Zestology Podcast with Tony Wrighton

I was lucky enough to bump into Tony Wrighton at the Health Optimisation Summit in London in September. Tony is a fellow bio-hacker and Sky Sports TV presenter. So I gave him a breathwork session and afterwards we recorded a podcast interview.

We talk about:

• How I discovered breathwork

• My studies in psychotherapy and the problems this industry faces

• How I bio-hack my home and my life

Check it out here

Tony is also a big advocate for a low histamine diet. You can find more info about this on his website here.

Is addiction an environmental deficiency disease?

Winnicott saw how mental health problems could arise in later life if the environment of the infant were not ‘good enough’. This essay will look at what this is and the trauma that arises from ‘not good enough mothering.’ Winnicott (cited in Mitchell and Black, 1995, p125) used the phrase “environmental deficiency disease” to make the point that mental health problems like psychosis, depression or addiction were the symptoms of a disease that lies within. The term, ‘good enough mothering’, is what Winnicott believed was required to nurture a child into an emotionally healthy adult.  The mental and physiological impacts of trauma often lead to loneliness. Loneliness can lead to addiction. This is one path that leads from traumatised infant to addicted adult trying to survive in an isolating environment. The parallels between Winnicott’s ‘environmental mother’ will be compared with the parallels of the adult environment that Johan Hari believes is not serving us anymore. Of course, there are many ways that a child can become addicted in adulthood, but these steps seem to be the most common in our society:

Not good enough mother > trauma > incapacity to be alone or to connect > depression & anxiety > addiction.

In writing this essay, addiction is referred to as one uniform entity. As one of the world’s most experienced experts on addiction Maté (2008, p129) says  “all addictions—whether to drugs or non-drug behaviours—share the same brain circuits and brain chemicals.“ The intention of the heroin addict is the same as the compulsive shopper: to change the physiological state of their brain. Maté (2010, p36) says that “a hurt is at the centre of all addictive behaviours.” The size of the hurt may differ, but it is still there. Like Winnicott, Maté has seen that “the effects of early stress or adverse experiences directly shape both the psychology and neurobiology of addiction in the brain.” These two are indeed in agreement that addiction is a problem of nurture rather than nature. When one is suffering from a common cold, one may have many different symptoms from a blocked nose to a cough. What one sees on the outside is coughing, but we know that inside, this is caused by a virus (Kolk, 2014). This is the same for addiction. On the outside, we might see someone injecting heroin or gambling their house away. Inside is not a virus, but pain.

Maté (2008, p33) believes that “addicts are self-medicating conditions like depression, anxiety, post-traumatic stress or even ADHD.” In our highly medicalised society, when one has the symptom of pain, they are given something to numb it.  So, when we talk about addiction, we are not talking about a completely separate diagnosis. We are talking about a solution to a problem: the numbing of pain. While this solution may not be the healthiest; if we look at it this way, we can understand the addict’s rationale. Maté’s (2008, XI) question is never “why the addiction” it is always, “why the pain?” Just as our doctors over-prescribe painkillers causing lasting damage to the gut-lining, the addict follows the same advice with their addiction. The prescription for depression or addiction has not been to heal the trauma, but to numb the pain. The pain is there for a reason. It is telling us that we need to change something in ourselves or our environment (Hari, 2018). A therapist’s role can be to help the client feel their pain and work through it.

To find out where the pain comes from it is best to start at the beginning. This is where Winnicott focused his attention; on the earliest days of an infant’s life. When Winnicott famously said, “there is no such thing as a baby” he was trying to emphasise the importance of the mother. He meant that “a baby cannot exist alone but is essentially a part of a relationship” (Winnicott, 1947). Separation for the baby or the adult can mean death.

Both Winnicott and his predecessor Melanie Klein moved the focus of psychoanalysis onto the earliest development of the infant. However, Winnicott believed that the infant is a social being from birth whereas Klein distilled this to merely a desire for instinctual gratification from an object. Winnicott contested that “it is not instinctual satisfaction that makes a baby begin to be, to feel that it is real, to find a life worth living” (Winnicott, 1967, p116) but the essential care provided by the mother.

In his work, Winnicott provided several vital roles that the mother must fill. Winnicott (1947) stated that an infant’s physical and emotional growth is dependent upon a ‘facilitating environment’. By this, he meant the mother herself. The mother was more than just another human who cared for the baby; she was the whole environment. She provided all the physical and emotional needs of the baby and also reflected the world into the baby’s eyes. 

The mother must provide protection from environmental impingements. E.g. the head not being supported, loud noises, repeated changes in technique or abandonment. Environmental impingements can be traumatic if they interrupt what Winnicott called ‘going on being.’ If there are frequent environmental impingements during the stage of ‘absolute dependence’, then the risk of later mental health issues increases (Karnac, 1991). If the environment is ‘good enough’, the child will begin to develop the capacity to gather the impingements ‘into the area of omnipotence’ and make the unpredictable, predictable. For the therapist, these concepts can apply to the ‘frame’. Maintenance of predictable time boundaries would demonstrate this.

Just as Winnicott suggested, a study conducted by Shroufe (cited in Kolk, 2014, p161) showed that children regularly pushed into “overarousal and disorganisation did not develop proper attunement of their inhibitory and excitatory brain systems. By late adolescence half of them had diagnosable mental health problems.” The use of the term ‘disorganisation’ is associated with Bowlby. While the language may remind us of Bowlby, the words ‘overarousal’ could be substituted for ‘interruption of going on being’. Bowlby and Winnicott stand in the space between the traditional drive-based psychoanalysis and relational-based theory. Bowlby shared Winnicott and Hari’s view that separation from people essential to survival would be catastrophic (Gomez, 1997). Bowlby would suggest that the reaction to this would be mourning, whereas Winnicott and Hari might see the reactions develop into psychosis or depression.

Combined with the protection from the environment, the baby requires ‘holding’. Holding included both the physical aspect of picking up a baby, plus meeting all the baby’s other physical needs. For physical needs to be understood, the mother needs empathy (Karnac, 1991). The mother must psychically tune into the baby, read its emotions and then meet the need. The inference of a psychic connection is reminiscent of Bion. He believed that this bond was an evolutionary survival mechanism that allowed communication before words were possible (Mitchell & Black, 1995). Similarly, empathy, holding and containment are all functions that the therapist must utilise to support their client.

The infant’s ego begins life as immature and weak but through the mother’s ‘ego-support’ and ‘holding’ it is made strong. By cultivating this mother-child bond, the child learns to trust the mother and the environment. This special relationship is what Winnicott called ‘ego-relatedness.’ This term was essential to differentiate the concept from the id-instincts that Winnicott’s predecessors in psychoanalysis developed.

What Winnicott and Bion called ‘ego-relatedness’ and empathy, might now be explained by the discovery of mirror neurons. Mirror neurons develop in the frontal lobe of the brain. They allow us to read people’s emotions and intentions. They help to explain why the baby is so vulnerable. We can read someone else’s anger and respond with negativity, and we can also be dragged down by reading their depression. In a familiarly Winnicottian way, Kolk (2014, p58) states that “trauma almost invariably involves not being seen, not being mirrored and not being taken into account.” Without a mother to demonstrate what emotional mirroring looks like the frontal lobe does not fully develop and the child will not be able to interact successfully with others. Kolk (2014, p60) asserts that “without flexible and active frontal lobes people become creatures of habit, and their relationships become superficial and routine.” The role of the therapist should be to demonstrate healthy mirroring so the client can feel connected and also learn these skills for themselves.

Winnicott believed that we are never totally independent. Karnac (1991) summarises how Winnicott saw infant growth in stages, from ‘Absolute Dependence’ to ‘Relative Dependence’ ending at a stage he called ‘Towards Independence.’ Notice that this is not complete independence but specifically a movement towards it. The child reaches the third stage if he has an “accumulation of memories of care, the projection of personal needs and the introjection of care details, with the development of confidence in the environment” (Winnicott, 1960).  The child who has this ability has a template to use for the rest of their life. When they start interacting with other children, they can tell a game from reality. They become good playmates; they learn to be in tune with other people and become valued members of society in an upward spiral.

Conversely, the spiral can turn downwards. Unable to read the voices and emotions of their playmates, they overreact to aggression, become bad losers or shut down quickly. They then get shunned for playdates. They spend more time alone watching YouTube and falling even further behind with social skills (Kolk, 2014.) Their isolation increases and loneliness follows.

The mother must teach the baby how to rest when alone as well as how to connect. Winnicott theorised that “rest for the infant means a return to the un-integrated state” (Winnicott, cited in Karnac, 1991). This is enabled by a mother who provides ‘ego-support’. Un-integration is a state of “being calm, restful, relaxed and feeling one with people and things when no excitement is around” (Winnicott, cited in Karnac, 1991).  To an addicted adult, this state may never be possible. “The capacity to be alone” (Winnicott, 1958) is vital for a person to recuperate without the adverse effects of loneliness.

A study by Cacioppo et al. (2009) portrays what it is like to be someone unable to rest in the un-integrated state. In this study, they put people who described themselves as lonely and people who said they felt ‘socially connected’ into a brain scanning machine. They saw that lonely people would spot a potential threat within 150 milliseconds and the socially connected people would take as long as 300 milliseconds. The lonely people know that no one is looking out for them, so they have to do it themselves. Many of Kolk’s (2014) most treatment-resistant patients have benefited from new techniques like neuro-feedback, and EMDR and Maté is an advocate for psychedelic-assisted psychotherapies like ayahuasca. These treatments are currently receiving a great deal of press and research. Of particular interest to the therapist may be psilocybin mushrooms which have just been categorised as a ‘breakthrough therapy’ for treating depression and 3,4-methylenedioxymethamphetamine (MDMA) which is now prescribed for the treatment of PTSD in the USA. Criticism of Winnicott from the likes of Bateman and Holmes (1995) suggests that simply creating a ‘holding environment’ is not enough for some clients. Tools such as those above could make valuable additions to what the therapist can offer.

A further problem that arises from ‘not good enough mothering’ is the development of ‘The False Self.’ This development happens at the time of absolute dependence if there was a failure in object-presenting and the mother is unable to allow the child to feel omnipotent. The child is made to feel omnipotent if its cries for milk are met with milk; its cries for sleep are met with sleep. If the mother can meet and make sense of these omnipotent expressions, she will give strength to their immature ego and a “True Self” will emerge. The ‘not good enough mother’ will not be able to understand the omnipotent gestures and will instead try to force her own gestures onto the baby. The weak baby has no choice but to comply with being fed when it is not hungry, and this compliance makes the mother think that the child is okay. This compliance is the ‘False-Self’ (Winnicott, cited in Karnac, 1991).  Sroufe has seen that when there is, what he calls, "an inflexible parent, the child becomes clingy and uptight." His study has shown that "the more insensitive, pushy and intrusive the parent is at six months, the higher the chance of producing a child with attention disorders and hyperactivity" (Sroufe & Jacobvitz, 1987). These pushy interjections could be where the addict learns to substitute one need with another.

From Freud to Kolk, trauma has always been seen as the root cause of mental health problems. Winnicott’s predecessors looked to the ‘internal drivers’ as the source of trauma. Freud was particularly interested in the three-person relationship and the ‘Oedipus Complex’ (Phillips, 1988). ‘The Object Relations Theorists’ focused on the helplessness of the infant and the relationship to the mother.  For Winnicott, environmental impingements caused trauma. While there may be disagreement on these theories, there is no disagreement that childhood trauma needs resolution in the adult or better still: prevention.

In a rat experiment, Meaney et al. (cited in Kolk, 2014, p152) showed the life-long physiological effects of a ‘good enough mother’. The more the mother licked a new-born rat pup during the first twelve hours after birth, the braver they were and the lower levels of stress hormones they produced. Not only during the early hours but for the rest of their lives. They also found that over a thousand genes were modified and their hippocampus, a vital centre for learning and memory, developed thicker connections.

We have seen clinical and theoretical evidence of the damage trauma does in the child, on top of this, loneliness itself causes physiological damage: in fact, it causes cortisol levels to rise as much as a physical attack (Cacioppo, 2010). The reason loneliness is such a problem is that when we were living in tribes, separation could mean death. Loneliness is accompanied by anxiety because our biology is telling us we must find our tribe.  As we have seen mental health problems rise over the last few decades, it is no surprise to see statistical proof of loneliness rising. Researchers asked how many people someone could call in a crisis. In 1985 the most common answer was three. In 2006 the most common answer was zero (McPherson et al., 2006). Loneliness may not lead directly to death anymore, but it can lead to depression, anxiety and addiction.

Addictions that ruin lives can seem confusing at first. When Marianne Faithful famously said, “heroin saved my life” (Hawksley, 2019) a typical reaction may have been disbelief. The media portrays heroin as an unequivocal evil. Faithful was highlighting that it was not the drugs themselves that were the problem; it was her environment. There is a war on drugs; heroin is right in the centre of that. If heroin is to blame for addiction then why don’t we look at gambling addiction and call a deck of cards evil (Maté, 2008)? The research is clear - addiction is not something that the weak-willed do for pleasure; most hard-core substance addicts grew up in abusive homes (Shanta, 2003).

A study known as ‘Rat Park’, (Alexander et al.,1981) demonstrates how the environment contributes to addiction. Here they compared the morphine addiction rates in rats either housed in cages or an ideal rat environment full of open space, flowing water and social interactions. With the rats housed in a healthy environment, Alexander stated that “nothing that we tried instilled a strong appetite for morphine or produced anything that looked like an addiction”. The caged rats consumed up to twenty times more morphine than those in Rat Park.

Darwin may have said that this was merely a case of ‘survival of the fittest.’ Rats or humans who are not able to adapt to the environment are not fit for survival. With the word 'environmental', you can see Darwin’s influence on Winnicott. Darwin had realised that the organism must comply with the demands of the environment. Winnicott transposed the relationship between the natural environment and the evolving animal onto the mother and the child. The mother, as the first environment, must adapt for the child to have its needs met and survive (Phillips, 1988).

In the adult environment, Hari (2018) proposes that we have created a society that does not enable everyone to survive. Unlike the animals Darwin observed, humans have the power to change their environment. One has to be aware of one's own biases when writing about such controversial topics.  As a recovering addict, there is a desire to refute the Darwinian interpretation and find evidence as to why it is not my fault. There is a desire to convince people that parents and society should be blamed. However, in changing my environment to incorporate Hari's recommendations like reconnecting with nature, disconnecting from technology and spending more time socialising, coupled with personal therapy, my life has improved. Therapists need to be aware that their psychological work in a short, weekly session may not be enough and that helping clients to change their environment in addition to therapy has value.

Winnicott, Hari, Maté and Kolk were all speaking about the Western Societies where they lived and cannot speak for every culture. However, we can see similar discontent around the world with the Indian philosopher J. Krishnamurti who famously said, “it is no measure of health to be well-adjusted to a profoundly sick society” (cited in Hari, 2018, p156).

The socio-political environment that Winnicott was working in may also have created a bias that led him to understate the importance of the father. In the following quote, we can see how Winnicott (Cited in Karnac, 1991, p107) mentions the father almost as an afterthought. He says that perfect care of the child is neither possible nor necessary. That “the infant needs what he usually gets, the care and attention of someone who is going on being herself. This applies to fathers too.” With the arrival of Klein and Anna Freud into the UK, there was a shift in psychoanalysis from Sigmund Freud’s focus on sexual drives to theories about emotional relationships. The next shift came with Winnicott and Bowlby after World War II. During the war, women in England needed to leave the home to work. At the end of the war women needed to migrate back. It may have been that Winnicott and Bowlby were trying to ease this transition by over-emphasising the importance of the mother (Phillips, 1988). There is also a belief that Winnicott’s mother suffered from depression when he was a child. A poem titled ‘The Tree’ (Kahr, 1996) is evidence of this. This depression, coupled with limited contact with his father, may have created an urge to change memories of his childhood by distorting the mother/father significance.

Winnicott’s quote from the last paragraph also assures mothers that their job is not impossible. With all addiction and mental health problems, it does not serve anyone to lay blame at the feet of the mother. Like Winnicott, Maté (2018, XXIV) agrees that “suffering is multi-generational” and that it will be passed “on unwittingly until we understand it and break the links in the chain of transmission within each family.” All parents do their best, but their “best is limited by [their] own unresolved or unconscious trauma.”

In an attempt to highlight the root causes of addiction, there is an urge to distil addiction into a simple problem consisting of early trauma plus an insufficient environment. This does not do justice to the vast scope of possible influences on addiction. Its causes are a combination of genetics, biology, neurology, psychology, emotions, sociology, politics, economy and spirituality (Maté, 2008). When one considers these factors, it can seem like an overwhelming problem. However, in looking at childhood trauma and the environment, we can at least try to understand part of the problem. Modern research methods are now supporting Winnicott's theories, which is encouraging. However, it is sad to see that mental health problems have only risen since Winnicott was working. 

Social interactions require compliance without being exposed. As we have seen, many addicted people will not be able to do this without further trauma. The role of therapy needs to be providing a ‘good enough environment’ where the adult can feel safe to feel their pain. They need to be mirrored and held in order to develop the skills required to connect and heal. With these skills, they can create healthier environments.  Continued research into areas like psychedelics and neurofeedback will also add to the number of tools a therapist can offer to the most treatment resistant.

References

Alexander, B et al., “Effects of Early and Later Colony Housing on Oral Ingestion of Morphine in Rats,” Psychopharmacology Biochemistry and Behaviour 58 (1981): 175–79.

American Addiction Centers. (2019). What Is the Success Rate of AA? [online] Available at: https://americanaddictioncenters.org/rehab-guide/12-step/whats-the-success-rate-of-aa [Accessed 13 Mar. 2019]. Cacioppo, J. T., Fowler, J. H., and Christakis, N. A. (2009). Alone in the crowd: The structure and spread of loneliness in a large social network. Journal of Personality and Social Psychology 97(6): 977–991.

Bateman, A. and Holmes, J. (1995) Introduction to Psychoanalysis: Contemporary Theory and Practice. East Sussex: Routledge Taylor & Francis Group.

Cacioppo, J. T. and Hawkley, L. C. (2010). “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms,” Annals of Behavioural Medicine 40, no. 2.

Gomez, L. (1997). An Introduction to Object Relations.  London: Free Association Books.

Hari, J. (2018). Lost Connections. Bloomsbury Publishing. Kindle Edition.

Hawksley, R. (2019). Marianne Faithfull: 'Heroin saved my life'. [online] Telegraph.co.uk. Available at: https://www.telegraph.co.uk/culture/music/music-news/11268024/Marianne-Faithfull-Heroin-saved-my-life.html [Accessed 17 Mar. 2019].

Kahr, B. (1996). D.W. Winnicott: A Biographical Portrait. London: H. Karnac (Books) Ltd.

Karnac, H. (1991) Boundary and Space: An Introduction to the Work of D.W. Winnicott. London: H. Karnac (Books) Ltd.

Kolk, Bessel van der. (2014) The Body Keeps the Score. Penguin Books Ltd. Kindle Edition.

Maté, G. (2008). In the Realm of Hungry Ghosts. Canada: Knopf.

McPherson, M., Smith-Lovin, L. and Brashears, M.E. (2006) “Social isolation in America: Changes in core discussion networks over two decades,” American Sociological Review 71: 353–375.

Mitchell, S.A. and Black, M.J. (1995) Freud and Beyond. New York: Basic Books.

Phillips, A. (1988). Winnicott. London: Penguin Books.

Shanta et al.(2003) “Childhood Abuse, Neglect and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study,” Paediatrics 111: 564–72.

Sroufe, A.L., and Jacobvitz, D. and L. A. (1987) “The Early Caregiver-Child Relationship and Attention-Deficit Disorder with Hyperactivity in Kindergarten: A Prospective Study,” Child Development. Vol 58, no. 6: 1496–504.

Sroufe, A.L. and Collins, W.A. (2009) The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press.

Szyf, M. (2011). The Early Life Social Environment and DNA Methylation: DNA Methylation Mediating the Long-Term Impact of Social Environments Early in Life. Epigenetics 6, no. 8: 971–78.

Winnicott, D.W. (1947). Further Thoughts on Babies as Persons. The child and the outside world: Studies in developing relationships. London: Tavistock.

Winnicott, D.W. (1958). The Capacity to be Alone. International Journal of Psycho-Analysis, 39, 416-420.

Winnicott, D.W. (1960) The theory of the parent-infant relationship. International Journal of Psychoanalysis, 41, 585–595.

Winnicott, D.W. (1963). From Dependence Towards Independence in the Development of the Individual. New Era in Home and School.

Winnicott, D.W. (1964). Further Thoughts on Babies as Persons. New Era in Home and School. 28(10).

Winnicott, D.W., (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. London: Hogarth.

Winnicott, D.W. (1967) The Location of Cultural Experience. The International Journal of Psychoanalysis. Vol 48. Part 3.

Winnicott, D.W. (1968). Communication Between Mother and Infant, and Mother and Infant Compared and Contrasted. Babies and Their Mothers. London: Free Association Books.

Can the works of existential philosophers like Jean-Paul Sartre be useful to psychotherapists working with addiction?

With addiction recovery rates estimated at somewhere between eight and twelve per cent, it is clear that a change in treatment approach is needed (American Addiction Centers, 2019). Freud believed that mental health issues could be understood by exploring someone’s past. Sartre and other existentialists think that it is easier to understand human behaviour when we look to their future. The question should be, what motivates a person to act out their addiction? While the focus on future motivations is vital, it is not possible to ignore how commonly trauma is linked to addiction. We will also see how addiction is not just the problem of the individual but also how society contributes to it. We will look at how the common existential themes of isolation, meaninglessness, responsibility and freedom can be understood in the context of addiction treatment. This essay is written for an integrative institution; we will also see whether new and alternative treatments need to be considered for the benefit of the client.

What is addiction

Addiction can take many forms, but this essay will discuss physiological addictions to substances such as illegal drugs and sugar rather than addictive behaviours. Alcohol or its chemical name ethyl alcohol is a psychoactive drug so will be referred to as a drug. Although it is a controversial subject, refined cane sugar will also be referred to as an addictive substance. As DiNicolantonio et al. (2018) concluded in the British Journal of Sports Medicine: “sugar has been found to produce more symptoms than is required to be considered an addictive substance”.

Personal Biases

My experiences with addiction must be acknowledged. I consider myself an addict in recovery from sugar addiction and Binge Eating Disorder (BED). It serves me to provide evidence that sugar addiction is as dangerous as other addictions as this allows me to feel like I am not merely a person of weak will. Similarly, if I can demonstrate that traumas cause addiction, then it absolves me of responsibility, and I am free to blame external factors rather than seeing addiction as a flaw in my character. I will monitor these motivations.

Does trauma cause addiction?

Dr Gabor Maté, one of the world’s leading experts on addiction states that “all addictions—whether to drugs or non-drug behaviours—share the same brain circuits and brain chemicals” (2008, p129). The intention of the heroin addict is the same as the compulsive shopper: to change the physiological state of their brain. Maté (2008, p36) says that “a hurt is at the centre of all addictive behaviours.” The size of the hurt may differ, but it is still there. This focus on the intention correlates with how Sartre saw man as “the being who hurls himself toward a future and who is conscious of imagining himself as being in the future” (1996, p259). The addict is hurling himself towards a future when he does not feel pain. Similarly, Heidegger (2001) believes that we pull ourselves from ahead with our motives, rather than being pushed from behind by past events. The existentialists, like Maté, understand behaviour through motives, not causes (Cooper, 2003).

If freedom from pain is the motivation for addictive behaviours, then it is necessary to understand what causes the pain.  Maté’s (2008, pXI) question is never “why the addiction” it is always, “why the pain? There are plenty of experts who believe that trauma causes addiction. To Shanta (2003), the research is clear - addiction is not something that the weak-willed do for pleasure; most hard-core substance addicts grew up in abusive homes.  Maté (2008) goes a step further and shares that in his twelve years of working on the Downtown East-side of Vancouver, every one of his hundreds of patients had suffered trauma. These traumas came from emotional, physical or sexual abuse.

Numbing the symptoms

Maté (2008, p33) believes that “addicts are self-medicating conditions like depression, anxiety, post-traumatic stress or even ADHD.” Our Western model of medicine rarely treats the cause of the problem but instead attempts to numb the symptoms. A U.K. based survey found that eighty per cent of doctors admitted to over-prescribing antidepressants (The Pharmaceutical Journal, 2004). The addict follows the same pathway when they use their addiction to numb their pain.

The pain is the message

Johan Hari (2018), urges us to see emotional pain as a messenger. The pain is there for a reason. The pain tells us that we need to change something in our lives. When a hand is placed on a hot stove, the pain forces the person to move the hand away. The emotional pain is trying to provoke the same reaction. It wants the person to move away from the cause of the pain.

A significant challenge to working with addiction is that the messages that the body is trying to communicate become so difficult to hear after trauma. Trying to work out the source of psychological pain is much harder than with a burning hand on a stove. Dr Bessel Van der Kolk (2014, p53), an expert in trauma recovery, states that “after trauma, the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos.” Much like Nietzsche, who stated that “there is more wisdom in the body than in your deepest philosophy” (1883, p48), Van der Kolk urges therapists to work with the entire organism and not solely with the mind. For the addict, the messages from the body become even harder to hear as they numb their inner chaos with their substances.

Is talking about trauma even helpful?

There are a growing number of therapists who question the efficacy of ‘the talking cure’ for dealing with trauma. Stanislav Grof (2018), the founder of Transpersonal Psychotherapy has said, that after years of psychoanalysis, clients can “give you lectures on their problems, only the problems do not change.”  Van Der Kolk does not trust Freud’s (Breuer & Freud, 1893) statement that trauma “immediately and permanently disappeared when we had succeeded in bringing clarity to light the memory of the event by which it was provoked.” He has found that “traumatic events are almost impossible to put into words” (2014, p231).  He uses T. E. Lawrence’s (1935, p27) description of fighting in the war to demonstrate this:

‘We learned that there were pangs too sharp, griefs too deep, ecstasies too high for our finite selves to register. When emotion reached this pitch, the mind choked; and memory went white till the circumstances were humdrum once more.’

Similarly, when the United Nations sent in Western Counsellors to help the victims of the Rwandan Genocide, the ‘talking-cure’ was not welcomed. The Rwandans felt that the aid workers were intrusive and re-traumatising victims by forcing them to relive their stories. One Rwandan (paraphrased by Leech, 2015) described how “they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to ask them to leave.” The Rwandans could not understand how talking to a stranger about highly sensitive material could be helpful and could suggest that the ‘talking-cure’ is merely ineffective. An alternative explanation is that this is a Western solution useful for solving Western problems and does not translate into other cultures.

Van der Kolk’s (2014) most treatment-resistant patients benefited from new techniques like neuro-feedback and EMDR and Dr Maté is an advocate of psychedelic-assisted psychotherapies like ayahuasca. These treatments are currently receiving a great deal of press and research. Of particular interest to the therapist may be psilocybin mushrooms which have just been categorised as a ‘breakthrough therapy’ for treating depression, and MDMA, which is now prescribed for the treatment of PTSD in the USA.  Garcia-Romeu et al. (2019) have recently concluded a study that saw a significant reduction in alcohol misuse disorder following LCD use. With more and more research being conducted in this area and cities like Denver and Oakland in the U.S. decriminalising psilocybin, the existential therapist may soon have another legal and effective tool to help them in their practice.

My recovery from addiction only began once I was introduced to modalities that involved the body as well as the mind. I had several years of traditional ‘talk-therapy’ that did not enable me to stop the addiction. It was only with the addition of Transformational Breathwork and Body Mapping that I saw progress.  My frustrations with the limitations of talk-therapy should be highlighted here. I remain aware of a desire to promote the use of alternative therapies in addition to ‘talk-therapy’ because it is my opinion that alternative methods of recovery are under-utilised.

What Van der Kolk and Grof do believe to be effective in ‘talk-therapy’ is the creation of the therapeutic relationship. Van Der Kolk (2014, p58) states that “trauma almost invariably involves not being seen, not being mirrored and not being taken into account.” Instead of trying to create theories and label the client’s past issues, the existential therapist can work on mirroring the client and being fully present for them. Yalom (2001, 08:56:30- 08:56:40) agrees that “overwhelming, research evidence shows that good outcomes depend on the intensity, the warmth, the genuineness [and] the empathy of the therapeutic relationship.”

Existentialism is too morbid for an addict.

Cooper (2003, p37) states that one of the most significant criticisms “of existential philosophy is that it is overly morbid: that it tends to focus on such experiences as despair, anxiety, and mortality to the neglect of more positive and pleasurable experiences.” As shown earlier, addicts have suffered a great deal. It may merely compound their misery to tell them that they are simply a ‘being towards death’ as Heidegger (1962) does. If even a great existentialist like Kierkegaard “withdraws from the dizziness of freedom” (Kierkegaard, 1941) then perhaps these ideas need to be softened for the addict. Gabriel Marcel’s (1949) work, with its focus on joy and hope, may be easier to hear for a client who has lost this perspective.

However, the argument for a focus on the starker areas of life is that it will enable the client to live a more complete and intense life (Cooper, 2003). The existential therapist can work on treating the causes of the addict’s pain rather than merely numbing the symptoms further as Gabor Mate encourages.  It is not possible to selectively numb emotions, when a person numbs anxiety, loneliness and fear of death they also numb joy, love and happiness (Brown, 2010).

Is taking responsibility helpful?

Similarly, a confrontation with one’s freedom and responsibility could overwhelm a struggling addict.  Sartre (1989, p34) thinks that “being is terrifying... characterised by its absolute mystery and impenetrability” and that you have “to take responsibility for things you have not initiated or wanted.” How does one inform a victim of child abuse that they must take responsibility for this? This suggestion could easily cause a rupture between the therapist and the client... or much worse. Sartre (1943a) and Heidegger (1962) would see it differently. They would emphasise that by denying the addict’s freedom and responsibility to choose their past, they also deny the freedom to choose a future of recovery (Cooper, 2003).

An understanding of Heidegger’s (1962) concept of ‘leaping-in’ and ‘leaping-ahead’ would be useful to the therapist. By ‘leaping-in’ and informing the client of their responsibility, Van Deurzen (2009, p69-70) would say that you are “robbing them of themselves and their openness to the world.” The intention should be to find a “way of giving the other his care back in an authentic manner”. Van Deurzen goes so far as to say that learning to ‘leap-ahead’ of the client and giving them “a sense of the overall perspective of their lives and of reality is exactly where existential psychotherapy is at.”

Is addiction a disease?

Addiction and many other mental health problems are labelled as a disease or illness by medical practitioners (Bierer, 2017). Szazs (2008, 38:10 - 38:28) says that mental illness is not “a disease with origins to be excavated but a behaviour with meanings to be decoded.” Laing shares Szasz’s views and argues that society holds on to a medical model of mental health because if its causes can be attributed to biology or genetics, then society does not have to examine how it contributes to the problem (Spinelli, 1989).

Van Deurzen (2012, p30) believes that actually, the psychologically distressed individual has just turned away from facing the typical struggles of life. They are not diseased; they have just become “clumsy at living.” Van Deurzen sees the role of the therapist as simply someone to help the client to face up to their situation and wake up from self-deception (Cooper, 2003).

Twelve Step Recovery Programs start by having the addict admit that they are powerless over their addiction. At first, this sounds like a very anti-Sartrean idea. However, the meaning is not that the addict is not responsible, but that they become powerless when substances are in their body (Immersion Recovery, 2018). Alcohol is an example of a drug that alters consciousness. If a mind is altered, then is the addict still free to choose their actions? Does Sartre’s (1943a) demands for responsibility and conscious awareness at all times apply when a substance has taken control of their consciousness? It could be argued that the person was conscious when they took the drug. However, if the person is an addict, then once the drug’s effects have worn off, the withdrawal symptoms would still be affecting the addict’s mind and body. Where this cycle starts or ends is not clear, but with alcohol addiction recovery rates being so low within the medical system and Twelve Step Programs it seems clear that labelling the problem as a disease has not helped (American Addiction Centres, 2019).

The opposite of addiction is connection

Johan Hari suggests that “the opposite of addiction isn’t sobriety. It is connection” (2015, p293). Sartre’s (1943b) famous quote that “hell is other people” demonstrates that social connections are difficult, not just for addicts.

Connecting is difficult, but the damage done by loneliness is even more severe.  This is supported by Eisenberger’s (2003) research that shows that the regions of the brain that light up in response to physical pain react in the same way in response to social ostracism. If this is true, then the existential therapist can help the addict by improving their social skills. This can be done in a manner favoured by Laing and existential-humanistic therapists like Yalom who says he tries to inquire about the client-therapist relationship  “at each session even if it has been productive.” Yalom (2001, p72) suggests questions like “How are you and I doing today?’ or ‘How are you experiencing the space between us today?’” Practising safe social interactions within the therapeutic frame could support the addict in connecting with people in the real world (Spinelli, 1989).

Sartre’s statement that one must “begin by isolating man on the instantaneous island of his present” (Sartre, 1943a, p109) is not supported by the U.K. Drug Policy Commission. In 2012 the Commission stated that “drug problems need to be seen and addressed within their wider social and economic context; entrenched drug problems appear to be significantly linked to inequality and social exclusion” (cited in Maté, 2008 XIX). Unsurprisingly the area of the U.K. with the highest addiction rates correlates with some of the highest unemployment rates. A prime example of this is in Hull, where the decline in the fishing industry has seen the simultaneous rise in both unemployment and addiction (Maté, 2008).

There is a famous study known as ‘Rat Park’ conducted by Alexander et al. (1981) that demonstrates the impact the environment has on addiction. In this study, there were two sets of rats, either housed in cages or an idyllic rat environment that enabled social interactions, flowing water and free space. Alexander shared how “nothing that we tried instilled a strong appetite for morphine or produced anything that looked like an addiction” in the rats kept in the idyllic environment. Whereas the caged rats consumed twenty times more morphine than those in Rat Park.

Does the addict need to find meaning?

Van Deurzen (2009, p89) interprets that in Sartre’s later work, freedom and action are “not seen as something that depends on the will and the isolated individual, but rather on the communal interest.” This echoes step twelve of Alcoholics Anonymous (Wilson, 1952) which requires a commitment from the member to move from self-serving motives to the serving of others by helping other alcoholics into recovery. A quote attributed to Nietzsche but used by Frankl (1967, p116) states that “he who has a ‘why’ to live for can bear almost any ‘how’”. By providing someone with meaning and purpose outside of themselves, they may find the motivation to recover.

Hari (2018) demonstrates how other cultures deal with the problem of meaninglessness and depression. He shares a story about a Cambodian rice farmer whose leg was blown off by a landmine, had a new limb fitted but did not recover. He became depressed, anxious and filled with despair. So, the local neighbours and doctor got together listened to his issues and decided to buy him a cow. They realised that he was anxious because he was in physical pain and unable to farm the land. However, they realised he could easily be a dairy farmer. The cow was the antidepressant and an analgesic. To them, Hari (p159) says “an antidepressant was not about changing your brain chemistry...it was about community, together, empowering the depressed person to change his life”. The difference was made because the man’s social situation was changed, he was able to find meaning in his work, and it was all enabled by the care of the community.

While finding meaning seems like a useful tool for recovery, a younger Sartre (1943a) might consider this an example of ‘bad faith’. It is merely a way of avoiding the confrontation with the meaninglessness and absurdity of being human (Cooper, 2003). Here we find an example one of Cooper’s (2003, p39) main criticisms of Sartre and all of existential philosophy; that it is “a vast and sprawling edifice, replete with debates, contradictions and half-completed arguments.”

Sartre’s philosophy seems to have changed in order to keep up with the changing political environment in Europe. Van Deurzen shows how Sartre made the point that the therapists “rather than seeking to change the individual by altering the self and its objectives, this has to be done in relation to the political, cultural and social world in which we exist.” (p100, 2009). Sartre’s earlier writing was set in a Europe that had just been confronted by the possibility of destruction by nuclear war. He was also writing in a France that had just come out of Nazi occupation. He was a man writing about freedom in a country that had just lost its freedom. As socialist sentiments grew in Europe, Sartre’s views on individuals and connection seem to have changed to keep up (Bakewell, 2016).

Cannon (1991) believes that a Sartrean existential therapist should help a client to create a life that balances their individual freedom with a worthwhile life project that encompasses the historical, social and political factors of the present time. This project needs to ensure that the ‘practico-inert’ features of the generation do not limit the progress into the future. It may be possible to take Kierkegaard’s (1884, p188) notion that “whoever has learned to be anxious in the right way has learned the ultimate.” If there is a ‘right way to be anxious’, Sartre would have that anxiety channelled into a project that finds this balance that Cannon (1991) describes.

Conclusion

For the existential psychotherapist, the goal of their work requires a great deal of balance. A balance between gaining an understanding of how past traumas affect motivations. They need a life project that balances individual freedom with community and meaning. Further work needs to be done to understand why psychedelic-psychotherapy has such beneficial effects in the trials and how to use this tool safely. Exploration of cultures that utilise more of the community’s ability to heal could help Western methods expand their range of strategies for healing. An integrated approach that embraces new tools like neuro-feedback and psychedelic-psychotherapy with proven existential techniques like phenomenology is going to be critical to the future of addiction recovery.

References

Alexander, B et al., (1981) “Effects of Early and Later Colony Housing on Oral Ingestion of Morphine in Rats,” Psychopharmacology Biochemistry and Behaviour 58: 175–79.

American Addiction Centers. (2019). What Is the Success Rate of A.A.? [online] Available at: https://americanaddictioncenters.org/rehab-guide/12-step/whats-the-success-rate-of-aa [Accessed 5 July. 2019].

Bakewell, S. (2016) At The Existentialist Café. Random House. Kindle Edition.

Bennet, C. (2013) Low self-esteem can lead to addiction: Available from: https://www.psychologytoday.com/gb/blog/heartache-hope/201306/low-self-esteema-disposition-can-lead-addiction [Accessed 7 June 2019].

Bierer, M., (2017) Is Addiction a Brain Disease? Harvard Health Publishing. Available at: https://www.health.harvard.edu/blog/author/mbiere. Accessed [29 June 2019].

Breuer, J. & Freud, S., (1893) The Physical Mechanisms of Hysterical Phenomena. In: The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth Press.

Brown, B. (2010) The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are. New York: Hazelden Publishing.

Cannon, B. (1991) Sartre and Psychoanalysis: An Existentialist Challenge to Clinical Metatheory, Lawrence, KS: University Press of Kansas.

Cooper, M. (2003) Existential Therapies. SAGE Publications. Kindle Edition.

DiNicolantonio J.J., O’Keefe J.H., Wilson W.L.(2018) Sugar addiction: is it real? A narrative review. British Journal of Sports Medicine; 52:910-913.

Eisenberger N.I.(2003) “Does Rejection Hurt? An fMRI Study of Social Exclusion,” Science, 10, 290–92.

Frankl, V. E. (1967) Psychotherapy and Existentialism, Harmondsworth: Penguin.

Garcia-Romeu, A., Davis, A.K., Erowid, F., Erowid, E., Griffiths, R.R., Johnson, M.W. (2019) Cessation and reduction in alcohol consumption and misuse after psychedelic use. Journal of Psychopharmacology. 2019 14 May :26.

Gymless, (2015) If You Don’t Want To Slip Up, Don’t Go Where It Is Slippery. Available from: https://www.gymless.training/articles/if-you-dont-want-to-slip-up-dont-go-where-it-is-slippery [Accessed 28 June 2019]. 

Grof, S. (2018) — Lessons from ~4,500 LSD Sessions and Beyond | The Tim Ferriss Show (Podcast) (13 December 2018) Added by Tim Ferris [Online]. Available at: https://www.youtube.com/watch?v=3mdYUmvTeig [Accessed 10 June 2019].

Hari, J. (2015) Chasing the Scream. London. Bloomsbury Publishing.

Hari, J. (2018) Lost Connections. London: Bloomsbury Publishing.

Heidegger, M. (1962) Being and time. Trans J. Macquarrie & E. Robinson. Oxford: Blackwell.

Heidegger, M. (2001). Zollikon Seminars: Protocols–conversations–letters. Trans F. Mayr & R. Askay. Evanston, IL: Northwestern University Press.

Immersion Recovery. (2018) What is powerlessness? Step one of the 12-steps of alcoholics anonymous. Available from: https://www.immersionrecovery.com/what-is-powerlessness-step-one-of-the-12-steps-of-alcoholics-anonymous-2/ [Accessed 10 June 2019].

Khoury L., Tang, Y.L., Bradley, B., Cubells, J.F., Ressler K.J. (2010) Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress Anxiety. 27(12):1077-86. doi: 10.1002/da.20751.

Kierkegaard, S. (1844) The Concept of Anxiety.  Trans. Alasdair Hannay. New Jersey, Princeton University Press.

Kierkegaard, S. (1941) Concluding Unscientific Postscript. trans. Swenson, D.F. and Lowrie. W., Princeton New Jersey: Princeton University Press.

Lawrence, T.E. (1935) Seven Pillars of Wisdom. New York: Doubleday.

Leech, A. (2015) Exporting trauma: can the talking cure do more harm than good? Available from: https://www.theguardian.com/global-development-professionals-network/2015/feb/05/mental-health-aid-western-talking-cure-harm-good-humanitarian-anthropologist [Accessed 5 July 2019].

Marcel, G. (1949). The philosophy of existence (M. Harai, Trans.). Freeport, NY: Books for Libraries Press.

Maté, G. (2008). In the Realm of Hungry Ghosts. Canada: Knopf.

Nietzsche, F. (1883). Thus Spoke Zarathustra: A Book for All and None. Germany, Ernst Schmeitzner.

Sartre, J.-P. (1943a). Being and nothingness: An essay on phenomenological ontology (H. Barnes, Trans.). London: Routledge.

Sartre, J-P. (1943b) No Exit and the Flies, trans. S. Gilbert, New York: Knopf, 1947.

Sartre, J-P. (1948) Anti-Semite and Jew, New York: Schocken.

Sartre, J-P. (1981).The Family: Gustave Flaubert, 1821-1857, Volume 5, Chicago: University of Chicago Press.

Sartre, J-P. (1989) Truth and Existence. Translation. A. van den Hoven, Chicago, IL: University of Chicago Press.

Sartre, J.-P. (1996) Existentialism. In L. Cahoone (Ed.), From modernism to postmodernism: An anthology. Cambridge, MA: Blackwells.

Shanta et al. (2003) “Childhood Abuse, Neglect and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study,” Paediatrics 111: 564–72.

Sinha, R. (2007) The role of stress in alcohol relapse. Current Psychiatry Report ;9(5):388-95.

Spinelli, E. (1989) The Interpreted World: An Introduction to Phenomenological Psychology. SAGE Publications.

Szasz, T. (1996). The Meaning of Mind: Language, Morality, and Neuroscience. Syracuse University Press: New York.

Szasz, T. (2008) Psychiatry: The Science of Lies. Syracuse University Press: New York.

The Pharmaceutical Journal, (2004) Most G.P.s are over-prescribing antidepressants. The Pharmaceutical Journal. Available at: https://www.pharmaceutical-journal.com/pj-online-news-most-gps-are-over-prescribing-antidepressants/20011591.article?firstPass=false [Accessed 29 June 2019].

Van der Kolk, B.A. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, Viking Publishing.

Van Deurzen, E. (2009) Everyday Mysteries: A Handbook of Existential Psychotherapy. London: Routledge.

Van Deurzen, E. (2012) Existential counselling and psychotherapy in practice (3rd ed.). London: Sage.

Wilson, B. (1952) The 12 Steps and 12 Traditions. New York, Alcoholics Anonymous Publishing.

Yalom, I. D. (2001) The gift of therapy: Reflections on being a therapist. Audible.co.uk. Audiobook. Available at: http://www.audible.co.uk (Downloaded: 1 June 2019).

Can the body and Eugene Gendlin’s idea of the ‘felt sense’ help the psychotherapeutic process?

This is an essay I wrote for my Psychotherapy studies, hence the formal style. I wanted to publish it so that people can see how common trauma is and that it is okay to say you have been traumatised. Its not something that it is only reserved for war veterans or the severely abused. We are all walking around with wounds and there is support out there for you if you want it.

Traditional forms of psychotherapy have mostly focused on healing the minds of clients. Additionally, most academic theories attempt to demystify the workings of just the mind by separating them into sections, such as Freud’s theory of the ego, superego and the id (Freud, 1923). These approaches may be robbing the client of the chance to recover fully as they ignore the issues that lie outside of the mind. A person also has a body and this body can be a useful tool in treating the emotional part of the person. The body could be used as a gateway to areas of healing that the mind cannot or will not go. In some cases, it may be essential to begin working with the body to free the client up to go further into the emotions and the mind. Eugene Gendlin was a big proponent of the body as a tool to aid mental health. In his research he was struck that so little attention had been paid to the body in psychotherapy that he had to coin his own term, the ‘felt sense’, to describe the processes held in the body. A meta-analysis by Rohricht supports this notion by showing that not enough clinical research has been conducted into body-psychotherapy (Rohrict, 2009). Whilst a greater emphasis on the body is useful, it may not be the panacea to cure the mental health problems of all populations. Before Freud came along with his focus on the mind, there were philosophers, such as Nietzsche, who believed that there was “more wisdom in the body than in your deepest philosophy.” (Nietzsche, 1885.) Long before that, Eastern healing practices placed this bi-directional communication between the mind and body at the centre of their treatments. A reversion back to this holistic approach may be beneficial and Gendlin’s ‘felt sense’ concept is a step in that direction.

Gendlin describes the felt sense as:

“A kind of bodily awareness that profoundly influences our lives and that can help us achieve our personal goals. The ‘felt sense’ is not a mental experience but a physical one. It is an internal aura that encompasses everything you feel and know about the given subject at a given time” (Gendlin, 2003, p 32.)

He believes that it is more than just an emotion as it includes factual information as well (Gendlin, 2003). When you are utilising the ‘felt sense’ you are able to access so much more information about a person or a subject than you can when you just try to use the mind. All of this information provides a much greater basis to heal (Gendlin, 2003). Unlike Freud, Gendlin does not try to separate the mind from the body as he believes every part of the body is in some way involved in living (Gendlin, 2003). By treating the person as a whole you have a much greater chance of making progress. It is startling that Gendlin had to coin his own term to describe this sensation, but he was not the first modern, Western psychologist to incorporate the body into psychotherapy.

Wilhelm Reich was one of the earliest people to focus on the body as a psychotherapeutic tool. He was part of the second generation of psychoanalysts following Freud and he published several books in the mid-1930s. Bioenergetic Analysis is a psychodynamic form of therapy still used today and it is based on Reich’s work. His idea of ‘armouring’ is one of its most enduring. This is the idea that muscular tension is caused by neurosis. An idea that has subsequently been backed up by research (Babbel, 2010). Gendlin believes that ‘armouring’ happens because, as children, we are socialised and taught to repress emotions, and this leads to a disconnection from our bodies and subsequently, our happiness. Bioenergetics links physical pain, muscular tension and postural disorders with the state of the client’s mind. Gendlin agrees that this can be bi-directional and that physical distress can be caused by suppressed emotions, unhappiness and anger (Gendlin, 2003). If this is true then some people who go for treatment to physical therapists, doctors and chiropractors for chronic physical problems may be wasting their time and would be better served by addressing their emotional issues.

A bodily approach to psychotherapy could be useful for chronic pain as it is often linked to trauma. According to some research, approximately 15-30% of patients with chronic pain also have post-traumatic stress disorder (PTSD). Peter Levine, the creator of a type of body-mind psychotherapy called Somatic Experiencing, asserts that trauma occurs when our ability to respond to a perceived threat is in some way overwhelming" (Babbel, 2010). Although there are disagreements over the exact definition of trauma most experts agree that responses to it include both physical and psychological symptoms. Equally, ignoring the physical symptoms and only intellectualizing the matter would not be the best approach.

It could be said that the traditional psychotherapeutic approach is to intellectualise the client’s issues. This tactic has come under attack from various experts, including Reich. He went so far as to say that human language was actually getting in the way of healing as it could be used as a defence against feeling the biological core. He stated that psychoanalysis had “become stuck in a pathological use of language” (Reich, 1933, p67). Perhaps Reich’s observations of clients getting stuck were actually patients who had experienced severe trauma. Trauma victims are often in a state of hypervigilance and if the brain is perceiving a constant low-level threat then no amount of insight is going to help quieten it (Van Der Kolk, 2014). Another approach must be implemented with these types of clients.

The right approach could be Gendlin’s ‘felt sense’ or other body-mind therapies. Alexander Lowen is a student of Reich and a critic of the mind-centred approach. He postulates that there is a difference between just talking about your feelings and feeling your emotions and your body. He believes that when you don’t feel your body you go into “a little bit of an insane world” (Lowen, 2012). He insists that the first steps are to help clients to feel the sensations in their bodies and utilise the ‘felt sense’. Staunton believed that this is necessary because core beliefs are embodied. Therefore, we must experience the pain held in them directly through our bodies. If we do not, they will continue to run our lives. Simply, understanding them mentally is not sufficient (Staunton, 2002). Babbel believes that physical pain could actually be used as a warning to people that more emotional work needs to be done and that there is still more trauma trapped in the nervous system (Babbel, 2010). These are good arguments for working with the body but there needs to be clarity on where talking therapies are not being effective.

Talking therapies are also criticised for not helping to change negative behaviours. Whilst talking about a client’s story can provide important information about their past it doesn’t have so much use in treating maladaptive procedural action tendencies in the moment. A maladaptive action is a way of coping with stress that does not increase functioning. It only temporarily decreases the symptom, while the stress remains the same or increases. An example of this would be a person getting drunk to forget about the stress of losing their job, however, once the person wakes up they begin to feel the stress again, with the additional stress of alcohol withdrawal symptoms. In order to help a client utilise adaptive coping behaviours, treatment needs to address the client’s present moment and how the past trauma is affecting it. The focus needs to be the “in the moment trauma-related emotional reactions and body sensations as they emerge” (Ogden, Minton, Pain, 2006, p168). The client can then explore these occurrences in an attempt to change. Exploring the ‘felt sense’ would be one way of doing this.

However, there are challenges with utilising the ‘felt sense’ too. In-the-moment emotions and bodily sensations may not be accessible to some clients. Brain scans of PTSD patients with early life trauma show no activation of the self-sensing areas of the brain. This is likely due to patients learning to cope with trauma by shutting down the visceral feelings and emotions that come with it. Unfortunately, these same areas of the brain are the ones that register the entire range of emotions. So not only are the patients not able to feel the negative emotions they have also shut down the positive ones (Van Der Kolk, 2014). This biological shut-down can manifest as symptoms of alexithymia, which is the inability to describe feelings and emotions (Levine, 2010). If a client is unable to even describe a feeling then neither Gendlin’s nor a psychoanalysts approach is going to work.

There is yet another step that needs to be taken before this. The client needs to be helped to feel safe. This is the approach of Bessel Van Der Kolk, a leading contemporary expert on trauma. He agrees that to release the tyranny of the past a physical self-awareness must be created but that it can’t happen unless the client is able to relax. (Van Der Kolk, 2014). Van Der Kolk is also strong in his assertion that it is not possible for traumatized people to recover until they have “become familiar with and befriended the sensations in their bodies” (Van Der Kolk, 2014, p 97). This is because they have learnt to ignore their gut feelings and bodily sensations in order to avoid becoming overwhelmed by them. He backs this idea up with neuroscience research that suggests this is the only way to change the way a client feels. In his research with trauma victims, he has found that during intended periods of relaxation such as a Shavasana, their Heart Rate Variability (HRV), goes down, which is a sign that their nervous system is still preparing them to fight. This complicates the matter, as without relaxation the client and therapist could experience that sensation of being ‘stuck’ that Reich wrote about.

The complications may be due to the severity of the trauma experienced by the client. Chronically neglected or abused individuals are usually in a state of immobilization or shut-down. While acutely traumatized people are much more animated, spending an excess of time in the fight or flight response. They may experience flashbacks and elevated heart rates while chronically traumatized people show no change or even a slowing down of the heart rate (Levine, 2010). It may be that many of the clients that Levine, Reich and Lowen encountered were the more acutely traumatised people, where progress with reconnecting to the body was more easily achieved. Another approach altogether may be needed for the chronic sufferers.

The recent trend in psychotherapy of incorporating the body has been fairly one-directional. Being dominated by mind-focused theories for so long it is natural that the reaction to this is to argue for the prioritization of the body in psychotherapy. Some may be going too far in their rejection of talking therapies. As the body therapies are not fully a part of the mainstream yet there has not been such a vocal argument against the use of the body. Some sort of balanced middle-ground may eventually appear. There seems to be little research or publications that actually deny the benefits of focusing on the body for those less severely affected by trauma. As time goes on it is likely that more information will emerge on what a focus on the body can and cannot help with. It may be that a focus on the body is only useful for those suffering from PTSD or something body-related like an eating disorder and that it is not useful for people suffering from existential issues.

A further question would be, is experiencing trauma in life a given and that it is so commonplace that people don’t even recognise it, as Peter Levine believes (Levine & Fredericks, 1997)? If it is a given, then perhaps the distinction needs to be changed from those who have or have not experienced trauma to those who have and have not recovered from the trauma. It may be that Levine’s belief is biased by the fact that he is a psychologist and only interacts with trauma victims. Those who have not suffered from trauma simply do not go to see people like Levine as they don’t have the need.

When reviewing the various approaches and theories it is striking how many gaps there are in the understandings of the body’s involvement in the emotions and the best ways of treating trauma victims. It is a reminder of how young psychotherapy is as a discipline. Thankfully, with the help of modern technologies like functional magnetic resonance imaging (fMRI) machines and quantitative electroencephalography (QEEG) more accurate research can be done to speed up the understanding of psychology. The use of HRV as a measure of the nervous system will also be helpful in understanding the body’s response to emotions and help trauma victims. It is important that with the growth in the understanding of the body in psychotherapy that traditional talking therapies do not get discounted. Either way, it seems that Gendlin’s ‘felt-sense’ and the use of the body is a useful addition to psychotherapy, whilst also not being something to solely rely upon.

This is where the essay ends and if you made it this far then here is your reward… A confession about one of my own wounds. I am publishing this because I have a need to be seen. I know this is a good essay as I received the best feedback I have ever had for it. So, I published it so I can be appreciated and have a hole filled. Knowing that I am motivated by this enables me to be more forgiving and refrain from judging myself for this. I hope that in the process of getting my own narcissistic supplies I can help someone else with their wounds and holes.

References

Babbel, S. (2010) The Connections between Emotional Stress, Trauma and Physical Pain, Available from: https://www.psychologytoday.com/gb/blog/somatic-psychology/201004/the-connections-between-emotional-stress-trauma-and-physical-pain [Accessed 17th September 2018].

Compton, N.H. (1969) Body Perception In Relation To Anxiety Among Women. Perception and Motor Skills, 28: 215–218.

Freud, S. (1923) The ego and the id. Vienna, W. Norton & Company

Gendlin. E.T. (2000) Eugene Gendlin introduces Focusing (Pt.1 International Conference Toronto 2000). Available at https://www.youtube.com/watch?v=j7PEC5Mh5FY. [Accessed: 30 August 2018].

Gendlin, E.T. (2003) Focusing: how to gain direct access to your body’s knowledge. 3rd edn. London, Rider.

Levine, P.A., Frederick, A. (1997) Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. Berkley, North Atlantic Books.

Levine, P.A. (2010) In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkley, North Atlantic Books.

Lowen, A. (2012) Alexander Lowen Interview - Spirit And Body. Available at: https://www.youtube.com/watch?v=H6QRg-l7ntA [Accessed 30 August 2018].

Marsella, AJ, Shizuru, L, Brennan, J and Kameoka, V. 1981. Depression and body image satisfaction. Journal of Cross-Cultural Psychology, 12: 360–371.

Nietzsche, F. (1883). Thus Spoke Zarathustra: A Book for All and None. Germany, Ernst Schmeitzner.

Ogden, P., Minton, K., Pain, C. (2006), Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York. W. W. Norton Company.

Reich, W. (1933) Character Analysis. New York, Farrar, Strauss & Giroux.

Röhricht, F. (2009) Body oriented psychotherapy. The state of the art in empirical research and evidence-based practice: A clinical perspective, Body, Movement and Dance in Psychotherapy, 4:2, 135-156, DOI: 10.1080/17432970902857263.

Staunton, T, ed. (2002) Body psychotherapy, New York: Brunner-Routledge. [Google Scholar], p. 4).

Van der Kolk, B.A., (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, Viking Publishing.

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Photo by christopher lemercier on Unsplash

Photo by Zoltan Tasi on Unsplash

Photo by J W on Unsplash