In my last post, I presented the case for perceiving IBS, not as a syndrome comprising a collection of as yet undiscovered diseases, but more the visceral expression of a state of mind-body dysregulation or dysphoria, that might be instigated by life events or even by changes in the colonic microbiome. Physiological or psychological stress, no matter how it is caused, or anything that triggers the memory of a previous threat, can alter the way we feel, think and the way we and our body react. Holistic treatments can help alleviate IBS, replacing symptoms of illness with feelings of hope and well-being. This post explores how.
Feelings of well being are so often linked to social connectivity and expressed in the muscles of our face, our tone of voice, posture, gestures, behaviour and our internal physiological state. As outlined in a previous post, these are integrated by an area in the brain stem, called the ventral vagal complex, for purposes of growth, health and restoration.
‘Our digestions going peacefully onwards, that is the source of all poetry.’
Anything that relaxes and connects us brings the ventral vagal system on line and replaces insecurity and hopelessness by feelings of safety and well-being.
Our brain affects the way our body works, often without us being aware of it. Conversely the actions and sensations of our body feed back to affect the way we feel and relate to each other. We all know this at some level, but perhaps we just take it all for granted.
Biological cues for safety and acceptance are to be found in our facial expression, which is regulated by the ventral vagal complex. The circular muscles around the eyes (the orbiculares oculi) are what gives our eyes their engaging character – the ‘look of love’. These are present in all mammals; they narrow and focus the gaze, often producing ‘crow’s feet’ in the corners of the eyes. Mothers and infants stare deeply into each others eyes and so do lovers as they try to divine each others’ souls. We know we are making a connection with another person when our eyes lock. This is reassuring when we are talking to someone and want to trust them, though a non-vocal stare from a stranger on an underground train can be deeply disturbing.
People who have features of autism and those who have been traumatised, find eye contact difficult; the upper part of their face is often rigid and featureless. If their eyes connect, they can seem to stare right through or past you, indicating a lack of social engagement. Therapists may engage such client with a soothing tone voice until they are ready to make eye contact.
It is a sad reflection on our health system that many GPs do not look at their patients, but stare at their records on a computer screen instead. When I was in my training psychoanalysis, I disliked lying on my therapists couch, preferring to sit up and see their eyes. By the same token, I find it disconcerting to have a conversation with somebody wearing very dark or reflective glasses.
If people look away while we are talking to them, we feel snubbed; it constitutes a violation of expectancy and withdrawal of reciprocity. Nevertheless, we can feel quite happy having an intense conversation with somebody while walking alongside them without ever looking at them. Perhaps the fact that our bodies conform by walking in step is sufficient communication.
Even the way we breathe can affect how we feel and how others perceive us.
Last weekend, Stephen Porges invited his audience to pair up with the person sitting next to us and take turn observing each other breathe. The first exercise was to take ten breaths with a long inspiration and a short expiration then to reverse it and take another ten breaths with a short inspiration and a long expiration. It was a strangely intimate exercise to look into a strangers face and watch them breathe. My partner was a slim, attractive woman, whom I would guess was in her forties. We both got the giggles during the long inspiration exercise but this calmed down and there was a deeper, more serious connection during the expiration. The next exercise was to compare shallow breathing from the upper chest with deep diaphragmatic breathing. My partner felt absent during the shallow breathing and could not recover during the deep breathing, but when I was shallow breathing, she said it seemed like I was drowning and she wanted to rescue me, but felt much more relieved during the deep breathing phase. For many people, the sight of somebody huffing and puffing can induce a sense of fear.
This exercise taught us just how much we can enter different psychological states by altering our physiology. Inspiration and shallow breathing excites our sympathetic nervous system and induces alarm, whereas expiration applies the vagal brake and calms us down. So there is some physiological validity in the advice from well-wishers to breathe deeply when we are upset. It calms us down and engages our mind.
Pranayama, yogic breathing, emphasises expiration often in association with a long ‘om’. Religious chanting, singing, playing wind instruments do the same thing. All are said to be relaxing. I enjoy wild swimming and have found that when entering cold water, it helps to breathe out through pursed lips in order to relax and focus. Breathing out also helps some people to pass urine and faeces when they feel ‘up-tight’, probably again by applying a vagal brake on the sympathetic nervous system.
So many different activities and holistic therapies tap into the same ventral vagal system. Activities carried out together enhance social engagement, containment and safety, applying the vagal brake on panic and dissociation. Dance, play, sport, theatrical performance, choral or community singing, making music, equal talking and listening (and being listened to), and shared laughter all induce a sense of togetherness and well-being. But play and humour do something more: they work with the unexpected, the violation of predictability and its subsequent repair. Rupture changes things, but subsequent repair gives us confidence and stimulates personal growth. Bill Shankly, one time manager of Liverpool Football Club, once said, ‘football is not just a matter of life and death, it’s more important than that’. It can certainly seem so. Sport is practice for life.
There is nothing that connects people more than being held or touched. It engages the ventral vagal complex and calms our internal physiological state, Therapeutic massage, reflexology, acupuncture, cranio-sacral therapy can all help to restore natural body rhythms and bring the defensive sympathetic and dissociative systems back under control. Even tapping on the clavicles, the wrists or other parts of the body (Emotional Freedom Technique) can restore function in people threatening to ‘lose it’.
Yoga, Alexander technique and Pilates alter physiology by regulating posture. Rhythmic movements, such as rocking may help to restore feelings of calm by rhythmically stimulating baroreceptors.
Not all techniques work with the body. By means of the induction of a trance like state of relaxation and focus, meditation and hypnotherapy restore a sense of relaxation and control, conducive to creative thought and confidence. EMDR (Eye Movement Desensitisation and Reprogramming), which seems like an application of hypnotic techniques, has been established as a useful treatment for trauma.
Psychotherapy is a process whereby the client/patient can feel heard and responded to, facilitating a sense of agency that can bring about a change in attitude and behaviour. But this doesn’t just apply to psychotherapy. A relationship with any health professional can make people feel better as long as they feel listened to and understood. Any physical treatment may be a surrogate, that the patient can take with them to maintain the feeling of well being. So it may not always be the drug that works but the relationship with the doctor. It may not be the diet itself, but the care and compassion of the dietitian. How else can we explain such a high placebo effect for unexplained illness?
Mindfulness is the new buzzword, encompassing not only meditation, but many other activities, in which we can lose ourselves. Jogging, sewing, knitting, gardening, cooking, listening to music, reading, fishing, woodwork; any activity that allows us to escape the daily sense of threat, get in the zone and focus, can restore the dominance of the ventral vagal system and open the space for creative thought.
There is nothing magical or specific in any of the above techniques; they just use different means to achieve the same end result, a shift in physiological state that quietens the alarm systems and optimises health and well-being, but some techniques may suit some people and not others.
People who have been traumatised may experience certain therapies as threatening, triggering anxiety and illness. For example, one person was triggered during the breathing exercise because it reminded her of the way her mother was breathing as she died. Certain yoga postures may reproduce a sense of vulnerability. Some people find acupuncture needles alarming. Others are fearful of being touched. Sounds are very evocative. Mellow sounds may be very calming or restful, but sounds that are high pitched trigger alarm and low pitched growls may sound threatening like predators. It is important for people to chose a technique that is reassuring.
Whatever method a person employs to self regulate, it is important that they can identify with it and it is health promoting. All too often, people use alcohol, drugs, food or sex to provide an escape from intolerable reality, only to suffer a loss of autonomy and increased dependence.