"The Body Keeps the Score"

  I have an agenda with today’s column. I want to get the following point across – the mind and body are connected. Yes, I know you have heard that before, but I am going to present a twist on that story that you may not have heard. My journey with this concept starts around 1988. At that time, I was a young attending physician in the department of general internal medicine at the New England Deaconess Hospital in Boston. Dr. Herbert Benson was a senior physician and researcher on the topic of Mind-Body connections. Specifically, Dr. Benson did pioneering research demonstrating that individuals who were trained, such as Buddhist monks, could lower or raise their body temperatures, or significantly change their brain waves monitored by EEG through meditation. He noted further that individuals who meditate regularly have lower blood pressure and over time, lower rates of metabolic stress. Dr. Benson coined the phrase “relaxation response” that characterized the array of physiological metrics that improved with a simple meditation technique. Dr. Benson taught that the relaxation response could be easily elicited by repeating a word or phrase and allowing extraneous thoughts to float away.

     Dr. Benson hired me part-time to work in his clinic with patients with high blood pressure. I saw time after time that stress contributed to high blood pressure and that invoking the relaxation response brought blood pressure down. I was therefore able to reduce the amount or totally eliminate blood pressure medications for the majority of patients that I worked with. Eliciting the relaxation response through regular simple meditation also brought about a new sense of well-being for many of these patients.

     With more years of internal medicine practice under my belt, I became ever more convinced that stress – work stress, family stress, financial stress, health stress, relationship stress, you name it stress – caused an unbelievable number of physical ailments. This is a very key point in the story -- stress, which is perceived as completely psychological and emotional played out for patients with multiple somatic symptoms such as high blood pressure, headaches, rashes, abdominal pain, fatigue and insomnia to name a few. In other words, the mind-body connection is alive and well.

     Now comes the newer learning for me that I came upon through my own adventure with yoga. My wife (who got me into yoga about 15 years ago) and I were invited to a lecture through the auspices of Kripalu, a yoga retreat center in the Berkshires where we go annually for a yoga vacation. The speaker that evening was Dr. Bessel van der Kolk. Dr. van der Kolk is a psychiatrist who specializes in treating patients with post-traumatic stress disorder (PTSD). I had known for a long time, as described above, that stress induces lots of physical symptoms. The insight that he delivered that evening is that the way out of emotional/psychological stress can also be physical! This is the new part and I have to repeat it. The way out of emotional/psychological stress is physical. What does that mean? It means that exercise, dance, singing, meditating with attention to breathing, yoga, and other physical forms of expression – can all lead to a profound release and decrease of stress. Now that may seem obvious to some of you who will say, “I always feel better when I exercise”. Or “dancing regularly helps keep the blues away”. Or “playing music totally keeps my spirits up”. It’s sort of reminiscent of what Glinda, the good witch of the North, tells Dorothy towards the end of The Wizard of Oz to the effect that, “You don’t need to be helped any longer. You have always had the power to go back to Kansas…” In other words, the power to evoke these curative processes is innately within each of us.

     Dr. van der Kolk in his book, “The Body Keeps the Score” skillfully shows how stress becomes physically lodged in our bodies, and that the very stress that brought it into the body can often be undone through physical means. This insight is earth shattering in the field of psychiatry which has been exclusively wedded to talk therapy and medications. Now don’t get me wrong. I am a big fan of what traditional psychiatry has to offer people with stress, anxiety and depression. I am simply suggesting that using these physical modalities to reduce stress can be remarkably helpful.

     Imagine for a moment two very stressed individuals, perhaps who also experience some degree of anxiety and depression. Our first person, Barbara, spends the entire day indoors in front of her laptop or television and gets no exercise and does not participate in any other form of physical, musical, artistic or other expression. Our second person, James, agrees to add daily walking outside for 20 minutes, a 20-minute daily stretching program, and 20 minutes of daily yoga while listening to his favorite music. Which person do you think is going to be feeling better in 2-4 weeks? You got it. James!

     You could possibly say that none of this is real, and certainly not provable. Dr. van der Kolk in his book reviews a large number of well-done studies that illustrate that this phenomenon of treating stress with physical modalities is truly effective.

Here are a few quotes from his book that caught my attention:

•  “Traumatic experiences … leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems”
• “Human beings are astoundingly attuned to subtle emotional shifts in the people (and animals) around them. Most of our energy is devoted to connecting with others.”
• “The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral is the royal road to emotional regulation, this demands a radical shift in our therapeutic assumptions.”
• “When we pay focused attention to our bodily sensations, we can recognize the ebb and flow of our emotions and, with that, increase our control over them.”
• “Once you start approaching your body with curiosity rather than fear, everything shifts.”

    Now is a time of major stress and challenge for all of us, with no clear end in sight. We can expect more stress, anxiety and even depression. Today’s column hopefully serves up some effective antidotes to the blues. People will gravitate to different solutions that make sense for themselves – some like exercise, some like dancing, some like meditation, some like music, some like other activities. The good news is the more of these activities you can do, the more beneficial effects you will accrue. As a physician, I would much rather prescribe a healthy activity than a pill – no side effects, no trips to the pharmacy and its free!

 References:

1. Bessel van der Kolk, M.D., “The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma”. Penguin Books, 2014.
2. Herbert Benson, M.D., “The Relaxation Response”. Harper Collins, 1976.