Here’s an idea about working with the body that you may not have considered before: that the patient already knows precisely what to do, and that all you have to do is provide a safe place for them to do it.
This may not be as crazy as it sounds. Consider what any counselor does when someone with a troubled mind presents himself or herself for care. They spend a good deal of their time quietly waiting for the words that they feel will help to emerge. They don’t tell people what to say, or judge the words that are spoken as long as they are authentic. A trained counselor knows that their client has the answer within them, but that they might need a little help in recognizing it. They know that what needs to be said might not be painless, and that it might surprise the speaker most of all.
Consider the way in which the muscles that drive speech react to a willful inhibition of their expression. When you don’t say what you truly want to, doesn’t your throat get pretty tight? If your friend came to you with a tight throat, wouldn’t you just let them move their mouth? Why do we always interpret muscular contraction elsewhere in the body so differently?
Perhaps it would help if we looked at active movement in two different ways: consciously and unconsciously controlled. The former comprises virtually all of the active exercise traditionally offered our patients and its primary goals are strength and increased range. While these qualities are often desirable, painful disorders typically require as well the correction of mechanical deformation if they are to resolve. Length and strength would not necessarily lead to this, and the many failures of traditional regimens of exercise for chronic pain are a testament to this.
A primary attribute of the muscle quality found in chronic pain is excessive, seemingly non-productive activity. It is not consciously bidden, often present beyond the patient’s awareness, and is thought to produce pain because of its constancy. Therapists do all they can to ablate it with manipulative technique and exhortations to relax.
But if your friend came to you with a tight throat, would you manipulate the muscles that drive speech? Would you tell them to relax? Wouldn’t that be like telling him or her to shut up?
I’m suggesting here that we reinterpret unconsciously bidden muscular activity wherever it might occur, and that we stop trying to make it stop contracting by manipulative technique or overt disapproval of its presence.
Radical, I know. But this idea is reasonable, and there s plenty of literature to support that reasoning.
The most influential theorist in both psychology and philosophy at the turn of the last century was William James. He is revered especially for his marriage of physiology and human thought, as it is manifest in our actions and their societal consequence.
In 1890 he wrote, ‘Whenever a movement unhesitatingly and immediately follows upon the idea of it, we have ideomotor action. (This is not a curiosity), but simply the normal process…’
You might ask, ‘What the heck is ideomotor action? I work in a profession devoted to the study of human movement, and I’ve never even heard of it.’
Well, pay attention. In 1852 The Proceedings of the Royal Institution reprinted a lecture by William Carpenter identifying ideomotor activity as a third category of nonconscious, instinctive behavior. Excitomotor, governing breathing and swallowing, and sensorimotor, governing startle reactions where established several years earlier. I don’t know about you, but my training as a therapist made me only vaguely aware of the first two, and the third (ideomotor) wasn’t anywhere to be found in my consciousness (no pun intended).
I read about the extensive study of this behavior in a book entitled Nonconscious Movements by Hermann Spitz. And in an article written for The Scientific Review of Alternative Medicine, the esteemed Ray Hyman details the presence of ideomotor action across the spectrum of human activity. Hyman wonders aloud why ‘the phenomena remains surprisingly unknown, even to scientists.’ I will admit, I wonder myself.
In any case, there is no question that an entire category of instinctive movement is present largely beyond the knowledge of my own profession, it is designed to make manifest our thoughts even though we might try to hide them, and (I think) we might make use of it to explain and, perhaps, treat effectively the kind of persistent muscular activity seen in chronic pain.
William James wrote ‘every mental representation of a movement awakens to a maximum degree the actual movement whenever it is not kept from doing so by an antagonistic representation present simultaneously to the mind.’ In other words, we would do what we instinctively desired if we didn’t willfully interfere because of fear or some specialized training.
And now the interesting part. Suppose without realizing it our culture worked to sublimate ideomotor activity to such an extent that its natural tendency to correct us and make us comfortable was no longer trusted. After all, simply shifting in our seats (without planning, by the way) in order to alter the blood flow to various parts of our body is a perfect example of ideomotor activity. If as a child you are always told to ‘sit still’ to hold yourself erect, and only praised if you were, well, wouldn’t that make you distrust your own nonconsciously directed tendencies?
What would a culture that was unaware of or distrusted ideomotor activity be like?
In Parts I and II I suggested that there was a kind of instinctive movement inherent to life that might be used therapeutically to resolve whatever mechanical deformation we acquire. I further suggested that our culture was deeply suspicious and downright disapproving of this movement. According to me, the result of this conflict between what we want to do and what we feel is ‘correct’ is an epidemic of muscular activity that we don’t consciously request and would certainly rather live without. For the most part, it’s isometric activity, and it’s commonly thought to have its origins in ‘stress.’
This last interpretation I would agree with as long as we adhere to the psychologist Sam Keen’s definition of stress. He says, ‘Stress means you’re living someone else’s life.’ I’ve always liked that, and I never said it to a patient who didn’t nod their head with immediate understanding. I have the distinct impression that the vast majority of people I see in chronic pain use their bodies as if they belonged to another. They pose and posture, they pretend to be someone they’re not, and they do this with special care and effort when I ask them to stand so that I might look at them. If they try for perfect erectness, the result is almost always more pain, not less. Of course, they do look better momentarily.
It is at this point that I feel my approach to care looks less like traditional physical therapy and a lot like counseling. Instead of judging the ‘improper’ alignment before me, I accept whatever is present. Instead of asking the patient for some willful effort, I encourage spontaneous movement that, up until then, had been manifest as the isometric activity I mentioned earlier. I don’t want relaxation; I want expression. I want this movement to surprise both the patient and myself. After all, unconscious expression should surprise us.
I asked at the end of Part II what a culture that distrusted ideomotor activity is like, and here’s my answer.
It’s a place where the smallest child is told to sit still, straight and tall the moment they enter school, where any deviation from the ‘normal’ erect stance is thought to imply a lack of discipline or a weakness in essential anti-gravity musculature. It is a society full of media advertising for vigorous exercise and weight loss, not solely for health, but largely for cosmetics and proposed enhancement of self-worth. It is a place where movement that expresses us uniquely is never fully done without immediately risking ridicule, or (at least) odd looks. The people there often suffer from ‘tight’ muscles, and an entire industry is devoted to its relaxation. Chronic pain is epidemic.
Maybe this place could use a ‘body counselor,’ someone who understands the presence and purpose of ideomotor activity. Someone who is willing to let their patients express themselves physically, and not suppose that all the answers reside in some imagined ideal of posture and use. Instead, the body counselor appreciates the patient’s unique way of being, and their handling is the manual expression of acceptance. These attitudes are the antithesis of modern therapy practice, I know.
I practice them each day.
Resources for Body Counseling
Spitz H. Nonconscious Movements: From Mystical Messages to Facilitated Communication. Manwah, NJ: Lawrence Erlbaum 1997
Carpenter WB. On the influence of suggestion in modifying and directing muscular movement, independently of volition. Proceedings of the Royal Institution of Great Britain. 1852;1:147-153.
James W. Principles of Psychology. New York, NY: Holt; 1890
Hyman R. The Mischief-Making of Ideomotor Action. The Scientific Review of Alternative Medicine Vol.3 No.2 (Fall/Winter 1999)