A lecture given for Confer, 27th March, 2001

As a body psychotherapist, I come from a therapeutic tradition, whose basic premise is that bodily processes are intrinsically involved in psychological processes, and vice versa. In this field the autonomic nervous system has long been recognised as a barometer of emotional intensity and internal conflict. Body psychotherapy developed out of the work of Wilhelm Reich, who was a student of Freud's. Its basic premise is that the mind and the body cannot be understood as separate phenomena, and therefore need to be addressed together in psychotherapy.

In body psychotherapy, the Autonomic Nervous System has been known by the more archaic term, the Vegetative Nervous System. Vegetative is derived from the Latin vegetare which means to quicken, animate or bring life; the autonomic nervous system governs the 'involuntary' visceral processes. I am going to be talking this a lot this evening about variations in autonomic function, and its role as a homeostatic regulator of emotional intensity. But its important to make the point that the ANS function of maintaining parameters is essential to life - a complete breakdown in functioning leads to death. Between initial perturbance and imbalances, which go back to infancy, and death there is usually a long intervening process of attempts to re-organise and rebalance the psychophysiological system.

My proposal this evening is that object relations are internalised in the body at every level of function and structure, including as modifications to the autonomic nervous system. I will be unpacking Reich's formulation that: the development of character is a progressive unfolding, splitting and antithesis of vegetative (i.e., autonomic functions). Although I'll be drawing on some very recent neuroscientific and metapsychological thinking, I want to give credit to Reich's insights which were so ahead of his time. (see end for discussion of Reich in relation to Schore]

I am going to take you from a basic picture of the functioning of the autonomic nervous system, as you would find it outlined in any physiology textbook, through a more developed holistic conception of it, to a model which situates it directly within conscious and unconscious communications/exchanges of object relations. As well as drawing on information from different disciplines, we will be moving from a simple cause and effect model of the nervous system to the more recent scientific perspective of dynamic complexity. If we are to progress in our understanding of the capacity of body and mind to function both as a unity and as a split object/subject, we have to firmly put behind us a search for 'cause', and even an explanation in terms of symbolic language, and look instead at emergent properties of complex interactions between systems (bodily, social, etc)

The Basic Physiology

The nervous system as a whole includes the Central Nervous System, consisting of brain and spinal cord, and the Peripheral Nervous System, whose nerve fibres connect all parts of the body with the central nervous system. The Peripheral Nervous System is further subdivided into two branches, the Somatic Nervous system and the Autonomic Nervous System. All these nerves are outside the Central Nervous System. The Somatic Nervous System controls musculoskeletal movement, and conducts sensory messages from the body to the CNS. (model is increasing decentralisation)

The Autonomic Nervous System has two branches, the Sympathetic and the Parasympathetic, which regulate the involuntary processes of the body, the viscera, and sense organs, glands and blood vessels. In evolutionary terms it is older than the CNS and its anatomical circuitry is broadly dispersed, creating a general response, quite unlike the highly specific pathways and response of the CNS. This generalised, widely distributed structure enables it to mediate overall changes in state; it is part of the limbic system which has also been known as the mammalian or emotional brain.

It was called autonomic because it was believed to function autonomously &endash; we now know that it is dynamically related to many other parts of the brain especially the orbitofrontal cortex. Autonomic also means self-regulating and this is a key principle of all body systems, which depend of constant feedback in order to maintain homeostasis. There are multiple feedback loops in the body which continually send and receive information about what's going on and the ANS is part of this wider complex.

In standard physiology the two parts of the ANS have been perceived as functioning reciprocally: the sympathetic governing arousal, the fight or flight reaction and the parasympathetic involving relaxation, recuperation and digestion. The sympathetic nervous system is activated by any stimulus over an individual's threshold (and the threshold can vary enormously), including feelings, and by noise, light, drugs and chemicals (e.g. caffeine).In response to the stimulus an immediate anticipatory state is generated by the release of adrenaline. This causes the heart to beat more quickly and strongly, increases blood supply to the muscles, raises blood pressure, dilates the bronchii and increases the breathing rate, raises the blood sugar level for increased energy, speeds up mental activity, increases tension in the muscles, dilates pupils and increases sweating. Non-emergency functions, such as digestion are lessened or suspended. (priming phase &endash; short-term) Walter Cannon coined the phrase 'fight or flight' to describe the function of the rapid mobilisation of resources.

The parasympathetic nervous system comes into operation after the stimulus has been responded to and action taken. It has the opposite effect to sympathetic activity, allowing the body to wind down and re-balance. The activation of the parasympathetic nervous system encourages relaxation of muscles, slowing the heart rate and lowering the blood pressure. It assists the breathing to return to its normal rate, digestive juices flow, bladder and bowels are ready to function, the pupils constrict and immune functions, such as the production of white blood cells are re-commenced. The parasympathetic mode supports rest and sleep. (the investment phase - long term). The standard physiological model of the ANS is of reciprocal tension - with the two parts keeping each mode in check &endash; When the sympathetic goes up, the parasympathetic goes down. A good example of optimal autonomic balance can be seen in cats who respond alertly to certain sounds or movements, but, as soon as the situation is assessed as safe, return immediately to a relaxed state.

Lets just stop a minute to become aware of our own autonomic state: tongue, heart rate, peristalsis, skin &endash; temp and moisture &endash; warm & dry; cold&wet; relaxation/tension. Attentiveness &endash; alert to broad awareness..

An understanding of the autonomic nervous system in terms of 'stress' was popularised in the 1950's in the work of Hans Seyle. This marked the beginning of the extensive concern with stress in psychological and medical thinking that is still around today. Seyle identified the physiological responses to environmental, lifestyle and personal change. He described a General Adaptation Syndrome which consisted of 3 stages: first, the emergency or alarm reaction which prepares the organism for immediate fight or flight; then there is the resistance stage in which many of the physiological changes associated with the alarm reaction are reversed, and the organism has increased resistance to the stressor. The final stage, exhaustion occurs when the body's ability to deal with stress runs out. It's a concept that is still useful and widely accepted. We notice that people can fight off illness when there are demands that need to be met, such as work, but that when they stop for a holiday, they succumb to illness.

The problem with the ubiquitous use of the word stress, as Rollo May pointed out in the revised edition of his classic work The Meaning of Anxiety, is that it is used as a synonym for anxiety and they are not the same thing. Anxiety is an intrapsychic phenomenon, which originates in a repressed internal conflict, often a repression of instinctual impulses that are actually bound up with survival. Stress, on the other hand, is typically attributed to externals &endash; stressful working and living conditions. It puts the emphasis on what happens to the person. It has an objective but not genuinely subjective reference.

The emphasis on the perception of danger in the name 'fight or flight', which embeds its meaning in more primitive roots, is both a liberating and limiting concept. Where it is useful is in helping us understand that any situation that is subjectively perceived as a threat to one's integrity - from an insult, to threatened loss of work &endash; can trigger a fight/flight response. But it has also detracted from an understanding that much subtler feelings , combinations of feelings, and conflicting feelings correlate with autonomic activity.

Emotional-Physiological Cycles

In body psychotherapy, and more recently in neuroscience, sympathetic activity, has been seen more broadly as an indicator of an impulse or a feeling being stirred. The word sympathetic &endash;sym pathos means with feeling. It is most easily understood as an upsurge &endash; those feelings which are experienced as coming UP &endash; anger, fear, excitement, desire, hatred &endash; and which if expressed involve movement out, or towards, or in the case of fear, away from, an object. Sympathetic physiology increases energy and readies the body for action &endash; so it is also about the need to do, express, act.

Conversely the parasympathetic action is a concomitant of coming DOWN &endash; disappointment, grief, shame, guilt, despair; and contentment, peacefulness, satisfaction - feelings which involve a decrease in tension, withdrawal of energy inward and tend more towards introspection. Laughter and tears are both usually a sign of parasympathetic activity.

Reich pointed out that pulsation, the movement of energy in and out &endash; is a fundamental quality of living organisms. It's evident in our breathing, heartbeat, and our need to take in and expel food. The autonomic nervous system which governs these activities is a manager of metabolic energy &endash; increasing it when necessary, conserving it the rest of the time. Sympathetic activity is catabolic &endash; it breaks down substances in the body to produce energy for activity. Parasympathetic activity is anabolic &endash; it builds up and restores. The parasympathetic phase is vital to the maintenance of long-term health. In optimal psychological and environmental conditions the body swings into parasympathetic mode to repair and maintain health.

It is well understood and documented now that chronic sympathetic activation, which can have many causes, undermines good health. A combination of factors means that the predominance of the sympathetic mode is the norm. Stimuli over a certain threshold of loudness, brightness, speed affect the nervous system, as do stimulants in food, drink and drugs. Culturally we're into over rather than under-stimulation. Further, an increase in acidity at cellular level predisposes the body to sympathetic activity (and correspondingly alkalinity links with the parasympathetic). And so, of course, vice versa: if the body is in a constant state of sympathetic activation, there is an over-acidity in the tissue, which has an effect on health.

One way in which the body protects itself from emotional intensity is the development of chronic muscular tension, which dampens down both external and internal stimuli. Reich called this character armour because it establishes ongoing defences against internal conflict &endash; the location of the armour relates to specific developmental conflicts around bonding, nurture, self-control, sexuality etc. Although sympathetic activity increases muscular tension, individuals with sustained high tension tend to have lower autonomic arousal than those with less muscle tension. Muscle tension creates a buffer, which reduces anxiety but at a cost &endash; a loss of contact with oneself and others. It can be a negative loop that leads to loss of self-regulation.

Too much muscular tension impairs health because it constricts and inhibits spontaneous processes in general (i.e. including feelings and thoughts), such as breathing, and the venous and lymphatic circulation, which are responsible for clearing the body of toxins. (Interestingly the word stress from the Latin stringere (to draw tight) is similar in meaning to the Latin word angere (to press tightly) which is at the root of our words anger, anguish and anxiety. This repressed inner turmoil translates in the body as tension at every level (visceral/muscular/autonomic etc), including hardening and narrowing the arteries, as in angina, a medical condition which can precede heart attack.)

On the other hand, chronic parasympathetic activation, which correlates more with psychological collapse and depression, is not healthy either. Its characteristics are low blood pressure, sluggishness. The organs and muscles lack tone &endash; in other words there is not sufficient tension.

Now I want to look at the correlative psychological modes of the sympathetic and parasympathetic activity. These are general qualities rather than fixed attributes.

Sympathetic Parasympathetic

Activity Receptivity

Speed Slowness

Tension Relaxation

Focus Scope

Convergent thinking Divergent thinking

Extraversion Introversion

Goal-oriented Process-oriented

Agency Presence

Direction Elaboration

So these are all resources, complementary modes, exquisitely differentiated states. Optimally and in health these modes support each other, interact, balance and modify the use of energy. Like a happy couple, they dance together, supporting creativity, flexibility and well-being.

Reich perceived the reciprocal action of sympathetic and parasympathetic as part of a four-beat cycle: tension-charge-discharge -relaxation. This is known as the vasomotoric (vaso &endash; blood; motoric &endash; mvement) cycle, and is a holistic model embracing both psychological and physiological function. One image I have of the sympathetic is the coiling of a spring; the parasympathetic is the rebound back to a resting state. The part in between &endash; the spring springing &endash; is a crucial transition. In the coiled wire this action is governed by physical laws &endash; the extent of its spring depends on fixed physical parameters. But in a human process its much more complicated. Suppose the client has an impulse to say something in a public setting which has a bit of charge &endash; they gather up the energy. They say it, the effects of saying it sink in. That's a cycle. Now suppose something interrupts this &endash; they dismiss the impulse almost as soon as they've had it, or they allow the excitement and anxiety to build, but then they bail out at the last minute, or they say it and are so overwhelmed with having said it that they can't follow through or take in the response. Or, they say it, start integrating, unwinding, but then are left with a remnant of anxiety so they can't completely let it go.

I'm sure all these patterns will be familiar &endash; the point I'm making is that they have direct autonomic correlatives. In standard physiology the autonomic nervous system is a closed system, where homeostatic balance is maintained by innate self-regulation. The parasympathetic will inhibit the sympathetic when it has reached a certain point, and vice versa. Its what keeps us alive. But you will understand that with emotional process it can get a lot more complex, and small variations in function have a significant initially subtle effect. This is because the body is also a relational body which makes it an open system, subject to modification by the impact of events and processes and the external environment.

Autonomic Splitting

In the example I've given, the inhibition at any point in the cycle means that something is not integrated &endash; its split off. If the words are not said, the person will inevitably start to wind down sooner or later &endash; just because of the in-built homeostatic regulation. The energy aimed for the speaking might be turned into a self-attack, or maybe the person will think it over and be a bit resigned. In this case the transition to the parasympathetic may overlay ongoing sympathetic activity. And this is a key thing to grasp. The internal psychological conflict operates as an autonomic split. The parasympathetic can mask the sympathetic, or the other way round. The two systems can be in active conflict, or lacking reciprocal tension and therefore chaotic.

With the parasympathetic masking the sympathetic, the person might leave the room and cry hot angry tears and feel collapsed but be unable to receive support because they are still angry. The inhibited anger/aggression isn't quite assimilated so that the parasympathetic mode of release through tears and a more vulnerable state can only be partially activated. Or the other way round, (sympathetic masking parasympathetic) they might feel deflated inside, but rally themselves to get on with it, thereby using a sympathetic mode to force the start of a new cycle. Here the sympathetic might manifest as a slightly compulsive quality of talking and acting &endash; a bit speeded up, overriding a deeper perceptible 'flatness'.

Obviously it is quite impossible for all impulses to be satisfied - the nature of life essentially means that there is a huge over-presence of all thoughts and impulses. And the way we deal with this is both positive and constructive (acts of creativity), and negative and destructive. Human beings have quite extraordinary and ingenious strategies of transforming the abundance of life stimuli. That said I'm going to focus this evening on how in particular the inhibition of strong emotions has an effect on health.

The autonomic split resulting from incomplete cycles may be a temporary compromise, but often it's a more fundamental physiological pattern (I'm going to talk about its developmental origins in a few minutes). The split off remnants remain in the body as generalised or localised areas of muscular tension, pain, flaccidity or numbness. They linger as particular controlled or constricted breathing patterns; for example an in-breath stimulates the sympathetic. It's a spontaneous thing to do as we initiate, but if we fear passivity we might force the in breath. The parasympathetic is activated by an out-breath &endash; again a natural way to end, or a defensive way of trying to get rid of stimulus (for example, the heavy sighs of someone who is repressing anger). Autonomic splits can lead to hormonal or immunological imbalances (the hypothalamus, which mediates autonomic action also effect the endocrine and immune systems).

What I'm saying is, an aspect of physiological functioning may become &endash; in Reich's word - sequestrated. Sequestrated means to seclude, set aside, to remove, render ineffective. Reich's word emphasises something temporary, lawful, purposeful. The splitting off &endash; paradoxically - maintains some kind of integrity. A part of the body holds on to its original impulse. This brings me to another way of translating autonomic - my favourite - from the Greek auto - noumous : 'the law of the self'. I believe that the functioning &endash; including the splitting - of the autonomic nervous system is fundamentally bound up with preserving the dynamic integrity of the self.

In health, physiological and psychological are relatively synchronous. There is a congruence between the feeling psychologically perceived and the feeling that is being embodied. Illness is always initially an attempt by the organism to re-stabilise after some impingement. It begins as a spontaneous response to a situation &endash; maybe a single event or a complex circumstance, with perhaps both external/internal factors. (I include in this both something actual, like a virus, and something subjective, like an unconscious fantasy)

Now before going further with this more complex model of autonomic fragmentation, I want to briefly go back to the characteristic defences and ego capacities which correlate with these two modes. I want to emphasise that these links I am making between autonomic states and defences are not fixed, and cannot be diagnostically isolated but perceived as part of an energetic pattern. They represent tendencies; autonomic states, as I have suggested, can overlay each other and fluctuate in ways that defy simplistic categorisation.

Sympathetic Parasympathetic

Flight Collapse

Aggression Passivity

Opposition/reaction formation Collusion/retroflection

Blame others Blame self

Hyperactivity Hyperreflective

(productivity without creativity) (creativity withoutproductivity)

Projection Introjection

Omnipotence Omniscience

Mania Depression

These defences arise from the foreclosure of an emotional-physiological cycle. We understand from Klein that these defences originate in the infant's vulnerability to and dependence on the environment. In adults the same physiological patterns and defences may be employed as habitual modes or under challenging circumstances, when the individual's capacity to act (sympathetic) or to digest feelings (parasympathetic) is inhibited for any reason. We could say that these defensive modes are signs of the organism moving into the margins of stress. I want to make the point that while that these defences are still healthy and functional while they are context appropriate. It is only when the splits become chronically embedded in alterations of the structure-function of the ANS that they are pathological.

I can think of a client who, because of a complication in labour, had to go into hospital although she had wanted to give birth at home. She had to deal with her dependency on the medical staff and her hatred of what they represented for her - a controlling, cold, mechanical mother. Everyone in the hospital became seen as either good or bad &endash; she was able to trust absolutely in a few key figures and managed to get rid of those she didn't like, either by ignoring them or by being overtly hostile. As soon as she had actually given birth, this dramatic splitting subsided, because it had fulfilled its temporary function &endash; to postpone one emotional cycle while a more urgent cycle was in progress. An important part of her resolution of her experience in hospital was talking, reflecting and writing about it. She called her birth story 'Chiaroscuro', from the Italian for light/dark &endash; ie. the good and the bad.

Self-Regulation: A Developmental Perspective

In a fascinating and detailed study of the relationship between attachment and neurological development, Allan Schore has helped illuminate just how individual nuances in autonomic activity are influenced by the infant's ongoing relationship with the mother. A baby's capacity to act is incredibly limited by its physiological and psychological immaturity &endash; a baby cannot, obviously, fight or flee something overwhelming. And the something overwhelming might simply be its own need of food or contact (Winnicott's 'clap of thunder' captures the experiential impact). It is dependent on mother or another caregiver for emotional and environmental regulation. If the parent can soothe and stimulate appropriately, these functions are internalised as capacities in the nervous system.

In a newborn baby, it is now suggested, the reciprocal tension of sympathetic and parasympathetic are not well-developed. A good example of this is colic which I did some research on a few years ago . Colic is a very common but quite distressing phenomena where the baby will have difficulty feeding and can cry every day for hours. The digestion (parasympathetic) is disrupted because the baby is over-stimulated (sympathetic). This over-stimulation may be a result of many things &endash; compression of the vagal nerve &endash; a crucial mediator of the parasympathetic nervous system -during birth; an environment or life-style that is unsettling; internal conflict in the mother etc (or of a combination of these). One of the best ways of reducing colic is for the mother to keep the baby in close physical contact &endash; such as in a sling &endash; for long periods. Her body and her more mature nervous system can help regulate the baby's arousal.

As the baby develops, the parasympathetic mode ( the soothing function) becomes more an established and is more able to inhibit the sympathetic, in other words to modify stimulation. The parasympathetic mode has a role in impulse control. However it can be over-dominant. If the parent greets a toddler's excitement with harsh disapproval, the toddler may respond to this withdrawal of contact with parasympathetic over-activation &endash; i.e. a collapse. The parent's rejection is experienced as a real down fall, a drop into shame, despondency etc. Another toddler might respond by further demands or mischief, which might successfully draw the parent back into relation, or it might be met with a slap. From these two examples I hope it becomes possible to imagine just how the interplay of the two modes can reflect a containing parent, or in a more conflicted or chaotic environment, the opposite. Constant opposition between parent and child may become internalised as an antagonistic relationship between the sympathetic and parasympathetic.

Deficits and failures in the primary relationships are laid down as autonomic patterns, which reflect the infant or child's default style of coping with its feelings. Styles of managing feelings are modelled explicitly or implicitly in the way parents respond or react to events. Autonomic identifications and polarisations become built in &endash; for example, a child may react like the over-excited mother (sympathetic); or they may become the complementary object and be mother's 'rock' steady, dependable, imperturbable (parasympathetic). Of course, as with all object relations, the child will internalise both, and what is lived out in their typical mode of being may give way under stress to its opposite. (The terms 'autonomic identification and polarisations' are mine; the examples are my phenomenological extrapolations from Schore &endash; his own descriptions are purely technical.)

Repeated patterns of interaction between parent and child have long term effects via the ANS. The ANS manages quantity and distribution of energy in the relationship between the organism and the environment. When the response called up in the organism is overwhelming, the overload can be managed in a variety of ways, intensification of autonomic reaction, localisation of a charge within an organ or a muscle group; usually all these means will be deployed to some degree, with the correlative psychological defences. What happens next is somehow more significant: the organism struggles to find equilibrium, to assimilate, elaborate or bind the energy/feelings in the longer-term. The psychologically and physically robust individual has the most options for tolerating, adjusting to or acting upon the environment. The more limited an individual's options, the more likelihood of chronic psycho-physiological compromise in the direction of illness (visceral, tissue, muscle and skin armour limit the health-maintaining functions of the organism); and behaviour including self-management strategies like addictions.

I want to move on to say something about trauma, which can be viewed specifically as a breakdown in autonomic functioning. So far I have talked of reciprocal function of parasympathetic and sympathetic, and of splitting or antagonism between the two systems. In trauma, we see another phenomenon. Instead of mutual inhibition, both sympathetic and parasympathetic become more and more strongly activated. In the face of a strong stimulus and a perception of no way out terror is aroused and can end in paralysis, freezing, black out etc If the danger cannot be met by fighting or running, or by expressing vulnerability, co-operativeness or whatever (I'm thinking of traumas as varied as rape, train crashes, fires, abduction etc), the body, like the mouse caught by a cat, may involuntarily play dead.

One of the defining characteristics of post-traumatic stress is a chronic disorder of the autonomic nervous system, manifest as a strong tendency to startle, blackout, hyper-irritability, disrupted sleep etc. A small but significant stimulus can trigger a panic attack. Where the trauma goes back to infancy and is an intrinsic part of the relationship with the caregiver, there is more likely to be severe personality disorder.

Four types of Autonomic Dysfunction

Characterologically and culturally, individuals will have predispositions towards the sympathetic or the parasympathetic. For example, racial groups originating near the tropics, needed to be more sympathetic dominant, to respond to the challenges of that environment, in which the capacity for flight was necessary. Further north, where people migrated to settle and farm, a more parasympathetic dominant tendency became embodied. Even farther north, where endurance was the main survival quality there was an even stronger tendency to parasympathetic predominance. Nowadays, with so much global movement and multi-racial interweaving, such simple metabolic biases no longer hold true. This reminds us of another way in which we need to take on board complexity in the organism-environment. (These patterns are recognised in Ayurvedic medicine, and have been more recently popularised in the blood type diet)

By autonomic dysfunction I really mean a chronic pattern of coping via psychological/physiological defences. Essentially I am proposing four types of autonomic dysfunction, which are reflected in all aspects of a person &endash; from subtle psychological and physiological processes to more extreme illnesses and disorders. In doing so I'm aware of collapsing normal distinctions between categories. This model is very speculative but it does draw on a variety of sources, including the major psychoanalytic theories of illness, recent neuroscience, holistic therapies and body psychotherapy.

These autonomic splits can exist in various combinations at various times and be more or less creatively handled. In chronic and serious illness, an equilibrium is established via some kind of compromise of an internal conflict. Depending on the nature of the condition, the symptoms may represent an appropriate adjustment, or a sustained defence against the intensity of one or many feelings.

I want to make the point that as well as being influenced by emotional factors, there are of course genetic weaknesses and the impact of specific factors in the physical environment which play a part. In fact what I am proposing is an environmental-organismic model, rather than an a purely psychological model. (see below for discussion of terms organismic-environmental)

The first kind I'm calling sequestration, using Reich's term. This is where a more or less isolated organ, muscle group or physiological function becomes symptomatic. It's a kind of damage limitation, and its isolation in the body is also a form of representation. And so a symptom emerges &endash; a frozen shoulder, an ovarian cyst, and a sore throat. In psychoanalytic literature this may be perceived as a break down in symbolic thinking &endash; the body becomes the metaphor. Such a view is also well popularised in various humanistic and New Age therapies where there is an emphasis on discovering the message that the symptom is carrying. There are many spectacular examples of symptoms clearing up when the message has been received and understood. (see below in 'Ways of Working' for further discussion of symbolisation).

A simple example of symbolisation is the woman with a severe facial rash, who, it eventually turns out, has been desperately putting a 'brave face' on deep distress and anxiety. In a more complex introject, I had a client with a frozen shoulder. There were obvious conflicts around shouldering responsibility and feeling burdened which we explored. Over a three month period I worked with increasing body awareness, exploring the mobility of the shoulder, releasing the tension in the neck through holding the head. But what became increasingly evident to me was that the client was struggling to avoid very painful feelings of exclusion and rejection. The frozen shoulder was an introject of the 'cold shoulder' she felt she has been given in a current life situation, in her early relationship with her mother, and in the transference with me.

The second kind I'm calling antagonism. Here there may be a war of attrition or a full scale battle between the sympathetic and parasympathetic, which correlates with a battle around drive and self-control. Heart attacks may fit more into this pattern &endash; the individual pushes themselves to achieve, maintaining overdrive, controlling anger, disappointment, frustration &endash; pushing on, on, on till the heart cannot cope. Heart attacks happen more often on a Monday and cluster around 9am &endash; the day and time when most people go back to work after the weekend.

This antagonistic pattern can also fuel addictions &endash; most addictive substances either stimulate, and wake you up, or they take you down and mellow you out. We can start to use drugs of all kinds, including caffeine, nicotine, alcohol, tranquillisers &endash; to get ourselves into the preferred autonomic state &endash; it's a sort of self-medication.

The third kind I'm calling instability. Here the two parts of the autonomic nervous system are failing to regulate each other, producing wild fluctuations in mood and body symptoms. This client presents as hysterical or hyperchondriac &endash; symptoms move around, change, get very intense but suddenly disappear. The key characteristic is instability. Doctors may investigate and find nothing wrong, but the client is tormented, and frightened of the body. I had a client with a history of chronic abandonment. In our work together, I would often sense that she had lost all connection with her legs. It became clear that this was associated with abandonments of any kind, where it seemed that 'the carpet was pulled out from under her feet'. She didn't lose the capacity to walk (a more extreme hysterical conversion), but to connect energetically with her legs and the ground (i.e.. a matter of fact here and now reality). Triggered by fear of abandonment, she was in some respects 'gone'. With my drawing attention to her legs, and putting my hands on her feet, she was able to re-own her legs (see below for discussion of motor-sensory integration.)

The fourth kind I'm calling trauma. The two parts of the autonomic nervous system escalate their functions. Here the symptoms are characteristic of high stress &endash; panic attacks, cold sweats, palpitations, nightmares, outbreaks of violence, inability to cope, rapid changes from hot to cold and back. Trauma, which makes the autonomic nervous system highly unstable, can contribute to any of the above patterns. In many cases, the traumatised client is more contained by illness than not &endash; hence the stubbornness of certain illnesses (i.e. resistant to interpretation) which are apparently 'psychosomatic'. Illness can be a sign of health &endash; the body is being allowed to elaborate its terror, rather than held in a state of permanent defence against spontaneous processes.

These splits could be seen as a progression of disturbance &endash; the ego is relatively rigid in the first two examples, and more fragile in the second two. In a very general way, we could say that in sequestration and antagonism the individual makes use of their body; what is feared is 'excess' i.e.. strong unmanageable feelings. In instability and trauma the body is experienced as radically unsafe; it is feared but not used. In the first two patterns, the body is a controlling container; in the second the body becomes the anti-container. These patterns repeat and embody object-relational experience, as well as racial/gender/social patterns, possibly encoded at a genetic level.

Sensory Motor Functions and Splitting

Having outlined the link between autonomic and emotional development as a relationship function, I want to go back briefly to physiology to look in more detail at how these patterns become embedded. There are multiple motor sensory loops in the body which send and receive information. They influence all body functions &endash; for example, the immune system responds to changes in the body, with appropriate immune reaction, such as the production of antibodies. And this loop stimulates concurrent signals that influence the individual's behaviour &endash; such as sending stimuli to drink or rest. Contributory factors to many chronic illnesses include the prolonged overriding of messages from the body to stop and rest; and chronic dehydration because most people have simply lost a healthy thirst reflex. In other words, there is a split between spontaneous (instinctual) survival impulses on the level of sleeping and drinking, and other influences (pressures of modern life) which reinforce a dissociation from body signals.

To understand why this happens we need to recognise that self-regulation in the widest sense (including its autonomic/emotional aspects) is intrinsically bound up with complex neural and chemical motor-sensory feedforward and feedback loops. When we use our muscles, for example, there's not just an instruction from the brain, but feedback from proprioceptors in the muscles and joints which monitor changes in tension, the speed of change, changes of pressure in the tissue, the position of joints in relation to each other etc. Although largely outside awareness the proprioceptors provide a dense, dynamic 3-d map of the body in space and in action. (See my article on the Motoric Ego, also on this site) Similarly there are interoceptors in the organs, complex chemical connections between all parts of the body which relay a constantly updated picture of what's happening in the body.

The Autonomic Nervous System and the Somatic Nervous System &endash; the muscular system &endash; are regulated by sensory-motor loops. The sensory input to the ANS concerns the exact nature of visceral activity, blood composition etc; the motor output actively modifies the organs, muscles, blood vessels etc. The pioneering neurologist Antonio Damasio has emphasised that the brain is dependent on the body for self-knowledge. Rather than language being the necessary feature of self-knowledge, it is the critical multiple feedback loops which inform the brain about activity in the body, which constitutes the basis of all self-knowledge. He argues that the emergent properties of complex activity in the body are emotional states. Feeling feelings allows us to make sense of our environment and act appropriately. (Note: self-knowledge is distinct from self-consciousness [the capacity to reflect on oneself]. Self-knowledge supports appropriate actions in a survival context, and provides the basis for more sophisticated reflective activity. )

Putting together some of the implications from Schore's and Damasio's work, I would say that when the containing function of relationship fails, there is a correlative breakdown of the sensory-motor loop. The sensory component (including sensation and feeling) is split from the motor function which is necessary for acting. Both feeling and doing are life-saving functions &endash; working together they constitute experience.

Interestingly, Bion defines 'thinking' in terms of the capacity to experience, to make links, and he attributes this to being able to integrate and assimilate sensory images (the alpha function). Intense feelings always have a correlative motor &endash;i.e. muscular &endash; impulse which includes all the primitive urges &endash; to suck, to hit, to reach, to cry, to tear, to cling. Bion argues that restraint upon motor discharge is provided by means of the process of thinking. I would qualify this by saying that motor restraint needs to be accompanied by the sensory information of the act of restraint in conjuction with the image of what is being desired. The linking of the two constitutes thinking. By contrast, splitting the motor and sensory function reduces the intensity and dilutes the conflict to make the self in relation to object less overwhelming, less threatening. The splitting may subsequently be followed by more integrative reflective activity, or not, depending on the autonomic capacity to contain the charge.

The motor-sensory split will also be reflected in a sensory dysfunction &endash; often marked by numbness or pain; and motor dysfunction &endash; typically manifesting in rigidity/flaccidity of the muscle, or a compulsive motor discharge (hyperactivity). An individual's body will be characterised by its own particular variations in muscle tone, body awareness, differentiation of muscle groups, tissue textures etc. The more 'split' the mental functioning, the more splits are observable to the trained body psychotherapist. The bringing together of sensory awareness and motility can increase healthy integration and differentiation of functions,

The word proprioception means 'to receive oneself', literally 'to be in touch with oneself'&endash; it is the basis of physical and emotional health. It is a condition of healthy embodiment ( by embodiment I mean congruence of physiological and psychological). Alexithymia, the condition of being unaware of one's feelings, and therefore unable to articulate them or think about them, must reflect an impairment of the integration of sensory information, and has an established connection with psychosomatic illness. A more extreme version of this, anosognosia (from the Greek nosos, disease; and gnosis, knowledge) is clearly determined by damage to specific parts of the brain. On the basis of his study of anosognosics, Damasio has clearly linked the failure of areas of the brain to integrate information from the body with the inability to feel and to reason, despite no damage to the language centres of the brain.

The contrary state to fully functional proprioception&endash; and the basis of ill-health, I want to suggest - is omnipotence. By definition omnipotence implies a dissociation from bodily functions &endash; because bodily capacities determine precisely the limits of what we can or can't do. The practicing phase is when the toddler has to repeatedly discover the physical and emotional limits of his/her capacity. The tears and tantrums of this age mark that constant painful confrontation with the reality of their emotional and physical capacity (including their capacity to contain impulses or feelings). Such discharges are the child's means of assimilating and coming to terms with the painful reality, re-balancing autonomically. Where tantrums and tears are met either with rebuff, punishment, or a collapse in the parent's boundary setting, there is more likely to be a narcissistic split. The intensity in the body has to be deeply controlled or dissociated from, either because its prohibited or because of the fear engendered by not having either internal or external boundaries to modify the sympathetic over-charge.

Earlier on I linked omnipotence with the sympathetic state &endash; one of the characteristics of high sympathetic arousal is that sense of 'I can do anything'. And in extremis, human beings can really push up against the limits &endash; sporting activity, the movement arts, moments of heroic transcendence can give us the sense that we can be superhuman. It can be an addictive state &endash; the adrenaline addiction, which fuels omnipotent fantasy. I think the changes in Western life in the last three hundred years have accelerated and amplified an innate human tendency towards omnipotence. Three hundred years ago the sheer arduousness of life, the dependency on nature and natural cycles, the limitation of medicine, the religious structure which separated notions of man and god, kept us anchored in physicality, and in the balance of sympathetic and parasympathetic.

Nowadays we can transcend so many limits of physical reality, that it is becoming the hallmark of our era &endash; virtual reality. We are being speeded up with cultural demands to do it better, quicker, bigger, to over come previous limits. We are adapting to high speed &endash; phone, email, cars, planes &endash; autonomically, but then when these systems fail (computer crash, traffic jam), we have to very abruptly shift down in gear and re-orient. No wonder there are outbreaks of road rage ! For to cope effectively we need to be superbly autonomically flexible to adjust to the variations in pace and their implications. I suggest that as well as looking at individual histories of illness, we need to understand many of the new illnesses, especially the increasingly common autoimmune illnesses as a symptom of a larger crisis and transition. There is a creativity in these responses, as well as pain and suffering. Just as there are extraordinary developments and achievements which are stemming from broad cultural changes.

It's very hard to find a simple language to talk about complex processes and not fall into the dualisms. Because it's a system with two branches, my talk has been structured around binary pairs, but I hope it's also clear that &endash; via splitting &endash; the binary process becomes a complex analogic pattern. I don't really like words like bodymind or psyche soma &endash; partly because they are tautological, and also because of their associations &endash; bodymind sounds rather New Agey, and psychosomatic seems to imply that there is a category of illnesses which can be separated off from organic illness. I'm dubious about that. I've gone with the word organism because it implies the functional identity of mind and body &endash; the disadvantage is that it then disavows the pervasiveness of splitting as a fundamental aspect of human function. On the other hand the word environment fortuitously implies both the emotional environment &endash; thanks to Winnicott &endash; and the physical, and economic, political and social environment with which the individual is having to contend. To give an example &endash; hot flushes, hyperirritability, difficulty sleeping, mood swings. These are the symptoms of menopause. A woman's experience of menopause - which is of course a hormonal change but affects and is affected by the autonomic nervous systems as well &endash; will be influenced by her own social, cultural and personal context, as well as her diet and lifestyle.

I want to conclude this part by going back to the quote from Reich: "The development of character is a progressive unfolding, splitting and antithesis of simple vegetative (i.e. autonomic) functions". Reich thoroughly grasped the paradox of the body-mind relationship: in ideal conditions, mind and body form a functional identity (in which feeling and thinking are informed and enriched brain-body processes); however, the vicissitudes of life engender deep and multiple processes of splitting within the organism, to the point where body systems and sub-systems act antithetically, i.e. in conflict. Reich's insight stemmed from his observation that pulsation was the primary regulating mechanism of organisms. He was not so interested in the intricate emotional regulation between the infant and its caregiver. Allan Schore's work, which spans an incredible breadth of contemporary sciences, comes also to the conclusion that self-regulation is fundamental, but he integrates into this model the complexity of object relations. I find that Reich's phenomenological appreciation of psychological process and his bold formulations both challenge and complement Schore's landmark work.

Allan Schore will be giving a lecture on 'Neuroscience: why should therapists be interested?' at 7pm on 9th July at Friends Meeting House, Euston Road, London. Contact Amy Band at UKCP for details: 020 7463 3002

Part two: the therapeutic implications - including the body in psychotherapy.

(This was not part of the talk I actually gave on 26th March for Confer, but it addresses some of the issues raised by the model I am proposing)

A few notesÉ

* Object relations are embodied:

- chronically in changes in structure/function

- acutely as charge in the transference relationship

The therapist can work towards supporting emotional self&endash;regulation by providing boundaries, meeting the charge in the transference, and increasing capacity for insight (itself a mini-cycle).

'Charge' relates to the intensity of a process, often indicating unconscious transference feelings. It is perceivable in the body in increase/ sudden decrease of tension, significant gestures, micro-gestures, changes in skin colour and breathing etc, as well as in language and attitude. It is palpable in the countertransference. (The concept of charge has been developed at The Chiron Centre for Body Psychotherapy, in the context of integrating body psychotherapy with object relations)

ˇ In contemporary body psychotherapy, the body is seen as both 'id' ie. the

source of primitive impulses and 'ego', ie the more or less conflicted container. We work to develop and establish the containing function of the body in and via the transference relationship. The individual's relationship with their body is itself a repetition of an earlier object relationship. (see Totton, Soth)

ˇ The conscious embodiment of feelings in the transference relationship can act cohesively and support autonomic re-balancing. ANS responsivity and robustness in the therapist contains intensity in the client (especially at high points of sympathetic and parasympathetic activation).

ˇ Surprise/shock/spontaneity manifest directly in the ANS and mark the impact on the organism of the environment and/or the unconscious. Intellectual activity may be part of elaborating an autonomic process OR a defence against the intensity of feelings, and shock/surprise/ spontaneity.

ˇ Sensory-motor integration & body awareness:

- sensory functions can be developed through sensing and exploring imagery (including dreams)

- motor functions can be developed via exploring movement, gesture and posture

e.g. In the client with the frozen shoulder I might have arrived at the interpretation of the introjected cold shoulder&endash; which did have the effect of shifting the symptom &endash; just through reflection and my own experience of the transference-countertransference. However, the contribution of the bodywork was the deepening of the client's sense of her own inhibition and pain. Also, holding of her head affected her at a level where she could experience her vulnerability and need of contact, and therefore prepared the way (softened the defences against) the interpretation of loss.

ˇ Working with physical symptoms:

- When did it/they start?

-

- Be curious about all aspects of the symptom. Explore what gets in the way of curiosity.

-

- The relationship of the client to the symptom parallels the early object relationships. E.g. is the illness an 'it'? nothing to do with 'me'? is it seen as persecutory? Is it tended to over protectively, ignored, denied, abused, idealised? Some illness can be treated as a vocation, as a calling from God.

-

- What is the symptom expressing in the transference?

-

- How is the symptom containing the wider environmental challenge to the organism?

- How can the symptom be more fully experienced?

A post-graduate course on Working with Psychosomatic Symptoms will be run by Margaret Landale at the Chiron Centre for Body Psychotherapy

Case study

Megan left her long-term partner eighteen months ago. For two years

preceding the final decision she had ongoing pain in her kidneys, a constant dry mouth and a knot in her stomach. She had been in turmoil daily with the question of whether to leave her therapist or her partner, Jane. She took up running, which she found relieved some of her symptoms. In the transference she had a sullen but stifled hatred of her therapist. She set a date to finish her therapy but changed her mind when, as she saw it, her therapist really stood up to her. She described that decision as being like a great ocean liner turning. Six months later she left Jane &endash; and experienced exhilaration and intense fear which she compared to jumping off a cliff.

Over the next year, as she struggled with housing and financial problems, and changes at work, she experienced severe stress symptoms &endash; frequent sweating, palpitations, insomnia, but the old symptoms disappeared. These bodily changes reflected the difference between a suppression of the flight reflex which led to symptoms of kidney dysfunction (pain, dryness), to the adrenaline being released to fulfil its natural function of flight. Despite the stress symptoms, there was an enormous overall improvement in her energy and health accompanied by a deep shift in her resourcefulness. As she allowed herself to depend more on her therapist, her process moved from 'dry' (sullen, stuck) to 'wet' (fluid, high emotional charge), both physiologically and transferentially. She began to use her therapy to contain intense feelings of panic, loss and rage, as well as desire and hope.

Bibliography

Body Psychotherapy

Boadella, D. (1987) Lifestreams: An Introduction to Biosynthesis (Routledge, London)

Boadella, D. (1997)' Awakening sensibility, recovering motility: psycho-physical synthesis at the foundation of body psychotherapy: the 100 year legacy of Pierre Janet (1859-1947) in International Journal of Psychotherapy, vol 2, no.2

Boyesen, M.L. (1974)'Emotional Repression as a Somatic Compromise: Stages in the Physiology of Neurosis' Energy and Character, vol 5, no 2

Reich, W. (1973) The Function of the Orgasm (Reprinted Souvenir Press, 1983)

Reich, W. (1972) Character Analysis (Reprinted Farrar, Strauss and Giroux, New York, 1990)

Rothschild, B (2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (Norton, London)

Soth, M. 'Body/Mind Integration. AChP Newsletter, nos 17,18,19

Staunton , T (ed) (2001) Advances in Body Psychotherapy (Routledge)

Totton, N. (1998) The Water in the Glass: Body and Mind in Psychoanalysis (Rebus

Press, London)

Anatomy & Physiology

Cohen, B.B. (1993) Sensing, Feeling and Action (Contact Editions)

Hartley, L (1994) The Wisdom of the Body Moving (N.Atlantic Books)

Juhan, D. (1987) Job's Body: A Handbook for Bodyworkers (Station Hill)

Kapit, W. (1987) The Physiology Colouring Book (Harper Collines, New York)

Neuroscience & Psychoanalysis

Damasio, A. (1999) The Feeling of What Happens: Body, Emotion and the Making of Consciousness (Heineman, London)

Damasio, A. (1994) Descartes Error: Emotion, Reason, and the Human Brain (Putnam, London)

Freud, S. (1950[1895]) A Project for a Scientific Psychology SE.1

Grinberg, L (1977) New Introduction to the work of Bion (Aronsom, New Jersey)

May, R. (1977) The Meaning of Anxiety (Simon and Schuster)

Moore, M. S, (1998) 'How can we remember but be unable to recall? The complex functions of multi-modular memory' in ed. Sinason, V. Memory in Dispute (Karnac)

Schore, A (1994) Affect Regulation and the Origin of the Self (Lawrence Erlbaum, Hove)

Solms, M. & Kaplan-Solms, K. (2000) Clinical Studies in Neuro Psychoanalysis (Karnac, London)

Psychosomatics

Broom, Brian (1997) Somatic Illness and the Patient's Other Story (Free Association)

Mindell, A (1982) Dreambody (Sigo Press)

Whitmont, E.C. (1993) The Alchemy of Healing: Psyche and Soma (N. Atlantic Books)

Scientific background: Chaos & Complexity Theory

Capra, F. (1996) The Web of Life: A New Understanding of Living Systems (Anchor Books, New York)

Coveney, P & Highfield, R (1995) Frontiers of Complexity (Faber, London)

fragmentation, I want to briefly go back to the characteristic defences and ego capacities which correlate with these two modes. I want to emphasise that these links I am making between autonomic states and defences are not fixed, and cannot be diagnostically isolated but perceived as part of an energetic pattern. They represent tendencies; autonomic states, as I have suggested, can overlay each other and fluctuate in ways that defy simplistic categorisation.

Sympathetic Parasympathetic

Flight Collapse

Aggression Passivity

Opposition/reaction formation Collusion/retroflection

Blame others Blame self

Hyperactivity Hyperreflective

(productivity without creativity) (creativity withoutproductivity)

Projection Introjection

Omnipotence Omniscience

Mania Depression

These defences arise from the foreclosure of an emotional-physiological cycle. We understand from Klein that these defences originate in the infant's vulnerability to and dependence on the environment. In adults the same physiological patterns and defences may be employed as habitual modes or under challenging circumstances, when the individual's capacity to act (sympathetic) or to digest feelings (parasympathetic) is inhibited for any reason. We could say that these defensive modes are signs of the organism moving into the margins of stress. I want to make the point that while that these defences are still healthy and functional while they are context appropriate. It is only when the splits become chronically embedded in alterations of the structure-function of the ANS that they are pathological.

I can think of a client who, because of a complication in labour, had to go into hospital although she had wanted to give birth at home. She had to deal with her dependency on the medical staff and her hatred of what they represented for her - a controlling, cold, mechanical mother. Everyone in the hospital became seen as either good or bad &endash; she was able to trust absolutely in a few key figures and managed to get rid of those she didn't like, either by ignoring them or by being overtly hostile. As soon as she had actually given birth, this dramatic splitting subsided, because it had fulfilled its temporary function &endash; to postpone one emotional cycle while a more urgent cycle was in progress. An important part of her resolution of her experience in hospital was talking, reflecting and writing about it. She called her birth story 'Chiaroscuro', from the Italian for light/dark &endash; ie. the good and the bad.

Self-Regulation: A Developmental Perspective

In a fascinating and detailed study of the relationship between attachment and neurological development, Allan Schore has helped illuminate just how individual nuances in autonomic activity are influenced by the infant's ongoing relationship with the mother. A baby's capacity to act is incredibly limited by its physiological and psychological immaturity &endash; a baby cannot, obviously, fight or flee something overwhelming. And the something overwhelming might simply be its own need of food or contact (Winnicott's 'clap of thunder' captures the experiential impact). It is dependent on mother or another caregiver for emotional and environmental regulation. If the parent can soothe and stimulate appropriately, these functions are internalised as capacities in the nervous system.

In a newborn baby, it is now suggested, the reciprocal tension of sympathetic and parasympathetic are not well-developed. A good example of this is colic which I did some research on a few years ago . Colic is a very common but quite distressing phenomena where the baby will have difficulty feeding and can cry every day for hours. The digestion (parasympathetic) is disrupted because the baby is over-stimulated (sympathetic). This over-stimulation may be a result of many things &endash; compression of the vagal nerve &endash; a crucial mediator of the parasympathetic nervous system -during birth; an environment or life-style that is unsettling; internal conflict in the mother etc (or of a combination of these). One of the best ways of reducing colic is for the mother to keep the baby in close physical contact &endash; such as in a sling &endash; for long periods. Her body and her more mature nervous system can help regulate the baby's arousal.

As the baby develops, the parasympathetic mode ( the soothing function) becomes more an established and is more able to inhibit the sympathetic, in other words to modify stimulation. The parasympathetic mode has a role in impulse control. However it can be over-dominant. If the parent greets a toddler's excitement with harsh disapproval, the toddler may respond to this withdrawal of contact with parasympathetic over-activation &endash; i.e. a collapse. The parent's rejection is experienced as a real down fall, a drop into shame, despondency etc. Another toddler might respond by further demands or mischief, which might successfully draw the parent back into relation, or it might be met with a slap. From these two examples I hope it becomes possible to imagine just how the interplay of the two modes can reflect a containing parent, or in a more conflicted or chaotic environment, the opposite. Constant opposition between parent and child may become internalised as an antagonistic relationship between the sympathetic and parasympathetic.

Deficits and failures in the primary relationships are laid down as autonomic patterns, which reflect the infant or child's default style of coping with its feelings. Styles of managing feelings are modelled explicitly or implicitly in the way parents respond or react to events. Autonomic identifications and polarisations become built in &endash; for example, a child may react like the over-excited mother (sympathetic); or they may become the complementary object and be mother's 'rock' steady, dependable, imperturbable (parasympathetic). Of course, as with all object relations, the child will internalise both, and what is lived out in their typical mode of being may give way under stress to its opposite. (The terms 'autonomic identification and polarisations' are mine; the examples are my phenomenological extrapolations from Schore &endash; his own descriptions are purely technical.)

Repeated patterns of interaction between parent and child have long term effects via the ANS. The ANS manages quantity and distribution of energy in the relationship between the organism and the environment. When the response called up in the organism is overwhelming, the overload can be managed in a variety of ways, intensification of autonomic reaction, localisation of a charge within an organ or a muscle group; usually all these means will be deployed to some degree, with the correlative psychological defences. What happens next is somehow more significant: the organism struggles to find equilibrium, to assimilate, elaborate or bind the energy/feelings in the longer-term. The psychologically and physically robust individual has the most options for tolerating, adjusting to or acting upon the environment. The more limited an individual's options, the more likelihood of chronic psycho-physiological compromise in the direction of illness (visceral, tissue, muscle and skin armour limit the health-maintaining functions of the organism); and behaviour including self-management strategies like addictions.

I want to move on to say something about trauma, which can be viewed specifically as a breakdown in autonomic functioning. So far I have talked of reciprocal function of parasympathetic and sympathetic, and of splitting or antagonism between the two systems. In trauma, we see another phenomenon. Instead of mutual inhibition, both sympathetic and parasympathetic become more and more strongly activated. In the face of a strong stimulus and a perception of no way out terror is aroused and can end in paralysis, freezing, black out etc If the danger cannot be met by fighting or running, or by expressing vulnerability, co-operativeness or whatever (I'm thinking of traumas as varied as rape, train crashes, fires, abduction etc), the body, like the mouse caught by a cat, may involuntarily play dead.

One of the defining characteristics of post-traumatic stress is a chronic disorder of the autonomic nervous system, manifest as a strong tendency to startle, blackout, hyper-irritability, disrupted sleep etc. A small but significant stimulus can trigger a panic attack. Where the trauma goes back to infancy and is an intrinsic part of the relationship with the caregiver, there is more likely to be severe personality disorder.

Four types of Autonomic Dysfunction

Characterologically and culturally, individuals will have predispositions towards the sympathetic or the parasympathetic. For example, racial groups originating near the tropics, needed to be more sympathetic dominant, to respond to the challenges of that environment, in which the capacity for flight was necessary. Further north, where people migrated to settle and farm, a more parasympathetic dominant tendency became embodied. Even farther north, where endurance was the main survival quality there was an even stronger tendency to parasympathetic predominance. Nowadays, with so much global movement and multi-racial interweaving, such simple metabolic biases no longer hold true. This reminds us of another way in which we need to take on board complexity in the organism-environment. (These patterns are recognised in Ayurvedic medicine, and have been more recently popularised in the blood type diet)

By autonomic dysfunction I really mean a chronic pattern of coping via psychological/physiological defences. Essentially I am proposing four types of autonomic dysfunction, which are reflected in all aspects of a person &endash; from subtle psychological and physiological processes to more extreme illnesses and disorders. In doing so I'm aware of collapsing normal distinctions between categories. This model is very speculative but it does draw on a variety of sources, including the major psychoanalytic theories of illness, recent neuroscience, holistic therapies and body psychotherapy.

These autonomic splits can exist in various combinations at various times and be more or less creatively handled. In chronic and serious illness, an equilibrium is established via some kind of compromise of an internal conflict. Depending on the nature of the condition, the symptoms may represent an appropriate adjustment, or a sustained defence against the intensity of one or many feelings.

I want to make the point that as well as being influenced by emotional factors, there are of course genetic weaknesses and the impact of specific factors in the physical environment which play a part. In fact what I am proposing is an environmental-organismic model, rather than an a purely psychological model. (see below for discussion of terms organismic-environmental)

The first kind I'm calling sequestration, using Reich's term. This is where a more or less isolated organ, muscle group or physiological function becomes symptomatic. It's a kind of damage limitation, and its isolation in the body is also a form of representation. And so a symptom emerges &endash; a frozen shoulder, an ovarian cyst, and a sore throat. In psychoanalytic literature this may be perceived as a break down in symbolic thinking &endash; the body becomes the metaphor. Such a view is also well popularised in various humanistic and New Age therapies where there is an emphasis on discovering the message that the symptom is carrying. There are many spectacular examples of symptoms clearing up when the message has been received and understood. (see below in 'Ways of Working' for further discussion of symbolisation).

A simple example of symbolisation is the woman with a severe facial rash, who, it eventually turns out, has been desperately putting a 'brave face' on deep distress and anxiety. In a more complex introject, I had a client with a frozen shoulder. There were obvious conflicts around shouldering responsibility and feeling burdened which we explored. Over a three month period I worked with increasing body awareness, exploring the mobility of the shoulder, releasing the tension in the neck through holding the head. But what became increasingly evident to me was that the client was struggling to avoid very painful feelings of exclusion and rejection. The frozen shoulder was an introject of the 'cold shoulder' she felt she has been given in a current life situation, in her early relationship with her mother, and in the transference with me.

The second kind I'm calling antagonism. Here there may be a war of attrition or a full scale battle between the sympathetic and parasympathetic, which correlates with a battle around drive and self-control. Heart attacks may fit more into this pattern &endash; the individual pushes themselves to achieve, maintaining overdrive, controlling anger, disappointment, frustration &endash; pushing on, on, on till the heart cannot cope. Heart attacks happen more often on a Monday and cluster around 9am &endash; the day and time when most people go back to work after the weekend.

This antagonistic pattern can also fuel addictions &endash; most addictive substances either stimulate, and wake you up, or they take you down and mellow you out. We can start to use drugs of all kinds, including caffeine, nicotine, alcohol, tranquillisers &endash; to get ourselves into the preferred autonomic state &endash; it's a sort of self-medication.

The third kind I'm calling instability. Here the two parts of the autonomic nervous system are failing to regulate each other, producing wild fluctuations in mood and body symptoms. This client presents as hysterical or hyperchondriac &endash; symptoms move around, change, get very intense but suddenly disappear. The key characteristic is instability. Doctors may investigate and find nothing wrong, but the client is tormented, and frightened of the body. I had a client with a history of chronic abandonment. In our work together, I would often sense that she had lost all connection with her legs. It became clear that this was associated with abandonments of any kind, where it seemed that 'the carpet was pulled out from under her feet'. She didn't lose the capacity to walk (a more extreme hysterical conversion), but to connect energetically with her legs and the ground (i.e.. a matter of fact here and now reality). Triggered by fear of abandonment, she was in some respects 'gone'. With my drawing attention to her legs, and putting my hands on her feet, she was able to re-own her legs (see below for discussion of motor-sensory integration.)

The fourth kind I'm calling trauma. The two parts of the autonomic nervous system escalate their functions. Here the symptoms are characteristic of high stress &endash; panic attacks, cold sweats, palpitations, nightmares, outbreaks of violence, inability to cope, rapid changes from hot to cold and back. Trauma, which makes the autonomic nervous system highly unstable, can contribute to any of the above patterns. In many cases, the traumatised client is more contained by illness than not &endash; hence the stubbornness of certain illnesses (i.e. resistant to interpretation) which are apparently 'psychosomatic'. Illness can be a sign of health &endash; the body is being allowed to elaborate its terror, rather than held in a state of permanent defence against spontaneous processes.

These splits could be seen as a progression of disturbance &endash; the ego is relatively rigid in the first two examples, and more fragile in the second two. In a very general way, we could say that in sequestration and antagonism the individual makes use of their body; what is feared is 'excess' i.e.. strong unmanageable feelings. In instability and trauma the body is experienced as radically unsafe; it is feared but not used. In the first two patterns, the body is a controlling container; in the second the body becomes the anti-container. These patterns repeat and embody object-relational experience, as well as racial/gender/social patterns, possibly encoded at a genetic level.

Sensory Motor Functions and Splitting

Having outlined the link between autonomic and emotional development as a relationship function, I want to go back briefly to physiology to look in more detail at how these patterns become embedded. There are multiple motor sensory loops in the body which send and receive information. They influence all body functions &endash; for example, the immune system responds to changes in the body, with appropriate immune reaction, such as the production of antibodies. And this loop stimulates concurrent signals that influence the individual's behaviour &endash; such as sending stimuli to drink or rest. Contributory factors to many chronic illnesses include the prolonged overriding of messages from the body to stop and rest; and chronic dehydration because most people have simply lost a healthy thirst reflex. In other words, there is a split between spontaneous (instinctual) survival impulses on the level of sleeping and drinking, and other influences (pressures of modern life) which reinforce a dissociation from body signals.

To understand why this happens we need to recognise that self-regulation in the widest sense (including its autonomic/emotional aspects) is intrinsically bound up with complex neural and chemical motor-sensory feedforward and feedback loops. When we use our muscles, for example, there's not just an instruction from the brain, but feedback from proprioceptors in the muscles and joints which monitor changes in tension, the speed of change, changes of pressure in the tissue, the position of joints in relation to each other etc. Although largely outside awareness the proprioceptors provide a dense, dynamic 3-d map of the body in space and in action. (See my article on the Motoric Ego, also on this site) Similarly there are interoceptors in the organs, complex chemical connections between all parts of the body which relay a constantly updated picture of what's happening in the body.

The Autonomic Nervous System and the Somatic Nervous System &endash; the muscular system &endash; are regulated by sensory-motor loops. The sensory input to the ANS concerns the exact nature of visceral activity, blood composition etc; the motor output actively modifies the organs, muscles, blood vessels etc. The pioneering neurologist Antonio Damasio has emphasised that the brain is dependent on the body for self-knowledge. Rather than language being the necessary feature of self-knowledge, it is the critical multiple feedback loops which inform the brain about activity in the body, which constitutes the basis of all self-knowledge. He argues that the emergent properties of complex activity in the body are emotional states. Feeling feelings allows us to make sense of our environment and act appropriately. (Note: self-knowledge is distinct from self-consciousness [the capacity to reflect on oneself]. Self-knowledge supports appropriate actions in a survival context, and provides the basis for more sophisticated reflective activity. )

Putting together some of the implications from Schore's and Damasio's work, I would say that when the containing function of relationship fails, there is a correlative breakdown of the sensory-motor loop. The sensory component (including sensation and feeling) is split from the motor function which is necessary for acting. Both feeling and doing are life-saving functions &endash; working together they constitute experience.

Interestingly, Bion defines 'thinking' in terms of the capacity to experience, to make links, and he attributes this to being able to integrate and assimilate sensory images (the alpha function). Intense feelings always have a correlative motor &endash;i.e. muscular &endash; impulse which includes all the primitive urges &endash; to suck, to hit, to reach, to cry, to tear, to cling. Bion argues that restraint upon motor discharge is provided by means of the process of thinking. I would qualify this by saying that motor restraint needs to be accompanied by the sensory information of the act of restraint in conjuction with the image of what is being desired. The linking of the two constitutes thinking. By contrast, splitting the motor and sensory function reduces the intensity and dilutes the conflict to make the self in relation to object less overwhelming, less threatening. The splitting may subsequently be followed by more integrative reflective activity, or not, depending on the autonomic capacity to contain the charge.

The motor-sensory split will also be reflected in a sensory dysfunction &endash; often marked by numbness or pain; and motor dysfunction &endash; typically manifesting in rigidity/flaccidity of the muscle, or a compulsive motor discharge (hyperactivity). An individual's body will be characterised by its own particular variations in muscle tone, body awareness, differentiation of muscle groups, tissue textures etc. The more 'split' the mental functioning, the more splits are observable to the trained body psychotherapist. The bringing together of sensory awareness and motility can increase healthy integration and differentiation of functions,

The word proprioception means 'to receive oneself', literally 'to be in touch with oneself'&endash; it is the basis of physical and emotional health. It is a condition of healthy embodiment ( by embodiment I mean congruence of physiological and psychological). Alexithymia, the condition of being unaware of one's feelings, and therefore unable to articulate them or think about them, must reflect an impairment of the integration of sensory information, and has an established connection with psychosomatic illness. A more extreme version of this, anosognosia (from the Greek nosos, disease; and gnosis, knowledge) is clearly determined by damage to specific parts of the brain. On the basis of his study of anosognosics, Damasio has clearly linked the failure of areas of the brain to integrate information from the body with the inability to feel and to reason, despite no damage to the language centres of the brain.

The contrary state to fully functional proprioception&endash; and the basis of ill-health, I want to suggest - is omnipotence. By definition omnipotence implies a dissociation from bodily functions &endash; because bodily capacities determine precisely the limits of what we can or can't do. The practicing phase is when the toddler has to repeatedly discover the physical and emotional limits of his/her capacity. The tears and tantrums of this age mark that constant painful confrontation with the reality of their emotional and physical capacity (including their capacity to contain impulses or feelings). Such discharges are the child's means of assimilating and coming to terms with the painful reality, re-balancing autonomically. Where tantrums and tears are met either with rebuff, punishment, or a collapse in the parent's boundary setting, there is more likely to be a narcissistic split. The intensity in the body has to be deeply controlled or dissociated from, either because its prohibited or because of the fear engendered by not having either internal or external boundaries to modify the sympathetic over-charge.

Earlier on I linked omnipotence with the sympathetic state &endash; one of the characteristics of high sympathetic arousal is that sense of 'I can do anything'. And in extremis, human beings can really push up against the limits &endash; sporting activity, the movement arts, moments of heroic transcendence can give us the sense that we can be superhuman. It can be an addictive state &endash; the adrenaline addiction, which fuels omnipotent fantasy. I think the changes in Western life in the last three hundred years have accelerated and amplified an innate human tendency towards omnipotence. Three hundred years ago the sheer arduousness of life, the dependency on nature and natural cycles, the limitation of medicine, the religious structure which separated notions of man and god, kept us anchored in physicality, and in the balance of sympathetic and parasympathetic.

Nowadays we can transcend so many limits of physical reality, that it is becoming the hallmark of our era &endash; virtual reality. We are being speeded up with cultural demands to do it better, quicker, bigger, to over come previous limits. We are adapting to high speed &endash; phone, email, cars, planes &endash; autonomically, but then when these systems fail (computer crash, traffic jam), we have to very abruptly shift down in gear and re-orient. No wonder there are outbreaks of road rage ! For to cope effectively we need to be superbly autonomically flexible to adjust to the variations in pace and their implications. I suggest that as well as looking at individual histories of illness, we need to understand many of the new illnesses, especially the increasingly common autoimmune illnesses as a symptom of a larger crisis and transition. There is a creativity in these responses, as well as pain and suffering. Just as there are extraordinary developments and achievements which are stemming from broad cultural changes.

It's very hard to find a simple language to talk about complex processes and not fall into the dualisms. Because it's a system with two branches, my talk has been structured around binary pairs, but I hope it's also clear that &endash; via splitting &endash; the binary process becomes a complex analogic pattern. I don't really like words like bodymind or psyche soma &endash; partly because they are tautological, and also because of their associations &endash; bodymind sounds rather New Agey, and psychosomatic seems to imply that there is a category of illnesses which can be separated off from organic illness. I'm dubious about that. I've gone with the word organism because it implies the functional identity of mind and body &endash; the disadvantage is that it then disavows the pervasiveness of splitting as a fundamental aspect of human function. On the other hand the word environment fortuitously implies both the emotional environment &endash; thanks to Winnicott &endash; and the physical, and economic, political and social environment with which the individual is having to contend. To give an example &endash; hot flushes, hyperirritability, difficulty sleeping, mood swings. These are the symptoms of menopause. A woman's experience of menopause - which is of course a hormonal change but affects and is affected by the autonomic nervous systems as well &endash; will be influenced by her own social, cultural and personal context, as well as her diet and lifestyle.

I want to conclude this part by going back to the quote from Reich: "The development of character is a progressive unfolding, splitting and antithesis of simple vegetative (i.e. autonomic) functions". Reich thoroughly grasped the paradox of the body-mind relationship: in ideal conditions, mind and body form a functional identity (in which feeling and thinking are informed and enriched brain-body processes); however, the vicissitudes of life engender deep and multiple processes of splitting within the organism, to the point where body systems and sub-systems act antithetically, i.e. in conflict. Reich's insight stemmed from his observation that pulsation was the primary regulating mechanism of organisms. He was not so interested in the intricate emotional regulation between the infant and its caregiver. Allan Schore's work, which spans an incredible breadth of contemporary sciences, comes also to the conclusion that self-regulation is fundamental, but he integrates into this model the complexity of object relations. I find that Reich's phenomenological appreciation of psychological process and his bold formulations both challenge and complement Schore's landmark work.

Allan Schore will be giving a lecture on 'Neuroscience: why should therapists be interested?' at 7pm on 9th July at Friends Meeting House, Euston Road, London. Contact Amy Band at UKCP for details: 020 7463 3002

Part two: the therapeutic implications - including the body in psychotherapy.

(This was not part of the talk I actually gave on 26th March for Confer, but it addresses some of the issues raised by the model I am proposing)

A few notesÉ

* Object relations are embodied:

- chronically in changes in structure/function

- acutely as charge in the transference relationship

The therapist can work towards supporting emotional self&endash;regulation by providing boundaries, meeting the charge in the transference, and increasing capacity for insight (itself a mini-cycle).

'Charge' relates to the intensity of a process, often indicating unconscious transference feelings. It is perceivable in the body in increase/ sudden decrease of tension, significant gestures, micro-gestures, changes in skin colour and breathing etc, as well as in language and attitude. It is palpable in the countertransference. (The concept of charge has been developed at by Michael Soth at The Chiron Centre for Body Psychotherapy, in the context of integrating body psychotherapy with object relations)

ˇ In contemporary body psychotherapy, the body is seen as both 'id' ie. the

source of primitive impulses and 'ego', ie the more or less conflicted container. We work to develop and establish the containing function of the body in and via the transference relationship. The individual''s relationship with their body is itself a repetition of an earlier object relationship.

ˇ The conscious embodiment of feelings in the transference relationship can act cohesively and support autonomic re-balancing. ANS responsivity and robustness in the therapist contains intensity in the client (especially at high points of sympathetic and parasympathetic activation).

ˇ Surprise/shock/spontaneity manifest directly in the ANS and mark the impact on the organism of the environment and/or the unconscious. Intellectual activity may be part of elaborating an autonomic process OR a defence against the intensity of feelings, and shock/surprise/ spontaneity.

ˇ Sensory-motor integration & body awareness:

- sensory functions can be developed through sensing and exploring imagery (including dreams)

- motor functions can be developed via exploring movement, gesture and posture

e.g. In the client with the frozen shoulder I might have arrived at the interpretation of the introjected cold shoulder&endash; which did have the effect of shifting the symptom &endash; just through reflection and my own experience of the transference-countertransference. However, the contribution of the bodywork was the deepening of the client's sense of her own inhibition and pain. Also, holding of her head affected her at a level where she could experience her vulnerability and need of contact, and therefore prepared the way (softened the defences against) the interpretation of loss.

ˇ Working with physical symptoms:

- When did it/they start?

-

- Be curious about all aspects of the symptom. Explore what gets in the way of curiosity.

-

- The relationship of the client to the symptom parallels the early object relationships. E.g. is the illness an 'it'? nothing to do with 'me'? is it seen as persecutory? Is it tended to over protectively, ignored, denied, abused, idealised? Some illness can be treated as a vocation, as a calling from God.

-

- What is the symptom expressing in the transference?

-

- How is the symptom containing the wider environmental challenge to the organism?

- How can the symptom be more fully experienced?

A post-graduate course on Working with Psychosomatic Symptoms will be run by Margaret Landale at the Chiron Centre for Body Psychotherapy

Case study

Megan left her long-term partner eighteen months ago. For two years

preceding the final decision she had ongoing pain in her kidneys, a constant dry mouth and a knot in her stomach. She had been in turmoil daily with the question of whether to leave her therapist or her partner, Jane. She took up running, which she found relieved some of her symptoms. In the transference she had a sullen but stifled hatred of her therapist. She set a date to finish her therapy but changed her mind when, as she saw it, her therapist really stood up to her. She described that decision as being like a great ocean liner turning. Six months later she left Jane &endash; and experienced exhilaration and intense fear which she compared to jumping off a cliff.

Over the next year, as she struggled with housing and financial problems, and changes at work, she experienced severe stress symptoms &endash; frequent sweating, palpitations, insomnia, but the old symptoms disappeared. These bodily changes reflected the difference between a suppression of the flight reflex which led to symptoms of kidney dysfunction (pain, dryness), to the adrenaline being released to fulfil its natural function of flight. Despite the stress symptoms, there was an enormous overall improvement in her energy and health accompanied by a deep shift in her resourcefulness. As she allowed herself to depend more on her therapist, her process moved from 'dry' (sullen, stuck) to 'wet' (fluid, high emotional charge), both physiologically and transferentially. She began to use her therapy to contain intense feelings of panic, loss and rage, as well as desire and hope.

Bibliography

Body Psychotherapy

Boadella, D. (1987) Lifestreams: An Introduction to Biosynthesis (Routledge, London)

Boadella, D. (1997)' Awakening sensibility, recovering motility: psycho-physical synthesis at the foundation of body psychotherapy: the 100 year legacy of Pierre Janet (1859-1947) in International Journal of Psychotherapy, vol 2, no.2

Boyesen, M.L. (1974)'Emotional Repression as a Somatic Compromise: Stages in the Physiology of Neurosis' Energy and Character, vol 5, no 2

Reich, W. (1973) The Function of the Orgasm (Reprinted Souvenir Press, 1983)

Reich, W. (1972) Character Analysis (Reprinted Farrar, Strauss and Giroux, New York, 1990)

Rothschild, B (2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (Norton, London)

Soth, M. 'Body/Mind Integration. AChP Newsletter, nos 17,18,19

Staunton , T (ed) (2001) Advances in Body Psychotherapy (Routledge)

Totton, N. (1998) The Water in the Glass: Body and Mind in Psychoanalysis (Rebus

Press, Lon