Book Notes for From Fatigued to Fantastic!
Chapter 10: Am I Crazy? Understanding the Mind-Body Connection
In this section:
Stone Agers in the Fast Lane:
An Evolutionary Approach
by Jeffrey Maitland, Ph.D.
Why Did This Happen to Me?
As Nietzsche so astutely observed, when it comes to our own suffering, any explanation is better than none. If our suffering is the result of something simple like a cold we willingly accept the explanation that a virus is the cause. A cold or flu normally does not propel us into questions about the meaning of life because we know that we will be feeling better in a few days. But when our suffering continues unabated over longer and longer periods of time, we are less and less satisfied with the explanations that appeal to immediate causes, even when they are accurate. Ultimately we want to know why we suffer. As legend has it, when the Buddha allowed himself to be struck with the full significance of suffering, he set out on a course of spiritual illumination that ultimately changed the world. Every kind of suffering we might imagine, no matter how we try to explain it, is always a bodily event. The story of Christ’s suffering on the cross and his resurrection is profound testimony to the universal struggle we all face as embodied beings.
It is easy to be content with explanations of intense suffering that appeal to immediate causes as long as the suffering is not ours. Anyone who has suffered the devastating effects of fibromyalgia knows the truth of this statement. As the reality of fibromyalgia begins to dawn on the sufferer, it is the rare person who is not tempted to wonder, “Why did this have to happen to me?” Haven’t we all had moments in our life when we have asked similar questions? Even the hard-nosed scientist will be tempted to ask, “Why?” when his research grants are cut just as his wife dies of cancer and his house burns to the ground after being struck by lightning. After such a tragic series of events, it would be hard to imagine how he could be satisfied with a mere description of how cancer causes death or a detailed analysis of combustion.
Science, of course, is not meant to answer the ultimate questions about the meaning of life; and we should not blame it for not giving us such answers. But in between the kind of explanation that appeals to immediate or proximate causes and the kind that attempts to understand the meaning of life, there is another kind of scientific explanation that not only can give us a more satisfying answer to our “Why?” questions, but can also suggest new treatment strategies. This newly emerging science is the field of Darwinian Medicine. It promises an understanding of suffering and disease that goes beyond, but does not reject, the traditional medical answers that appeal to immediate causes. Unlike the physicists of his day, Darwin did not reject “Why?” questions. Rather he gave us a new and scientifically respectable way to ask and answer questions about purpose in biology and medicine.
In this article, I offer an evolutionary explanation of fibromyalgia as a means of adding to our understanding of this devastating condition. As with all evolutionary explanations of disease and suffering, the theory of fibromyalgia that I propose here is not intended as an alternate explanation to the proximate medical explanations that already exist. Evolutionary and proximate explanations of disease and suffering work together in expanding our understanding and treatment strategies. At this point in our understanding of fibromyalgia, an evolutionary explanation promises a broader understanding of the nature of this disorder. By understanding fibromyalgia in its broader evolutionary context, we may be better able to understand the peculiar nature of this disorder, predict who is likely to succumb to it, and hopefully devise even better treatment strategies. It will also help us to understand why the most important and yet most difficult treatment strategy for fibromyalgia sufferers to embrace is the need to change their way of living. In terms of the impact of such a theory on the sufferers themselves, perhaps they will see in it a more satisfying answer to their question, “Why did this happen to me?”
One of the more striking conclusions of this evolutionary approach is that fibromyalgia is, in part, a result of a useful adaptation to an environment that no longer exists. Fibromyalgia, then, should not be considered so much a disease in the usual sense, but rather as a fear disorder that is too sensitive for the chaos of the modern world. Like all evolutionary explanations, if this theory of fibromyalgia is properly constructed it should be capable of being tested and have certain predictive value. And if it, or some variation of it, is correct, it will not only support many of the observations and recommendations for treatment that have already arisen from the proximate theories, but it will also suggest new diagnostic and treatment strategies.
Once we understand that many of our evolved adaptations are better suited to a time when our ancestors were stone age hunters and gatherers (probably the Pleistocene savannah from 10,000 to 1,700,000 years ago), we will better appreciate the importance of critically examining how we are living our lives, especially in America, where fibromyalgia exists in alarming proportions—presently 12 to 15 million people in the United States are estimated to have fibromyalgia. People presently suffering from fibromyalgia are demonstrating to the rest of us certain warning signs that we would do well to heed. At this point in time they are more like the canaries that were taken into the mines as early detectors of poisonous gas than people who have fallen prey to some new disease. Their plight and ever increasing numbers, especially in America, are early warning signs that there is something terribly wrong in the way we are living our lives.
More so than with so many other causes of suffering, fibromyalgia is a condition that demands we change our lives. In many ways, it is one more among many signs of our spiritual crisis: a profound demonstration of our loss of connection to ourselves and our world. Even though a broader evolutionary approach can give us a deeper and more satisfying understanding of fibromyalgia, ultimately its significance lies in the spiritual crisis of our times.
We no longer need a prophet to tell us that we are out of touch with the wellsprings of life and living too fast. Not only have we lost touch with the rhythms of our bodies, but our fast-paced modern urban environments are chronically at odds with our biological inheritance. Under such conditions we must finally come to understand that no inoculation, drug, herb, diet, or manual therapy by itself or in combination can solve the problems that result from a world gone awry—unless, of course, we heed the all too obvious signs and change our ways.
An evolutionary explanation of a disease or suffering of any kind is not, as I stated above, an alternative to or in competition with a proximate explanation. Both are necessary for understanding and treatment. “Proximate explanations answer ‘What?’ and ‘How?’ questions about structure and mechanism: evolutionary explanations answer ‘Why?’ questions about origins and functions...an evolutionary approach to disease studies not the evolution of the disease but the design characteristics that make us susceptible to the disease....Evolutionary explanations thus predict what to expect in proximate mechanisms.”1
An evolutionary or functional explanation can take one or a combination of four different forms. They are: (1) explanations that demonstrate how what appear to be disorders or diseases are actually defenses that have evolved to protect the organism, (2) explanations that demonstrate how an adaptation is the result of a genetic quirk, (3) explanations that show how certain genetic adaptations impose costs that are worth their benefit to the organism, and (4) explanations that point to true, but rare genetic defects.
As an example of the first kind of explanation, let us consider Margie Profet’s functional understanding of morning sickness. A proximate explanation of morning sickness would tell us about the immediate causes and workings of nausea and vomiting, but it gives us little understanding as to why it happens. Profet argues that the nausea, vomiting, and food aversions that accompany early pregnancy evolved as a way to protect the developing fetus from toxins ingested by the mother. If her hypothesis is correct, one would expect morning sickness to begin when fetal-tissue differentiation begins and decrease as the fetus becomes less vulnerable. This prediction as it turns out is true, and Profet’s theory is supported by substantial evidence.2
This evolutionary account of morning sickness has obvious and important consequences for the treatment and care of pregnant women. Once we realize that morning sickness is an adaptation that evolved as a way to protect the developing fetus, we immediately see that understanding it as a disease or abnormality could be a grave mistake. Any attempt, for example, to block the symptoms of morning sickness by drugs or other means could have dire consequences for the unborn child.
Some adaptations work quite well for the stone age environment in which they evolved and cause great difficulties for us in our present environment. These disorders are what Williams and Nesse call a “genetic quirk.” Our modern couch potato is a good example. In the correct amounts, fat and sugar are an important source of nutrients. In the hunter gatherer phase of our distant ancestors, fat and sugar were not easily procured. Our ancestors adapted to a fat and sugar scarce environment by evolving a great and unbridled desire for these nutrients. So whenever fat or sugar became available, they would eat as much of it as they could in order to store it for leaner times. They would “pig out” as we would say today and lie around minimizing activity as a way to perhaps conserve their stores. Over consumption of these nutrients was not a problem for our ancestors for a number of related reasons: fat and sugar were not readily and always available, it took a considerable expenditure of energy (what we in the modern world consciously try to accomplish by exercise) just to survive and find food, and our ancestors did not live much past forty years when the damage of overconsumption usually appears. Since we have not yet evolved a “governor” for these unbridled tastes, in our present environment where we can find as much fat and sugar as we want, it is hardly surprising that we have developed a culture of couch potatoes.
Contrary to the wisdom of the day, we do not have to feel guilty for these desires. An evolutionary explanation shows that it is probably a mistake to think that some of us have addictive personalities and others don’t just on the basis of our overwhelming desire to consume large quantities of fat and sugar. Certainly, such desires could very well become part of a psychologically driven eating disorder. The fact that psychologically driven eating disorders are rooted in adaptive biostrategies helps explain why these disorders are so difficult to treat. Ultimately however, the patient and therapist must come to terms with the fact that these desires will never go away and realize that a cure of an eating disorder cannot be predicated on the assumption that the desires must one day disappear. So it is not always necessary to go casting about for some childhood trauma or unconscious loss of mother love to explain why many of us eat too much fat and sugar. For many of us these desires are not due to an addictive personality rooted in childhood trauma. Clearly they are also not due to a genetic defect. Rather, they are due to a genetic “quirk”: an adaptation that was selected for and worked well in the stone age environment, but doesn’t work well in our modern enviroment.
Certain genetic adaptations can be understood by means of a cost/benefit analysis. Their disadvantages to us are outweighed by their advantages. Sickle-cell anemia is a good example of a disease that has a genetic cause but which also provides a great advantage by protecting its bearers from malaria. As one would expect, since African Americans live in an environment in which malaria is rare, natural selection has been decreasing the frequency of the sickle-cell gene just as evolutionary theory predicts.
“Finally, there are ‘outlaw’ genes that facilitate their own transmission at the expense of the individual and thus bluntly demonstrate that selection acts ultimately to benefit genes, not individuals of species.”3 Genetic defects that cause disease and suffering are rare, however, because they are maladaptive. They are constantly being eliminated by environmental pressures and natural selection.
Before we look at the proximate and evolutionary theories of fibromyalgia, it is important to clear up a possible misunderstanding surrounding teleological explanations. Earlier I pointed out that evolutionary explanations provide respectable scientific answers to “Why?” questions. It is important to understand what this claim means. It does not mean that evolutionary theory rests on the view that natural selection involves any sort of consciousness that foresees or predicts a future that it then plans for in its design of organisms. Natural selection is not a form of planning or goal directedness. Rather natural selection operates blindly by means of a slow accretion of minute changes that make an organism a more fit reproducer for an environment or changing environments. Darwinian evolution should not be understood according to Spencer’s misleading slogan “survival of the fittest” but more properly as the perpetuation of the best replicators. “Functional explanations in biology imply not future influences on the present but a prolonged cycling of reproduction and selection. A bird embryo develops wing rudiments in the egg because earlier individuals that failed to do so left no descendants. Adult birds lay eggs in which embryos develop wing rudiments for the same reason. In this sense, a bird’s wing rudiments are preparation for its future but are caused by its past history.”4
A Proximate Explanation of Fibromyalgia
One of the best and most easily accessible books on fibromyalgia and chronic fatigue was written by Dr. Jacob Teitelbaum, a physician who also suffered the devastating effects of chronic fatigue.5 It is also an excellent example of a proximate explanation of fibromyalgia and a manual for its treatment. Since my purpose is to give an example of a proximate explanation in preparation for an evolution explanation, what follows is a rather brief over-simplification of Dr. Teitelbaum’s theory.
Dr. Teitelbaum suggests that we view fibromyalgia as one among a number of related patterns of severe chronic fatigue states. Three patterns among many patterns of severe chronic fatigue that Dr. Teitelbaum elucidates are drop-dead flu, fibromyalgia, and the autoimmune triad. In the drop-dead flu pattern, the patient comes down with a “brutal flulike illness” that never goes away. A virus is suspected, of course, but even long after one would expect the virus to have been vanquished, symptoms persist. The functioning of the hypothalamus is suppressed by the disease. Since the hypothalamus coordinates and directs how the other glands function and work together, its dysfunction adversely affects other important glands like the adrenal and thyroid gland that also control our energy levels. The resulting hormonal dysfunctions also disrupt the immune system leaving the patient susceptible to chronic infections.
For most people, fibromyalgia and chronic fatigue are the same disorder. Fibromyalgia is accompanied by a sleep disorder and shortened achy muscles that have many trigger or tender points. Dr. Teitelbaum says that fibromyalgia patients rarely get a good night’s sleep because they are unable to fall into a deep restorative slumber. Sleeping on achy muscles, he says, is like trying to spend the night sleeping on marbles. As in the case of the drop-dead flu, the hypothalamus, thyroid, adrenals, and the immune system are all adversely affected which in turn help perpetuate the disorder.
In the autoimmune triad the immune system attacks parts of the body as if they were invading organisms. This autoimmune reaction also creates fatigue by suppressing the hypothalamus, thyroid, adrenals, and the cells that aid in the absorption of B12.
Fibromyalgia and chronic fatigue are peculiar in that any one of the problems mentioned in the three patterns or any other pattern can trigger the other problems thereby resulting in and perpetuating chronic fatigue. Dr. Teitelbaum lists the following most common complaints of chronic fatigue and fibromyalgia: overwhelming fatigue and poor sleep, frequent infections, brain fog, achiness, increased thirst, allergies, anxiety, and depression. He also recognizes that most chronic fatigue patients are type-A personalities and that their perfectionism, their need to control, and their drivenness to succeed are ultimately rooted in the development of low self-esteem in childhood coupled with the feeling of not being able to defend their emotional boundaries. Given the peculiar nature of severe chronic fatigue, that problems in any pattern can trigger and perpetuate the disorder, Dr. Teitelbaum recommends a holistic approach that treats all the problems at once. He recommends a treatment program that includes various drugs, hormonal supplements, herbs, vitamins and mineral supplements, Rolfing, Trager, chiropractic, physical therapy, properly modulated exercise, and psychotherapy. If only one or two problems are treated, the existence of the other untreated problems will simply cause the chronic fatigue to reassert itself.
Dr. Teitelbaum mentions that there has never been a stable society in the history of human culture that has experienced the rapidity of change that we have. He fully recognizes that our fast-paced way of life is an aberration. And even though some people seem to thrive on it, more and more people are burning out from this chaotic way of living. He says, “I suspect that the physical processes that make up CFS [chronic fatigue syndrome] and fibromyalgia are manifestations of this [abnormal lifestyle]—and that we are just beginning to see the tip of the iceberg.”6 I couldn’t agree more with Dr. Teitelbaum’s assessment, and although he does not offer an evolutionary theory for fibromyalgia, his suspicions definitely point us in that direction.
The evolutionary approach will broaden and confirm why Dr. Teitelbaum’s suspicions are correct. It will give us a way to articulate what fibromyalgia is, why it manifests as the complex of symptoms uncovered by the proximate explanation, and why certain people succumb to it. An evolutionary explanation will also allow us to understand why fibromyalgia is not a disease in the ordinary sense, but a fear disorder that involves the whole person and his world.
An Evolutionary Explanation of Fibromyalgia
One rather straightforward way to understand the nature of a genetic adaptation is to remove it or interfere with its effects and observe how the organism malfunctions. Take something simple like the experience of pain. We might be tempted to believe that a life free of all pain would be a great blessing, but clearly it is not. Those rare people who are born without the ability to feel pain usually die by the age of thirty. Since their bodies do not register pain, they often unknowingly damage parts of themselves. Since they never feel uncomfortable, they often sit too long in one position, develop pressure sores, and eventually ruin their joints. Pain is obviously an important adaptation that serves to protect the organism and without it our life would become a precarious affair.
The same considerations apply to the nature of fatigue. What would a life look like without the ability to feel fatigue? The answer is quite simple: remove our ability to feel fatigue and we would eventually destroy ourselves. But if fatigue functions this way, how is it that chronic fatigue sufferers have managed to override this adaptation and so thoroughly and profoundly burn themselves out? Part of the answer to this puzzling question lies in understanding the nature of emotion, and especially the nature of fear.
In order to understand the adaptive function of emotion, let us consider what life would be like without emotion or when emotions have been blocked or suppressed. We only have to look to the field of psychology to find ample information about the effects of suppressing or interfering with the natural expression of emotion. Studies of child rearing practices in Northern Germany, for example, revealed the existence of many strict, cold, and unfeeling mothers who were unable to properly contact their infants. The child raised by a contact-avoidant mother is also contact-avoidant and “is not only to a degree ‘depressed’ but also angry and likely to express this socially in later life. The angry avoidant individual may be brilliantly successful as the world knows but potentially dangerous to himself and others. A society dominated by such individuals, as Reich in various ways has already suggested, can be a danger to the world.”7
Or consider what happens when people are subjected to abuse of any kind. To those who know nothing about the psychology of abuse, the existence of battered women unable to leave their abusive partners seems impossible to understand. Although the response to abuse is much less complicated in animals, we see some of the same pattern at work in humans. When animals are subjected to aversive stimulation that they can neither control nor escape they too become “helpless victims.” After being subjected to the abusive experiments, and then placed in experimental situations where they could easily learn to escape by jumping a barrier, these animals failed to extricate themselves from their situation. They had lost their ability to protect themselves. Other animals that had not been subjected to the aversive conditions first, managed to escape quite easily.8
Unlike the more complicated human emotions like embarrassment or the more tonic emotions like joy, fear evolved as part of an alarm system designed to protect us from danger. This conclusion was dramatically demonstrated in an experiment with guppies. On the basis of how they responded to one of their predators, a small mouth bass, the guppies were divided into three groups: timid, ordinary, and bold. Each group was then put into a tank with a bass. After sixty hours, forty percent of the timid guppies and fifteen percent of the ordinary guppies had survived. None of the bold guppies made it.9
We no longer live in the kind of environment in which the adaptation of fear originally developed, but obviously a life without the ability to feel fear, like a life without the ability to feel pain, would probably be very short indeed. Fear is clearly a very important and useful adaptation. In the stone age environment those humans who were born with little or no fear probably did not survive. As a result their genes did not become part of the gene pool. Those who did survive developed a highly sensitive and responsive alarm system, so sensitive in fact that our ancestors often found themselves responding to many false alarms. But this is just what one would expect. This sort of adaptation is based on what Nesse and Williams call the smoke-detector principle: it is better to have a very sensitive smoke-detector that gives many false alarms than a house burned to the ground. With respect to fear, “The cost of getting killed even once is enormously higher than the cost of responding to a hundred false alarms.”10
As phenomenologists have pointed out, human emotions are disclosive forms of intentionality.11 They cannot be reduced to mere neurophysiological processes or to the release of chemicals like adrenaline or noradrenaline, because they are also forms of understanding. Emotions not only warn us when we are about to make wrong choices, they also can propel us toward exciting new opportunities. Emotions inform us about the nature of our world and guide us in knowing what we truly want. Before we find the right words to explain our actions, we often know that a course of action is wrong simply because it feels wrong. The great intellectual virtuosity that we modern people display is a quite recent development in our evolutionary history and we often forget that our ancestors relied primarily on feeling to understand and manage their world. The suppression of feeling and bodily sensation is an aberration of the modern world, not an evolutionary advance. A healthy, modern person would be one in whom the cognitive and feeling functions are integrated. The intellect of a healthy person does not attempt to understand the world at the expense of feelings and bodily sensations that have been suppressed. Nor is a healthy person an anti-intellectual or one who allows his conflicted emotional states to override appropriate cognitive functioning.
Without our emotions, we lose our sense of connectedness and our bearings. A situation that brings us great sadness also teaches us to avoid similar choices in the future. A low mood may prevent us from acting “precipitously to escape temporary difficulties, but as difficulties continue to grow and our life’s energies are progressively wasted, this emotion helps to disengage us from a hopeless enterprise so that we can consider alternatives. Therapists have long known that many depressions go away only after a person finally gives up some long-sought goal and turns his or her energies in another direction.”12 Without the ability to mobilize our anger when attacked we would be unable to defend ourselves. Free flowing feeling and sensation connect us with nature and with others. Warm openhearted humans are not driven by perverse, unconscious desires to destroy their environment, abuse their children, or dominate others.
When we integrate the evolutionary perspective with the phenomenological and psychological, we see that our emotions evolved as a way to understand our world, and, in the case of fear and anger, as a forms of protection. Healthy emotion and feeling help to guide and direct our lives. In certain respects they are like the adaptations of pain and fatigue. When they are blocked or suppressed they can cause us and others great harm. But when they function properly, they are an integral part of how we come to understand, care about, manage, and find our place in the universe and our world.
By consolidating the above insights, we can understand the seemingly incomprehensible way that people with fibromyalgia override their bodies’ defense against overexertion and end up exhausted. Fibromyalgia is not a disease in the usual sense, it is a fear disorder based on a genetic quirk. It is a maladaptive fear response that results when unrelenting stress and trauma, destructive parenting, and/or childhood trauma are coupled together in a highly sensitive individual who pursues the futile attempt to live in a chaotic world at odds with his or her bodily and psychic resources. Since fibromyalgia begins as a maladaptive fear response, it begins as a central nervous system disorder that then spreads to the entire body, but especially to the endocrine and immune systems.13
Ever since Hans Selye published his ground-breaking research on stress, there is hardly anyone who does not know how damaging stressors can be to our bodies and our immune systems. Recent evidence suggests, for example, that secretion of the stress hormone cortisol may actually be part of the way the body protects itself from the damage from other aspects of the stress response. A life free of stressors is impossible and probably not even desirable. In truth, only when stress becomes distress do problems result. Even though many fear responses are false alarms, in manageable numbers with enough time in between, such responses are still adaptive and not damaging to our bodies in the long run.
But consider what happens to people whose alarm systems are always being triggered. Their body would never have enough time to recuperate from the stress response. They would become hypervigilant and unable to experience the restorative nature of deep sleep or parasympathetic relaxation. They would always be getting ready to either defend themselves or flee, and their autonomic nervous system would be locked into a high state of sympathetic arousal. Their ability to experience deep restorative sleep would deteriorate further and over time they would become achy and exhausted. (Research demonstrates that when normal people are deprived of deep restorative sleep, they develop the symptoms of fibromyalgia within two weeks, including achy shortened muscles.) They would become cold and experience more thirst, and they would become susceptible to infections because their hypothalamus, thyroid, adrenals, and immune system would cease to function properly. This description is clearly the picture of fibromyalgia, but the question still remains, “How did these people get locked into this fear state, a state in which their alarms are constantly being triggered by their world?”
All animals and humans have an instinctive desire to discharge sympathetic arousal. If an animal or human is successful in dealing with a dangerous situation by fighting or fleeing, sympathetic arousal will be successfully discharged. The nervous system will shift from its state of high sympathetic arousal to the relaxed parasympathetic response. But if an animal is unable to successfully deal with an attack, it will “play possum.” It will go into a high state of sympathetic arousal, a freezing immobilization response that mimics death. This immobilization response serves at least two functions: it anesthetizes the animal from pain, and it may deceive the predator long enough so that the animal can escape when the predator is not looking. If the trauma is unrelenting as in the study cited above where animals were put into abusive experimental conditions, the animal can remain stuck in fearful and helpless immobility unable any longer to defend itself.
In the face of threats or injuries that we can neither control nor escape, we humans also have the ability to immobilize ourselves. We do it by simultaneously freezing (becoming rigid) and falling into a disassociated state of collapse. Indeed, most traumatized people who have not received appropriate therapy show varying degrees of both the rigid freezing response and the collapsed dissociated response. Unrelenting or unresolved trauma leaves us fearful and helplessly immobilized in a state of high sympathetic arousal that we are unable to discharge. Not recognizing how their high sympathetic arousal and immobility are rooted in fear, many severely traumatized individuals become thrill seekers in an attempt to discharge their highly agitated state. Unfortunately, this unconscious strategy provides only a momentary illusion of discharge. In reality, it actually creates even more highly charged states of sympathetic arousal and immobility. Many also experience a kind of helpless immobility that leaves them unable to summon the volition and energy to defend themselves or leave their abusive situations. They become “victims.” Since neither way of being allows for discharge, these people can never fully relax. Under such conditions exhaustion is the expected sequella.14
Fibromyalgia can be divided into two broad and sometimes overlapping types, posttraumatic and primary. Posttraumatic fibromyalgia seems to result from a series of traumatic events such as multiple car accidents or surgeries. Even though posttraumatic patients may not always exhibit the same psychological and emotional precursors that patients with primary fibromyalgia do, both types are clear examples of a chronic fear condition. For both types the world has become a fearful place.
As Dr. Teitelbaum points out, most primary fibromyalgia patients have low self-esteem; they are perfectionists who are driven to control their world and succeed in it. As he said in a lecture once, most of these patients, even if they were to receive four Nobel prizes, would still think they hadn’t done enough. Due to their low self-esteem many have a fear of being seen as weak. As an unconscious strategy to get the approval they never received as children, they become driven overachievers and perfectionists. As a result, they burn out in the futile attempt to feel good about themselves by seeking external approval. Their low self-esteem is sometimes the result of having been abused or made to feel inadequate by destructive parents or significant care givers. As adults, many find themselves caught in seemly impossible no-way-out situations where their every action seems to make all the difference between imminent disaster and a momentary reprieve. Everything seems to depend on them and they seem incapable of ever extricating themselves from a life full of imminent disaster, stress, or danger. As a result they constantly sacrifice themselves and rarely do what makes them happy.
Like the abused experimental animals and many battered women, people with fibromyalgia have lost the ability to protect themselves and do what is best for their own well-being and happiness. Many unconsciously believe that they were the reason for the abuse that they suffered as children. As adults they often think that they are the cause of other people’s outbursts. Like the abused experimental animals, they cannot jump the barrier and escape damaging and exhausting ways of living. Like most people with fear disorders, they suppress and deny their fear and, as a result, block their ability to trust. Unable to trust they often find themselves unable to open to the love we all want and expect. In place of defending themselves, many talk excessively about their situation, often complaining bitterly about how they have been mistreated and misunderstood. In the end, they are only looking for someone to give them the love, support, and sense of safety they never had. For only in a safe therapeutic environment is it possible for traumatized individuals to appropriately discharge their highly tuned states of sympathetic arousal.
Another very interesting characteristic of people with fibromyalgia is that they tend to be very sensitive people, hypervigilant and alert to what others are feeling around them, and often much better informed about their condition than most doctors. Some are even psychic. Their sensitivity may be the defensive result of the unresolved trauma suffered in childhood or the result of evolution—or both. It may be that our genetic susceptibility to fear can be placed on a continuum, and that fibromyalgia patients tend to be more sensitive than others. This kind of sensitivity was a great advantage in a stone age environment, and these kind of people were probably highly prized by their communities. But when this sensitivity is combined with destructive parenting, excessive unresolved trauma, and/or unrelenting stress, it produces fearful people. In the case of primary fibromyalgia, it produces driven people with perfectionist tendencies who have a need to prove themselves. When people with this kind of fear disorder, whether primary or posttraumatic, choose or are forced to compete in our chaotic modern environment with its high levels of stress and never-ending onslaught of real and imagined dangers, they cannot help but find themselves in a constant state of fear as their alarm systems are continually being triggered. For such people, it is no wonder they become more and more exhausted and fall into severe chronic fatigue. When people with primary fibromyalgia meet our modern environment with their perfectionism, the consequences are deadly and the logic clear: driven to succeed, perfectionists can never reach their impossible goals, and exhaustion is the byproduct of all their efforts.
The extreme sensitivity of people with fibromyalgia brings them into conflict with the important people in their lives who often imply that their symptoms are “all in their head.” They are often made to feel guilty about their suffering by their doctors, therapists, and significant others. This reaction is especially prevalent among those whose own feelings are deeply repressed, because such people find the sensitivity and pain of the fibromyalgia patient a threat to their tidy, overly intellectualized, and repressed world. It is no wonder that fibromyalgia sufferers become angry and depressed. Depression and anger are not the causes of fibromyalgia or necessarily part of the array of symptoms, but the secondary results of it. Anger is a natural response to a physical and/or verbal attack and not being understood. Abused people are understandably angry, but when anger is repressed, as it often is in fibromyalgia, it also leads to exhaustion and depression.
In studies of vervet monkeys, researchers discovered that the high ranking alpha males had twice the amount of serotonin levels than other males. “When these ‘alpha males’ lost their position, their serotonin levels immediately fell and they huddled and rocked and refused food, looking for all the world like depressed humans.”15 When Prozac was administered to these deposed alpha males, these behaviors did not appear. Even more surprisingly, when the alpha male was removed from a group and Prozac was administered to any randomly chosen male, he became the new alpha male every time. Prozac can raise serotonin levels, but when given to a person suffering from the fear driven nature of fibromyalgia, such a prescription may only be a temporary solution that masks a complicated disorder. If the driven nature of the fear disorder is ignored, Prozac may give the patient an illusory boost, but one that could propel him to take up his stress filled lifestyle once again. The eventual result would be to drive the patient into further exhaustion.
Loss of position and loving what we cannot have also leads to depression. Every fibromyalgia sufferer is either in the process of losing their position in the fast-paced modern world or has already lost it. Especially in the early days of treating their problem, many sufferers still dream of returning to the chaotic pace and competition of the world even though they no longer have the energy to compete and be successful in it. Many still want to return to this kind of chaos even when they know that this is the kind of existence that brought them to their present state of overwhelming exhaustion. If they get a momentary boost of energy from their treatment program, they often immediately jump back in to their fast-paced approach to life and work all the harder trying to make up for lost time. As a result, they create a terrible flare-up and are exhausted and nonfunctional for days. The hardest lesson the fibromyalgia patient has to learn, the most bitter pill they have to swallow, is that they cannot return to their old life. When they finally realize the truth of this life-giving recommendation and give up trying to achieve what they cannot have, their depression lifts and they can begin the process of overcoming their suffering.
Whether real or imagined, if our fear is constantly being triggered by the world in which we live, we will become frozen in the numbing immobility response that constitutes high sympathetic arousal. In such a state, if we persist in the futile effort of trying to keep up with a world that is at odds with our psychophysiological resources, the downward spiral of chronic fatigue is the likely outcome. When we are exhausted and no longer able to protect ourselves, the world becomes and is perceived as an even more dangerous place. A fear disorder begets more fear and, as a result, the sufferer’s world becomes increasingly more alarming.
Under such conditions, it is easy to understand why people with chronic fatigue are subject to frequent infections. Since they are constantly responding to alarms that they can neither fight nor flee, their fear begets more fear; they are driven to higher and higher levels of sympathetic arousal that they are unable to discharge and, as a result, they become more and more exhausted. Their fear results in a state of constant neurological overdrive that eventually exhausts their entire organism, which then in turn depresses their immune system.
Through the pioneering research of Candice Pert, Ph.D., we now know that a group of molecules called peptides are both produced by and act as the communicating link between the nervous, endocrine, and immune systems. Every cell in the body has an abundance of specific receptor sites to which peptides can attach themselves. It is no longer possible to view the nervous, endocrine and immune systems as three separate systems serving different functions; rather they must be seen as one network in communication with the entire organism. “By interlinking immune cells, glands, and brain cells, peptides form a psychosomatic network extending throughout the entire organism. Peptides are the biochemical manifestation of emotions; they play a crucial role in the coordinating activities of the immune system; they interlink and integrate mental, emotional, and biological activities.”16 Peptides alter behavior and feeling states and some researchers suspect that each peptide may evoke unique emotional states. The entire intestine is filled with peptide receptors that allow us to experience our feelings at a “gut level.” Recall the research summarized in footnote 13 that showed a connection between the central nervous system and increased sensitivity to visceral pain and it becomes very clear that a maladaptive fear response is a kind of neurological overdrive, which by virtue of the peptide communication system, must affect the entire organism. In the end, it cannot but exhaust and defeat the immune system’s ability to ward off or resist disease.
By consolidating the broader evolutionary explanation within the phenomenological perspective, our examination of fibromyalgia as a maladaptive fear response reveals an even deeper, more far reaching understanding of immune system disorders than one might otherwise suspect. As I pointed out elsewhere,17 a phenomenological approach to fear shows that it is an orientation toward the world in which the person does not want to be present. For most people, a loaded gun placed at their head accompanied by angry threats is enough to make them not want to be present. Fear mobilizes us for action. But as we have seen, if we are constantly subjected to the kind of pain, stress, or abuse that we can neither control nor escape, we will remain helplessly immobilized and unable to defend ourselves. In order not to be present to our suffering under such conditions, nature has given us a way to escape by providing us with a way to numb our experience. If we are unable to escape by running away or by fighting, we immobilize ourselves by going into high state of sympathetic arousal. If we remain stuck in this immobilization response, we, in effect, anesthetize the boundaries of self and body and cease being fully present in the present.
Living organisms are self-organizing. They persist because they are constantly in the process of forming boundaries in response to their ever-changing environments.18 In a sense, an organism is like a water fountain whose constituent materials are being rapidly replaced while small but related variations of the form remain the same over time. But unlike a fountain where the form is maintained by outside forces, organisms have the inherent power to maintain and adapt their form to a changing environment. This is part of what it means to be alive. To be is to be a form. Every form has a boundary. Remove the boundaries of a form and it ceases to be. Since living forms are different from nonliving forms in that they are self-organizing, they must continually maintain and adjust their boundaries to ever-changing internal and external environments. Maintaining and evolving boundaries in the face of ever-changing environments is also part of what it means to be healthy and to have a self.
By numbing their boundaries through rigidity and collapse, people with fear disorders manage to escape their situation to some degree, but at a great cost. As we have already seen, they lose their ability to defend themselves. But the ability to defend oneself rests on the prior condition of having a clear sense of self and boundaries. In a very real sense, a fear disorder is a swoon into formlessness. People with fear disorders live a life in which their psychobiological form wants to become formless. Because identity and the on-going creation of boundaries go hand in hand, the swoon into formlessness is also a loss of the integrity of one’s own identity. Without a clear sense of self-identity, defense of self is difficult.
With these considerations in mind let us turn our attention to the immune system. One obvious function of the immune system is to defend us against invading disease organisms. But more interesting than the question of the how the immune system accomplishes this amazing feat of defense is the logically prior question as to how the immune system distinguishes between self and not self in the first place. Defending oneself against an attacker and defending oneself from disease both require a sense of self identity. Although it may sound as though I am merely trading on metaphors to make this point about the self and the immune system, recent immunological theory and research is beginning to confirm Elie Metchnikoff’s revolutionary and profoundly important insight that the immune system may be the biological ground of self-identity.
Metchnikoff (1845–1916), a Russian zoologist, was the first to recognize immunity as an active response of the host to infection. In marked contrast to genetic reductionism that claims that all biological properties of an organism, including morphology, are determined and can be explained by their genes, Metchnikoff pioneered a sophisticated holistic understanding of the whole organism that began with his investigations into the immune system. For Metchnikoff, “immunological processes are, above all, those activities that constitute organismic identity, and only as a consequence of secondary phenomena do they also protect. Correspondingly, these processes cannot be simply reduced to functions of recognition of other and/or protection of host. Rather, in Metchnikoff’s more far-reaching view, self-identity arises from the dynamics of these immunological activities. The heuristic value of this information has yielded extraordinary insight.”19
The inability of a person with a fear disorder to defend himself is the same as the immune system’s inability to defend itself against infection. A person with a fear disorder has a problem in self-identity and hence, self-organization. Since the human organism is a unified being that includes an evolved consciousness, this problem of self-identity is not just a psychological problem: it exists all the way down from the psychological to the cellular level. The essential structure of biological organization is “shared at the cellular, individual, and ecological levels....This reflects a highly dynamic, holistic vision of biology with the ‘self’ taking its rightful place as the unifying concept of actively developing, diverse selective systems.”20
An organism that has lost some of its boundaries is an organism unable to protect itself at all levels. When human organisms cease to function without a clear sense of self and boundary, they can become “helpless victims” subject to infection and in danger of repeated insults from their world. They will also become subject to autoimmune diseases because they have trouble clearly distinguishing aspects of themselves from invading organisms. Likewise, they will become subject to self-destructive tendencies because they have trouble distinguishing themselves from their abusers. As I mentioned earlier, it is a well known fact that adults who were abused as children have the sense that they were somehow at fault and therefore brought the abuse upon themselves.
Our exploration of proximate and evolutionary explanations gives us the understanding that fibromyalgia is a fear disorder that begins in the nervous system and ultimately compromises the whole person. A phenomenological consolidation of these insights reveals that fibromyalgia cannot be fully understood unless we see it as an existential condition—a problem in the way in which the whole person lives his or her world. Since fibromyalgia is a disorder of the lived-reality of the whole person and his or her world, no one treatment, by itself, will turn the tide of chronic fatigue. A conventional corrective approach that only addresses the problem symptom by symptom cannot be successful. Fibromyalgia by its very nature requires a holistic approach.21 Fortunately there is hope as Dr. Teitelbaum’s research and holistic approach to treatment demonstrate. Gentle Rolfing, physical therapy, osteopathic manipulation, Trager, massage, hormone supplements, certain drugs, certain vitamins and minerals, diet, properly supervised exercise in the latter stages of treatment, herbs, acupuncture and the like are all helpful, but only when they are done together—and, most importantly, in the order that suits the unique requirements of each patient.
Since fibromyalgia is a fear response rooted in unresolved trauma and/or relentless stress that is constantly being triggered by the patient’s world, it goes without saying that a form of psychotherapy that is capable of discharging chronic sympathetic arousal is an extremely important part of the treatment program. Since fibromyalgia is an existential condition that involves the whole person, its sufferers must first learn how to release themselves from the conflicts and fixations that stand in their way of protecting and caring for themselves. Then they must learn the more difficult task of how to live their lives differently in a chaotic world. By itself, psychotherapy is not enough, just as by itself, Rolfing or drug therapy is not enough. Unless all the therapies are employed in the correct sequence within a com-prehensive holistic program, there is little hope for recovery. If the theory advanced in this article or some version of it is correct, then such a program of treatment must fully recognize that fibromyalgia is an existential condition, and address how this way of being is rooted in an immobilizing fear response that is constantly being triggered by the patient’s world.
The Existential Crisis of Fibromyalgia
Our modern world is an aberration. It is filled with people who have lost touch with the wellsprings of life and being. Since we live in a world that has suppressed and does not value the kind of whole body feeling and sensation that connects us to our world and with one another, we live too fast and are in continual search of new thrills to stimulate our anesthetized bodies. Instead of using the wonderful discoveries of science and technology to care for our environment and others, we seek more ways to entertain ourselves while we destroy the very environment upon which our survival depends. We are the first species to systematically disassociate from our roots and soil our own nest.
The conceptual framework that supports the crisis of our modern world was first formulated 2,500 years ago by Plato and completed in the 1600s by Descartes. Plato asked the question, “What is being?” not by wondering how we experience it, but by asking the epistemological question, “How do we know being?” From the moment Plato asked the question this way he set the stage for how the Western world from then on would approach the nature of reality and self. Eventually this epistemological turn gave rise to science. Plato also argued that the mind is to the body as the pilot is to the ship. Everything that has to do with the ever changing earth plane, such as bodies, feelings, emotions, nature, and femininity are all imperfections to be eschewed for dwelling with the eternal masculine principles of mind and reason. Plato said that our true home is in a non-bodily, eternal, unchanging realm not of this earth.
Many centuries later Descartes attempted to lay the foundations of science by arguing that nature and living bodies are nothing but machines to be understood according to causal laws articulated in the language of mathematics. In Descartes’ view, a human being is like a ghost that somehow mysteriously inhabits a body that is nothing more than a soft machine. By the nineteenth and twentieth centuries this mechanistic assumption had infected the way most people view their bodies and the nature of life in general. Like so many repressed people, both Plato and Descartes extol the virtues of reason and mind over the messiness of body and feeling. Both philosophies support an understanding of spirituality that stands in denial of our bodily being and connectedness to nature. Because these views are at the foundation of how conventional medicine approaches most disorders, and how many modern people think about themselves and their world, and because they support so many unhealthy ways of being, I prefer to call this kind of philosophy the metaphysics of disease.
The modern world and the rise of science are unthinkable without the philosophies of Plato and Descartes. We have both benefited and suffered enormously because of this conceptual framework. Because of it, many of us are now living in unbelievable and unprecedented material comfort while simultaneously experiencing a deep sense of disconnection from our bodies and environment. Meanwhile our cities are crumbling, many of our children have become drug addicts and hardened criminals, and people everywhere are complaining of stress and looking for the meaning of their life. We know that something is dreadfully wrong, but we have no idea what to do about it. It is as if we were on a fast train that we know is careening out of control, but that is so deliciously seductive and fascinating that we can’t quite get off.
Fibromyalgia is but one manifestation of a world out of control. Like so many of our problems that require a whole system reorganization, it is often not recognized for what it is. Instead of recommending the much needed holistic treatment approach, ineffective piecemeal, mechanical solutions are typically all that are offered to patients. Chronic fatigue syndrome is a wake-up call for the rest of us and a profoundly important expression of the spiritual crises of our times. The word “crisis” means “turning point” and a true spiritual turning point is one that stops us dead in our tracks and demands one and only one solution—that we transform the way we live. The best hope for people with chronic fatigue is to see through the seductions of the modern world and get off the train. Anything short of transformation is nothing more than a mechanical stopgap measure, and simply the wrong solution.
A spiritual crisis arises when we reach the end of our belief in short term attempts to change the symptoms of our distress. At such moments we finally come to understand that the solution ultimately lies within ourselves. When we have reached the end of our rope, the solution is not to hang on for dear life, but to surrender. Surrender in this context does not mean to give up or submit unwillingly to outside demands, but to let go of our conflicted and fixated self in the profound sense embraced by all the world’s great spiritual teachings. For it is in such moments of profound creative surrender that all healing happens.22
Creative surrender is not demanded when we know how to deal with a problem. When we have the flu or a flat tire, we are not tempted to ask about the meaning of life. But when we find ourselves caught in a true crisis, only creative surrender is capable of transforming our situation. The phenomenological consolidation of the proximate and evolutionary explanations is important because it helps us to understand how chronic fatigue is a fearful way of being-in-the-world that begins in the nervous system and ultimately compromises the entire person in relation to a world gone awry. But the ultimate solution to an existential condition is the one that reaches all the way to the spiritual crisis at the heart of the problem. The phenomenological consolidation of the proximate and evolutionary explanations is necessary and important, but the ultimate answer to the question, “Why did this happen to me?” is the transformation of the person who asks the question.
We have all the knowledge we need to change our world. What we are lacking is the kind of wisdom that is represented in traditional cultures and the great religions—the kind of wisdom which, because it transcends blind belief, dogma, and cultural bias, can transform a life and the world. “Wisdom is not out of reach. It requires a recalibration of the ego. The mental equipment is there but unused. Like chimpanzees who do not know how intelligent they are, we are only dimly beginning to perceive the possibilities of which our minds, operating in society, are capable.”23 Recalibration of the ego, or as I prefer to say, transformation of the whole person is indeed possible, but it also requires a transformation of the conceptual framework through which we view ourselves and nature. Since so much of our health care system rests on the assumption that the body is nothing but a soft machine, it is committed to treating their patients as if they were composed of symptomatic parts. The failure of fibromyalgia patients to respond to such an approach very clearly demonstrates the need for a holistic approach. Such an approach should be properly grounded in the holistic advances of the new biology, as well as sensitive to the unified nature of our whole being in relation to a world, and our inherent drive to understand our place in all of this of which of we are a part. A crisis is always at the heart of every turn toward transformation and the crisis of our times is no different. Its existence predicts a revolutionary shift toward a new kind of wisdom that embraces a science that is true to realization and fulfillment of our human being in relation to being itself.
The spiritual crisis at the heart of fibromyalgia is the same one at the heart of our modern world. On a small scale, any attempt to transform the life and world of a person with fibromyalgia is the same as the attempt to transform our shared world. All the signs are here, of course, but now is the time to resurrect our bodies, our deep biological feelings of connection, and to engage the whole of what we are in every attempt to understand and transform our world—not so that we can regress to a simpler stone age existence, but so that we may integrate our philosophy, science, technology, conventional, and complementary therapies to evolve a better world.
Appendix F: Stone Agers in the Fast Lane: An Evolutionary Approach to Fibromyalgia
1. Randolf M. Nesse and George C. Williams, Why We Get Sick: The New Science of Darwinian Medicine, (New York, NY: Vintage, 1994), p. 7. The title, “Stone Agers in the Fast Lane,” as well as many of examples I use in this article come from this book. After a number of stimulating discussions with Bruno D’Udine (formerly senior researcher of the Italian National Research Council responsible for bilateral research projects with the Universities of Cambridge and Edinburgh, and presently at Parma University, Italy), I was encouraged to write this article on fibromyalgia. Along with many other important articles and books, he recommended that I read Nesse and William’s work in evolutionary medicine. I am grateful for his support and untiring efforts at pointing me in all the right directions. I also especially want to thank Jacob Teitelbaum, M.D., and Thomas Romano, M.D., for reading an earlier version of this paper and offering their thoughtful criticisms and insights.
2. Ibid., pp. 88-90.
3. Ibid., p. 10.
4. Ibid., p. 243.
5. Jacob Teitelbaum, M.D., From Fatigued to Fantastic, (Garden City Park, NY: Avery Publishing Group, 1996).
6. Ibid., p. 74.
7. John H. Crook, The Evolution of Human Consciousness, (Oxford, 1980), pp. 285–292.
8. Ibid., p. 291.
9. Nesse and Williams, op. cit., p. 213.
10. Ibid., p. 213.
11. Jeffrey Maitland, Spacious Body: Explorations in Somatic Ontology, (Berkeley, CA: North Atlantic Books, 1995). See especially Chapters Two and Three for an explication of intentionality and a theory of emotion that includes an analysis of the important differences between fear and anxiety. Fear and anxiety are obviously related physiologically, but phenomenologically they are quite different. Fibromyalgia is not a panic or anxiety disorder, even though panic attacks and anxiety are often experienced in this disorder. My attempt in this article is to consolidate the proximate and broader evolutionary explanations within a phenomenological perspective in an effort to show how fibromyalgia is an existential condition rooted in a maladaptive fear response that is constantly being triggered by the sufferer’s world. The proximate and evolutionary explanations show that fibromyalgia is a fear disorder that begins in the nervous system and ultimately compromises the entire person. The phenomenological perspective shows how fibromyalgia is a problematic way of being-in-the-world—an existential condition that involves the whole person in relation to his or her way of living a world gone awry.
From the point of view of how to treat fibromyalgia, this broader evolutionary and phenomenological perspective is important for two related reasons: 1) it explains why any corrective treatment protocol that addresses this disorder symptom by symptom cannot be effective, and 2) it supports and explains why the holistic approach to fibromyalgia is so critically important to its proper treatment.
12. Nesse and Williams, op. cit., p. 217.
13. Some studies suggest an important link between the central nervous system and chronic fatigue. Researchers John LaManca, Ph.D., and Benjamin Natelson, M.D., compared the ability to concentrate of patients with chronic fatigue to normal controls after exercise. They found that the cognitive functioning of chronic fatigue patients was significantly impaired. One hour after exercise their ability to concentrate was significantly impaired and twenty-four hours later it had diminished even further. Daniel Clauw, M.D., discovered that not only is pain sensitivity increased in the peripheral muscles of people with fibromyalgia but also in their smooth muscles of the viscera. Both of these discoveries point in the direction of CNS dysfunction in fibromyalgia. These results were reported in the Fibromyalgia Network, 36th edition, January, 1997, Tucson, Arizona, p. 7 and p. 10 respectively. I am grateful to my colleague and well-known expert in chronic fatigue and fibromyalgia syndrome Darice Putterman, P.T., who shared the above research with me. Her valuable insights and knowledge have been of great benefit to me in writing this article.
14. My understanding of the immobilization response to shock-trauma comes from the pioneering work of Dr. Peter Levine, a physiological psychologist, therapist, and Rolfer, and my fellow instructor at the Rolf Institute of Structural Integration who is also a gifted trauma specialist, William Smythe. For more information on this important work, see Peter Levine’s Waking the Tiger: Healing Trauma (Berkeley, 1997). Also important to my understanding of the sympathetic and parasympathetic response is the work of researcher, Rolfer, and physical therapist, John Cottingham. Cottingham and his colleague Steven Porges, a physiological psychologist, were able to demonstrate that the application of the Rolfing holistic approach of manual therapy not only changed structure, but also significantly boosted the parasympathetic response. There are many important insights to be gleaned from their studies, but one of the more interesting is the comparison of the effects of a symptomatic or corrective approach to a holistic approach on the parasympathetic response. As it turns out, only the holistic approach to manual therapy produces a significant and long lasting parasympathetic response. See the following publications by John T. Cottingham: Healing Through Touch: A History and Review of the Physiological Evidence, (Boulder: Rolf Institute, 1985); “Effect of Soft Tissue Mobilization on Pelvic Inclination Angle, Lumbar Lordosis, and Parasympathetic Tone: Implications for Treatment of Disabilities Associated with Lumbar Degenerative Joint Disease,” presented to the National Center of Medical Rehabilitation Research of the National Institute of Child Health and Human Development, March 19, 1992, Bethesda, Maryland and reprinted in Rolf Lines, Rolf Institute, (Spring, 1992), pp. 42–45; “Soft Tissue Mobilization (Rolfing pelvic lift) and Associated Changes in Parasympathetic Tone in Two Age Groups,” co-authors Steven W. Porges and T. Lyon, Physical Therapy, Vol. 68, 1988, pp. 352–356; and “Shifts in Pelvic Inclination Angle and Parasympathetic Tone Produced By Rolfing Soft Tissue Manipulation,” co-authors Steven W. Porges and K. Richmond, Physical Therapy, Vol. 68, 1988, pp. 1364–1370.
15. Nesse and Williams, op. cit., p. 219.
16. Fritjof Capra, The Web of Life: A New Scientific Understanding of Living Systems, (New York, 1996), pp. 282–283. See also Molecules of Emotion: Why You Feel the Way Feel by Candice Pert (New York, NY: Doubleday, 1997).
17. Jeffrey Maitland, op. cit.
18. Francisco J. Varela, Principles of Biological Autonomy, (New York, 1979).
19. Alfred I. Tauber, The Immune Self: Theory or Metaphor, (New York, NY: Cambridge University Press, 1994), p. 43.
20. Ibid., p. 96.
21. The holistic approach to many problems is often more successful than the corrective approach. For a case study that compares the holistic and corrective approach to the treatment of chronic low back pain, see “A Third Paradigm Treatment Model Using Soft Tissue Mobilization and Guided Movement-Awareness techniques For Patients with Chronic Low Back Pain: A Case Study” by John Cottingham, P.T., and Jeffrey Maitland, Ph.D., The Journal of Orthopaedic and Sports Physical Therapy, September, 1997, Vol. 26, No. 3, pp. 155–167.
22. For a more detailed examination of what it means to surrender in the contexts of healing, creativity, and transformation, see my book, Spacious Body, (Berkeley, 1995), especially Chapter Four. Also relevant are my articles, “Creativity” in The Journal of Aesthetics and Art Criticism, (Vol. XXXIV, No. 4, Summer, 1976), pp. 397–409; and “Creative Performance: The Art of Life” in Research in Phenomenology, (Vol. X, 1980), pp. 278–303.
23. John H. Crook, op. cit., p. 411.
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