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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!

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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:

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Embodiment of social context – “Sites of Shaping”

Here’s another wonderful and fascinating presentation from Staci Haines of the Strozzi Institute. (Thanks to Mark Walsh for the heads-up.)


[From StrozziInstitute]We are always living inside of a social context. We embody our social contexts, just as we are shaped by and embody our family contexts, communities and the land/environments that influence us. When we are looking at transformation, social context is one of the most influential forces, whether we are focused on personal, community or systemic change.

For another great presentation by Staci Haines (on Somatic Transformation), see this video.

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Integral seeds found in my Human Development textbook

I took a course this summer in Human Development as part of my graduate program in counseling. I had taken a similar course as an undergraduate, back in 1990, and I was pleasantly surprised by how much more integral/holistic the field has become in the last twenty years, at least as put forth by Dr. Laura Berk in her Development Through the Lifespan book. Berk summarizes the lifespan perspective on development as follows:

…a balanced view that envisions development as a dynamic system. It is based on assumptions that development is lifelong, multidimensional (affected by biological, psychological, and social forces), multidirectional (an expression of both growth and decline), and plastic (open to change through new experiences). (p.41)

Sounds pretty integral-ish to me!

Dr. Berk continually reminds the reader of the complex, biopsychosocial nature of development, which challenges any simplistic conclusions we might draw based on any single factor, like heredity, for instance. An example of this is the study (Caspi et al, 2002) referenced where boys, even when they had a gene known to predispose people toward aggression, did not in fact show abnormal levels of aggression as long as they were raised in an family environment free from abuse.

I was struck by the degree to which psychological and social factors were shown to influence human development, even at the prenatal stage of life. Considering the number of factors— environmental, relational, political, etc.— that can impact the emotional stress of pregnant women, it is mind-blowing to contemplate the number of things that can indirectly put babies at risk for a wide range of potential problems. One study (Yehuda et al., 2005) showed how the events of 9/11 indirectly affected cortisol levels in infants’ saliva (which can impact the developing child’s susceptibility to a wide range of developmental problems later in life) by causing extreme anxiety in some mothers who happened to be pregnant during the terrorist attacks. So, even something as seemingly remote as our political relations with other countries can have an impact (indirectly) on the physiological development of our children. This understanding is, of course, consistent with the models of integral health presented here on this site.

While I was heartened by the general trend toward a more comprehensive, biopsychosocial approach to the modern study of human development, I was troubled that healthy development in adulthood is still for the most part described as if it’s a matter of conforming to conventional roles and social norms, while poor adjustment is linked to being out-of-step with societal expectations. At one point in the book, an adult’s inability or refusal to conform to society’s age-graded expectations (the “social clock” marking life events like first job, marriage, having kids, etc.) is linked not only to increased psychological stress, but also to undermining the stability of society:

…the stability of society depends on having people committed to social-clock patterns” (p.471)

This, of course, gets to the deeper questions, such as What does it really mean to be an adult?, that are still largely ignored in mainstream academic inquiry. Personally, I’ve never defined my adult status and development in terms of education, career goals, jobs, intimate relationships, parenthood, home-ownership, or even age. Rather, I conceive of maturity and personal growth as a process of continually getting deeper in terms of 1) my self-awareness/self-knowledge, and 2) my capacity for love and compassion. That said, it’s still good to see the mainstream study of human development embracing a more holistic approach in recent years.

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Stephen Fry – All about I

An interesting interview with actor/author/comedian Stephen Fry. His main point here, I think, is to emphasize the spiritual value of shifting focus from oneself to others. This is an insight I understand intellectually, but I often forget about it in my zeal to delve ever deeper into my own subjective experience in search of truth and wisdom. Reflecting back on the most profoundly transformative times in my life, I must admit that this inward focus often took a back seat to an intense engagement with other people. Of course, it’s not an either/or scenario, and we can all benefit from inner, self-focused work as well as from passionate social engagement. Fry’s commentary is a good reminder, though, for folks like myself who tend toward an overly-individualistic, me-against-the-world style of bootstrap spirituality.

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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.

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The Science of Mindfulness – TEDx talk by Diana Winston

A nice introduction to mindfulness by Diana Winston, the director of Mindfulness Education at the UCLA Mindful Awareness Research Center:

Former Buddhist monk Diana Winston is the director of Mindfulness Education at UCLA Mindful Awareness Center, and the author of several books on mindfulness and meditation. With more than 20 years in the study and practice of mindfulness, Diana explains how routinely taking the time to be in the moment can have a profound impact on our everyday lives and relationships.

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Dr. Mike Evans and his “favourite medicine”

I’ve recently added My Favourite Medicine to my list of integral health web resources. The site is an effort by Dr. Mike Evans to “curate the best health information found online.” He has produced a couple of excellent whiteboard-style animated health education videos. The first video below (“23 and 1/2 Hours”) addresses the question: “What is the single best thing we can do for our health?”

Dr. Evans recently released a follow-up video that focuses on “The single most important thing you can do for your stress.”

If you appreciate these videos, you might also enjoy this brief, three-part series called “Stress Explained by Dr. Mike.”

Enjoy!

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Sam Harris leads 4000 atheists in a guided meditation

This might be my favorite of all the Sam Harris talks I’ve seen to this point. It takes some moxie to ask a group of 4000 atheists to close their eyes and practice mindfulness meditation for ten minutes. Harris was speaking at the 2012 Global Atheist Convention in Melbourne, Australia. The title of this talk is “Death and the Present Moment,” and in it Harris attempts to answer the following question (among others): “What does atheism have to offer in the face of death?” Below is a mishmash of quotes and paraphrasing:

Atheism is just a way of clearing the space for better conversations. The challenge is to get people to engage in these conversations, given the seemingly irreconcilable differences between believers and non-believers.

What people are really worried about is death. When we’re arguing about teaching evolution in schools, we’re really arguing about death. The only reason for a religious person to care about evolution is because they know that if their holy books are wrong about our origins, then they’re very likely wrong about our destiny after death. So when you say to someone that “you are a fool for not believing in evolution” or “you are a fool to think the universe is 6000 years old,” I think that gets translated as “You are a fool to think that your daughter who died in a car accident is really in heaven with God” — and that is a very different communication.

[Note from Bob: A Gallop Poll just released on June 1st found that: “Forty-six percent of Americans believe in the creationist view that God created humans in their present form at one time within the last 10,000 years.”]

How can people make sense of tragedy? Religion provides an answer — not a good one, but an answer that most people think they need. Belief in God is very consoling in the face of tragedy and death. Atheism doesn’t offer real consolation on this point.

Holidays, architecture, music, humility, awe, profundity — this is not what we necessarily lose when we jettison religion. All of that can be had within the purview of reason, and it can be had without lying to ourselves–or to our children, or other people and their children–about the nature of reality. The thing that gets lost, for which there is no real substitute, is total consolation in the face of death. If we want to build a bridge to a rational world that the better part of humanity can cross, then we have to deal with this fact.

People who face death are often struck with the realization or regret that when life was normal, their attention was too often bound up in petty concerns. There will come a day, for all of us, when we will look back at the kinds of things that captured our attention and think, “What was I doing?” We tend to live tacitly as if we will live forever, wasting time on things we don’t really care about. People who don’t believe in an afterlife have a particularly compelling reason to make the most of the present moment.

So what is the point of life? Is anything sacred? Do such questions even make sense? These questions do make sense and there are answers to them, but the answers are not about getting more information. The answer is a change in attitude. There are ways of experiencing life as sacred without believing anything, and certainly without believing anything on insufficient evidence. There are ways to really live in the present moment.

As a matter of conscious experience, the reality of your life is always now. I think this a liberating truth about the nature of the human mind, in fact I think there is probably nothing more important to understand about your mind than that, if you want to be happy in this world.

You must know that I don’t want to stand in front of 4000 atheists and do my best impression of Lao Tzu :0)

This is not a matter of new information or more information. It requires a change in attitude, in the attentiveness you pay to your experience in the present moment.

How can we be truly fulfilled in life, given that our lives come to an end?

There are techniques available to deeply explore the present moment: I want to try a little experiment with you. Please close your eyes… [Sam then leads the group through a mindfulness meditation exercise, at about the 29:32 mark.]

We are all trying to find a path back to the present moment and a good enough reason to just be happy here. The practice of meditation I just showed you (mindfulness meditation) is just a trick for doing that, a trick for setting aside your to-do list (if only for a few moments) and actually locating a feeling of fulfillment in the present.

The conversation we have with ourselves every minute of the day comes with a cost. Discursive thought can be useful, but it is also the mechanism by which most of our suffering is inflicted — the sorrow, the self-doubt, the anxiety, the fear. And yes, the fear of death. Thinking is useful, but being perpetually lost in thought isn’t. Being the mere hostage of the next thought that comes careening into consciousness, isn’t useful. If there’s an antidote to the fear of death and the experience of loss, that’s compatible with reason, I think it’s to be found here.

The purpose of life is pretty obvious, beyond mere survival. We invest so much in culture and relationships because we are constantly trying to create and repair a world that our minds want to be in. Religion is not a good way to do this, and so we have to start a new conversation.

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Planting seeds

I’m currently reading Mindfulness and Psychotherapy (Edited by Germer, Siegel & Fulton), widely considered to be one the best books yet published on the topic. Four chapters in, and I’m enjoying the book thoroughly. I just came across a section on the value of cultivating empathy through Buddhist-inspired practice. I like the image the authors (Susan & William Morgan) use to connect intention, practice, and whatever sought-after quality one is trying to cultivate (in this case, empathy):

Concentrate on your intention to open your heart more fully. Trust that by planting seeds (intention) and attending to them (practice), the harvest (empathy) will follow organically.

I’m thinking about the creative struggles in my life, particularly with writing and music, and how this process of intention-practice-fruition comes into play. Something to ponder and play with…