A human body is seen as an object when viewed from the outside. Western medicine commonly treats chronic pain from this objective perspective. Each one of us experiences living in a body from the inside. Our experience is shaped by biological, psychological, sociological and transcendent forces. Objectively, a body is seen as a physical machine. When our body is treated as an object, solutions are determined based on what is wrong and why it’s there. Knee pain? It looks like you are squatting incorrectly. Low back ache? ’caused by sitting all day. Chronic headache? I can see you have poor posture. Although these are possible factors contributing to the pain, what can be seen, or observed, from the outside only provides part of the story.
Pain and Consciousness
Pain is not an object. Chronic pain is a personal experience based on a web of interactive factors. Pain is not located in any one place, there is not a primary “pain center” in the brain or body. Instead, chronic pain emerges through the integration of a host of brain centers and is influenced by subconscious material. (See more here.)
Consciousness continues to be one of the great unknowns: how is it and where it is found? Perhaps we might look to our fascial matrix for some answers. A plain stated and basic definition of consciousness is the ability to be self-aware, to be conscious of self. And then, there is the dark side of consciousness, that is our subconscious mind operating below the level of conscious awareness. One common idea from neuroscience is that unconscious processes comprise 95% or more of human cognitive function. Unconscious processes influence our behavior and include our beliefs, memories, values, attitudes and motivations.
Objective Fix and the 5%
So here’s a common scenario: I have a pain problem so I decide to seek help from an expert so they can fix it and take the pain away. Maybe I see a doctor, or a chiropractor, a manual therapist or a physical therapist. Depending on the expert, a particular assessment or screening is performed. Perhaps this is a health history intake, a blood pressure reading, a postural assessment or other movement assessment. Then, based on the intake findings, I am given a prescription for a pain killer or an anti-depressant, an adjustment, or a few exercises and then I go home. Good luck with your pain problem.
I might feel temporary relief for awhile. And this depends on how often and regularly I take the pills, get adjustments or treatments, or do the exercises. Inevitably, I don’t feel better over time: I don’t feel fixed. When our responsive, adaptive, living bodies are treated as machines, instead of resonance fields, the treatments look like band-aids rather than relational processes. There’s little chance for sustainable healing if only superficial information is gathered about my pain, the treatment doesn’t require my embodied participation and all of life’s stressors continue rolling in the same way. (Important clause: I know there are holistic practitioners out there and I thank you for who you are and what you offer.)
If we desire change, hanging out in the 5% will do little to disrupt the holding pattern that underlies the chronic pain. Imagine randomly opening a book of 100 pages and reading 5 pages total from somewhere in the middle of the story. You will probably get a gist of some part of the story- but of what? And how many more questions is that 5 pages of reading going to leave you with? Then there’s the question of who you are reading the book with and how you are as you are reading.
There is another red flag in this scenario above, and that is wanting someone to fix me rather than to participate with me. The western medical model has played into a spell that a symptom can be treated/ fixed as an isolated event. If my car sputters and knocks, then I bring it to the mechanic to get the issue fixed. Our body is not a machine. We are living. We are life. We are nature’s design.
The Other 95 Pages
Two common factors contributing to pain include our perceptual artifacts in the pain pattern and life stressors. Pain science recognizes that chronic pain is not always associated with tissue damage. We also know that unresolved trauma is linked with certain health conditions, behavioral disorders and chronic pain. Unconscious processes are at play in our belief systems, coping strategies, defense responses and our sense of identity and worthiness in the world. Buried in the other 95 pages of unconscious programming, we find autonomic functions, limbic-emotional functions, habitual functions and messaging functions below the neo-cortex.
In terms of life stressors, there is eustress and then there is distress. We grow and thrive with eustress. This occurs when there is appropriate time to recover after the stressor and if we have the resources to recover. Distress is something that happens with a constant barrage of stressors that we just can’t quite get out from under. Of course, there is our perception of the stress which may be the most detrimental- and this brings us back to unconscious processes. Overall, what we know is the chronic stress response is extremely toxic and life diminishing.
Physiological Load
At the center of chronic pain is the subjective experience. So although objective data has a place, without bringing in the human experience, without investigating behind the curtain, the pain management model will fall short on providing bodymind ease and quality of life improvements. Chronic pain, trauma and inflammation are products of central sensitization. Central sensitization is a heightened sensitivity to pain due to the increased responsiveness of pain receptors in the central nervous system. Essentially the nervous system is in a consistent state of high reactivity.
Central sensitization is associated with poor coordination, poor short-term memory, increased levels of emotional distress and malaise. The adverse stress of chronic pain increases the physiological load and may cause increases in global muscle tone, tissue dehydration, digestive distress, emotional instability and decreased immune function. These are largely processes of the autonomic nervous system and the sensorimotor integration driving central sensitization occurs below conscious perception. To effectively change the interacting neural inputs to reduce the physiological load, the subconscious material needs to be brought to awareness. Enter: somatic inquiry.
Somatic Inquiry
Practitioners managing chronic pain seem pretty comfortable with their various tools for the objective treatment of the body. The skill-set missing includes how to safely and effectively work with the lived experience of our body, or soma. Our soma is body from our body’s viewpoint. Soma is the first person perspective of our living, breathing, sensing, feeling, moving body.
Somatics is the experiential study of personal consciousness, the experience of our body from the inside out. Somatics has a multitude of facets and applications. The somatic field has influenced many different disciplines such as movement education, psychology, social justice, body work, holistic health and therapeutic approaches. At the most basic level, the somatic viewpoint is the birthright of each one of us, as it is our body’s knowing.
There are many schools with highly developed somatic methods, insights and theories. These specific somatic modalities have challenged traditional western assumptions that our body is something to be repaired in a 3-step protocol by an outside expert. The field of somatics has proven itself as an effective way for weaving us back to connection. Somatics is our contemporary solution for dissolving the spell of a mind-body split.
A primary skill-set in guiding somatic inquiry is the ability to help someone tune into their experience of sensing and feeling. The somatic guide offers maps for trail systems that reveal our living territory. One of these maps is the sensing-perceiving-acting cycle that help us identify limiting patterns so that we can choose new ones. Importantly, somatic guides honor the personal sovereignty of each body while inspiring curiosity and possibility.
Through somatic inquiry, a process of paying attention and then playing with the discoveries, new information is sent to the brain. We become active participants in building new neural networks. Somatic inquiry has the potential to change the neuroendocrine responses leading to the central sensitivity. One reason for this shift is due to eliciting the parasympathetic nervous system through our sensory practice.
Self-regulation
Self-regulation is the ability to manage one’s own behaviors, thoughts and emotions without discharging on others. The state of our nervous system is the foundation for self-regulation. Somatic movement practice and inquiry provides easy access to our parasympathetic nervous system which feels like a calm, steady and spacious place in our body.
In Somatic Groundwork, our primary practice for self-regulation is yielding. Yielding begins with active attention to the relationship with earth and space. Often practiced in constructive rest position or in other restorative postures, the fundamental action of yielding can be experienced in any moment and in any position. Yielding is a process of sensing into our tissue architecture and how we are in contact with the ground. The practice of yielding supports intimacy in touch and contact and underlies our basic relationship with ourselves and the world we are embedded.
While yielding, we notice our body breathing us. Breath is our first movement of life on land outside of the ocean-like womb. Breath is the primal movement that initiates all other motion in our body. Offering entrance to the shape-shifting of our inner spaces, our breath is ever present and provides us with immediate feedback on the state of our bodymind. With somatic awareness of our breath expanding and condensing, we influence autonomic functions like heart rate, vagal tone, blood pressure, hormone release and myofascial tone.
Try yielding for yourself in the Somatic Groundwork class I taught on my birthday.
Interdisciplinary Care
We need a new framework for managing health and wellness, including chronic pain. The framework is built on polarity flow: objective and subjective, cognitive and intuitive, goal-oriented and process-oriented and evidence-based and discovery-based. The framework is also client-centered and implements a whole-person approach. Finally, the framework is collaborative so that healthcare providers, wellness practitioners and movement professionals work together to serve our community at the highest level.
Client-centered honors the experience of the individual as paramount in the change process from how they are now to how they desire to be. In this framework of care, clients are treated with respect for their inner authority and with the potential to be creative, resourceful and whole through a process of learning and application.
A whole person approach uses both outside-in and inside-out methods to attend to the client’s needs. Objective measures are in place to collect information, assess the baseline of the client’s bodymind (specific to each practitioner and scope of practice) and to provide techniques related to the practitioner’s expertise. The integrated approach includes somatic inquiry to support self-regulation, to bring unconscious processes to awareness and to promote client participation in their healing journey.
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Further reading:
This post was inspired by this article to bring somatic movement practice into the discussion.
The Ghost in the Machine- Is Musculoskeletal Medicine Lacking Soul?