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.
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?
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
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
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
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.'
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.
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
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.'
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
I practice them
Resources for Body Counseling
Spitz H. Nonconscious
Movements: From Mystical Messages to Facilitated Communication. Manwah,
NJ: Lawrence Erlbaum 1997
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)