear the word "trauma", we usually think of a life threatening emergency or catastrophic event. In psychotherapy, however, not all "trauma" is life threatening. There is "Trauma" with "a big T": life threatening events, and "trauma" with "a little t": events that overwhelm our coping capacity and lead to nervous system dysregulation. Many of us experience the second kind of trauma without calling it traumatic, and have ongoing effects without realizing their connection to the traumatic event.
In somatic psychotherapy, we distinguish between two different kinds of trauma: developmental trauma and shock trauma. Developmental traumas are events and interactions that are mismatched or misattuned to the child's developing brain, nervous system, or temperament. These are usually traumas with a "little t." Some examples include inadequately reflecting positive emotions; punishing negative emotions; humiliation; lack of physical affection; excessive authoritarian demands; expecting children to meet our emotional needs. Even well-meaning parents can contribute to developmental trauma. In order to tolerate these faulty interactions, children develop character defenses or personality styles that become generalized and projected into future relationships as well. See Character Style.
Shock traumas are events characterized by brief, sudden, and massive impact on an individual, often perceived as life threatening. These are more often traumas "with a big T", such as natural disasters and motor vehicle accidents, or violence, such as physical and sexual assaults, sexual abuse, domestic violence, and combat, etc. These traumas have immediate and profound effects on the nervous system, eliciting either the "Fight or Flight" response, freeze response, or dissociation.
Repeated shock trauma early in a person's life, such as childhood physical or sexual abuse, can contribute to character styles as well. The Diagnostic and Statistic Manual of Mental Disorders (DSM IV) recognizes this as Borderline Personality Disorder. Certainly these interactions create negative internalized self-images that continue to affect us in future relationships with feelings of low self-worth.
Post-Traumatic Stress Disorder (PTSD)is the term the DSM IV gives to the long term negative effects of shock trauma. Some of these effects are:
Any effective treatment of trauma involves re-experiencing the troubling aspects of the event with more effective resources than were available to the individual at the time. Both timing and "dosage" have to be right for the effective treatment of shock trauma. Timing refers to what else is going on your life at this time, and dosage refers to the degree of re-exposure to the past events.
While most people who want help with trauma want it as quickly as possible, the pace of treatment must not exceed an individual's capacities to deal with re-experiencing aspects of the event. For this reason, we discuss whether or not this is a good time in your life to deal with past trauma; periods of high emotional or physical stress, school finals, Board exams, job transitions, home remodeling, etc., which already call upon our internal resources, are generally not good times for trauma work. We also consider the amount of emotional support you have in your life; whether or not you are using substances to alter your moods; and any self-destructive behaviors. If you have problems in any of these areas, we begin by building your internal and external resources before doing trauma work.
Some Effective treatment techniques for either developmental or shock trauma are EMDR and Somatic Experiencing. Peter Levine's Waking the Tiger offers an excellent description of trauma effects and resolution. A CD collection of his treatment for trauma, called "Healing Trauma", is available through www.Soundstrue.com.
Dissociation is a disruption in one or more of the ego functions of consciousness, memory, identity, or perception of the environment. The experience of dissociation is common to all humans. For example, we are dissociating when we daydream while driving and miss our exit on the freeway, or arrive at home and wonder how we got there without paying attention.
Dissociation is both a defense mechanism and a symptom of an underlying problem. During times of traumatic stress, such as a life-threatening assault, we might dissociate and "leave the body" when facing overwhelming terror. In this case, dissociation is a defense mechanism as it protects us from dealing with something we are not prepared for. Later, we might begin to dissociate under familiar circumstances that remind us of the past trauma; now dissociation is a symptom of an unresolved issue. As either a defense or a symptom, excessive dissociation interferes with our fullest functioning.
In treating dissociation we are looking to restore and integrate an aspect of individual experience to wholeness so that the individual can function more optimally. The treatment process is necessarily slow, as we have to take care not to flood the individual with too much experience. After all, it was overwhelming distress that caused the defense to arise in the first place. Most of all, we do not want to re-traumatize someone with the intended treatment!
Some of the steps and strategies for treating dissociative disorders with Somatic Psychotherapy and Mind/Body Medicine include:
In general, eating disorders are divided into two types: Anorexia, or restrictive eaters, who limit their food intake, and Bulimics, overeaters or bingers, who eat excessively and then often purge their food through forced vomiting, diuretics and laxatives, or excessive exercise. There are any number of variations in between, such as eating only once a day, or only after 5PM; eating only certain kinds of food; eating alone so no one else can see what you're eating; etc. The result is abnormal weight range, including severely underweight women with Anorexia, and sometimes moderately overweight women with Bulimia. Other health problems follow, including abnormal electrolyte and potassium levels; anemia; amenorrhea; loss of dentition; esophageal scarring; cardiac, kidney, and liver problems. Early and severe anorexia may contribute to infertility in adulthood.
All types of eating disorders share the features of a distorted body image, low self-esteem, and over controlling the body and emotional states with food. Most often there is an underlying anxiety disorder or depression as well. Food is treated as a mood-and image-altering substance, for better or worse. At the end of the day, self-worth is measured in how successfully one has either restricted food, or purged or exercised away its effects.
Because eating disorders can be life-threatening, their diagnosis and treatment is complicated and require a team of care providers, including: an MD with experience in this area, regular lab work, and access to an inpatient program; a nutritionist for education, daily meal plans and weekly weight monitoring; group therapy; and individual therapy.
There are many factors that contribute to developing an eating disorder, including family dysfunction; social forces; anxiety and depression; and character style. Somatic Psychotherapy can assist in healing from an eating disorder by:
Mind/Body Medicine and Somatic Psychotherapy can play an important role as "complementary medicine" in recovering from serious medical conditions and chronic syndromes. Along with your medical care providers, a somatic psychotherapist can be part of your treatment team and help you bridge the gap between your mind and body when you need it most.
Whether we are facing a life threatening illness or a chronic syndrome, the diagnosis of a serious medical condition triggers an emotional and psychological alarm in the body that can impair our coping ability. Foremost among our reactions are shock, fear, anxiety, and depression. A common and troubling response is feeling betrayed and angry at our own body. If we do not acknowledge the devastating emotional effects of a medical condition, we will be left with only a fraction of our resources in trying to recover.
The treatment of many serious medical conditions can be enhanced by Mind/Body Medicine. The most common conditions for which people seek additional help are the diagnosis of cancer, chronic pain syndromes, organ transplants, heart attacks and cardiac procedures, among others. In these serious cases, it is most helpful to know that you are not alone, and you have someone who is willing to face dreaded circumstances along with you. Mind/Body Medicine assists in treatment by:
Syndromes are a special category of medical conditions, as they are multiple system deregulation brought on over time. Some examples of syndromes are Chronic Fatigue Syndrome, Fibromyalgia, Multiple Chemical Sensitivity Syndrome, Irritable Bowel Syndrome, etc. Autoimmune Disorders are also considered syndromes, in which one body system misidentifies other parts of itself as a threat or "the enemy." It is usually impossible to pinpoint exactly when a syndrome starts, but it is very common for folks with these conditions to have histories of extreme trauma (such as childhood sexual or physical abuse; intense family conflict; severe and chronic stress). For this reason, the etiology of syndromes appears related to stress reactions and the eventual deregulations of the sympathetic and parasympathetic nervous systems.
Because it understands the central nervous system and works with the complex relationship between the sympathetic ("Fight or Flight" or "Stress Response") and parasympathetic ("Relaxation Response") nervous systems, Somatic Experiencing is a very helpful method of working with syndromes.
Most people would not think of seeing a psychotherapist, even a somatic psychotherapist, for pain management. For most of us, physical pain begins as a medical problem rather than an emotional or psychological one. Also, some people may feel insulted or dismissed by the suggestion to seek psychological help for their pain, as if they were being accused of fabricating their symptoms. However, there are some very good reasons for seeking the help of a somatic psychotherapist when dealing with chronic pain. Medical science recognizes that the experience of pain is highly personal and subjective, and it cannot always be objectively measured or quantified. Certainly we cannot quantify or stand in judgment of a person’s suffering. Even pain for which a clear physiological cause cannot be identified needs to be addressed and treated.
Some good times to seek psychological help for physical pain are:
Somatic psychotherapy can assist with effective pain management, and, in some cases decrease pain and suffering, by: