Many years ago, when struggling with anxiety, I saw a psychologist. I was asked to fill out a lot of forms. One of them asked, “do you cry a lot?” I answered ‘yes” and then wrote off to the side, “and I think this is healthy”. The psychologist asked me why I wrote that and I responded, “because just asking the question implies there is something wrong with you.” He actually appeared somewhat perplexed to me, and in the end the session was more about his process of trying to label me with a diagnosis to determine the best recommendation for a medication referral. Suffice to say I did not go back.

I have “worn my heart on my sleeve” my entire life and have faced a great deal of external and internal difficulty around that, but have learned that crying is a way to manage the flow of both conscious and unconscious energy and information through the ‘bodymind’, and ultimately is a strength. I was taught (and any indigenous Lakota person that is reading this, please correct my version of this teaching if I am not relaying it correctly) that in the Lakota language, the root of the word ‘to cry’ is shared with the word ‘to pray’! When we cry, it is also a calling out to spirit. This can be seen as an expression of creative inquiry and a form of not just our mind-body connection, but of spiritual communion.

Crying means that you are not afraid of experiencing your emotions, which is a challenge for many. We often get messages in childhood, from long-standing familial or cultural beliefs and patterns, that result in the suppression of emotion and a distorted relationship to our feelings. Examples include, “Don’t be a cry baby” and “If you don’t stop crying, I’ll give you something to cry about”. What sort of messages around crying and emotions did you receive in your family of origin? We become masters at the art form of hiding from that which makes us uncomfortable or that we do not yet know how to deal with. Comfort with emotions, and their expression, of which crying is a sort of “collapse all” for everything from grief to fear to joy, is a sign of strength. Crying can become a sign of cultivated emotional resiliency…

Unfortunately crying generally remains frowned upon in society – for both genders. Men who cry are often labeled as weak or ‘unmanly’, especially by other men. When women cry, they’re often labeled unstable, ‘crazy’, or dramatic. Crying, despite these unhealthy stigmas, shows that you’re not afraid to challenge unhealthy social norms that are rooted in ignorance around the topic.

Individuals who are comfortable with openly crying when emotion arises, give others permission to do the same, and this supports social engagement. There is a complex science to this. In essence, when we are vulnerable, it challenges shame and promotes courage. Others will feel safer and at less risk for judgment, being around you.

I have recently been learning more about the topic of personality and personality disorders.

What I’ve learned is that each of us has the characteristics and traits that define personality disorders, but since they exist on a spectrum, the majority of people do not experience their personality as problematic. One might be considered personality disordered if the traits and habits that make up the personality are inflexible, damaging, and/or create pain and suffering. More specifically, if one’s personality causes impairment in the ability to work, the ability to establish and sustain healthy relationships over time, and/or contributes notably to a sustained lack of contentment and happiness, then it may fall into the category of being “disordered”. Only 15% of the population are believed to have a personality disorder.

So what exactly is personality? Personality relates to how a person characteristically views themselves, the world, and how they interact with it to get their needs met. There are two aspects of personality: traits and habits. Traits are inherited and habits are learned. Traits, which comprise one’s “temperament”, account for 60% of personality, are in place at birth or by age 1, and are highly resistant to change. Habits, or acquired patterns of thinking and acting (character), comprises ~40% of personality formation, and are easier to change. Habits are largely in place by age 7.

Stella Chess, a famous psychiatrist and researcher who passed away at age 93 in 2007, created a model of 9 core traits. Dr. Chess devised a system of being able to test children within the first year of life that is able to predict with 95% accuracy where they will fall on the personality continuum by middle school/high school! One example of these traits is the extent to which a person is comfortable or uncomfortable with novelty and change – which exists on a spectrum from being highly change aversive to being a thrill seeker. Another example relates to a person’s comfort level with disorder in their environment, which exists on a spectrum from having a high need for orderliness to someone who doesn’t sweat a detail or demonstrate much of any concern for order in their environment.

So what does this have to do with mind-body medicine?

The first is a reminder that all things “mind”, including our personalities, are found to have neurophysiological and biological correlates. It is represented not just by chemical and electrical patterns in our nervous system, but also by more “physical” patterns in terms of body language, posturing, behavior and movement patterns, tone of voice, breathing patterns, and more.

Understanding one’s own personality, using a mindfulness approach designed to cultivate non-judgmental self-awareness in the present moment, can contribute to our ability to regulate the stress that occurs when our personality interacts with others and the environment around us.

Additionally, learning mind-body medicine skills can help us support our personality’s drive to seek fulfillment of fundamental human needs such as safety, comfort, nurturance, and empowerment, in healthier ways.

I have been learning more, through introspection, about the workings of my own experience of personality. I have been contemplating which aspects are more easily changeable (habits) and which are more fixed or fundamental (traits). I am slowly learning how to work with both sides of that spectrum by meeting it all with as much self-love, acceptance, and compassion as I can, especially around the parts are a little more “rough” and create tension or friction in how I relate to others and the world around me.

This image has received a lot of press in recent weeks.

It comes from this study.  What are your thoughts on this?

I have found in my work that many people are not aware that there is a complex physiology to emotion that it is intertwined inextricably with the body.  This separation is rooted in the historical splitting of “mind” from “body”.  Emotional physiology is increasingly being studied in relationship to bodily processes including pain.  It is not possible for the experience of pain to not have an emotional component due to the wiring and chemistry of the brain, nervous system and body.  All bodily sensation and both internally generated and external (incoming) information passes through emotional interpretive and threat detection “centers” (regions/pathways in the central nervous system).  In addition, it is well known that many areas of our body hold emotional tension and when that emotional component is addressed alongside the physical experience of it, the potential for improvement in the experience of pain increases.

Joseph LeDoux, a neuroscientist, has studied and written extensively on the biological underpinnings of emotion and has made many good contributions to the topic.  However, the title of his primary work, The Emotional Brain, makes a common error which I call “brain-centrism”. The current accessibility of research methods that look at activation patterns in the brain, while necessary, important and of great interest, also has led people to focus excessively on the brain and miss what’s happening in the body.  There is a two-way communication going on at all times.

This free public access article from NIH provides some framework for understanding bidirectional processes, “top-down” and “bottom-up”.

In a practical example, if I am very stressed and emotional, it can not only lower pain threshholds when presented with a physical stimulus, but can contribute directly to feeling physical pain and tension in the body (top-down) independent of a tissue stimulus or injury.  Similarly, if I have a direct injury to the tissues of the body, emotion is produced as a natural part of that experience (bottom-up).

If you’re suffering with chronic pain, you are probably already aware of the connection between mental and emotional stress and physical tension and pain.  I have worked with persons experiencing chronic headaches for many years, and experience migraines myself from time to time, and stress/emotion is a definite part of the pattern.  Most of us experience this in one way or another at different times in our lives.  Often this is through muscular tension, but it can also show up in upset stomach, anxiety, widespread fatigue, or other stress related symptoms.  It is important to remember that stress involves a complex physiology that involves the entire body. It is important to remember that this connection is not “out there” or abstract.  The involvement of stress and emotion in the development of pain is not a weakness and a person is assuredly not to blame.  Yes, the brain is intimately involved in the experience of pain, but it is not “all in the head” meaning that it is not real or somehow the experience of it is “made up” or purely a psychological phenomena.

To summarize, there is a very real physiological connection between emotion and the muscles, nerves and other tissues and functions of the body.

Historically we have tended to think of the mind, body, and emotions as separate things, but they are not actually separate.  They are all part of a whole, the “living system” that we each are.  Mind, body and emotions have shared physiology – electrical, cellular, chemical…  For an overview of this, the classic book by Candace Pert, Molecules of Emotion, is a great starting point if you would like more information.

Let’s talk a bit more about emotion.  I like to think of emotion in the abstract and energetic context, even though we can easily look at it from the physiological.  Emotion is e-motion – energy in motion.  As we experience life, emotions arise out of a complex set of energies that include but are not limited to environmental stimuli, physical patterns, chemical and nutritional factors, cognitive/mental, and so on.  Emotions can be seen as energy patterns moving through the body in response to continually changing experiences, events and stimuli.  When emotions are moving freely they help us to process, learn from and integrate our experiences in life. When emotion is allowed to move up and through the body/mind, they do not contribute to lasting physical tension or chronic pain. Problems arise when our emotions are not recognized, purposefully or unconsciously ignored, or sustained (“stuck on”).  I believe it was William Blake who said something similar to “All emotions are innocent”.  We can eventually learn to embody this teaching, but most of us start out finding that we have fixed patterns of emotion and/or that we tend to avoid certain emotions.  This can happen when the brain learns that certain emotions are a threat to our wellbeing. This can happen either through negative early life experiences (read about the “ACE” studies for more information about the impact of early life stress on health later in life and the connection to the emotional and stress responses in the brain and body) or simply via longer term/sustained activation of the body’s stress response system. When that happens, our mind and body learns to protect us from uncomfortable emotions by unconsciously suppressing them and blocking the natural expression of emotion.

The questions I pose to the people I work with is: “How does emotion show up in your body?”  “Where does the flow of energy and emotion get stuck in your body?” “Is it in tight/tense muscles?”  “Is it through poor breathing patterns?” “Is it in an upset stomach?” Exploring this and working simultaneously with the physical tissues of the body alongside emotional awareness and self-expression is a necessary combination and skill for each of us to learn.

A goal in mind-body skills training is to learn how to become aware of your emotions and then to be able to express them.  An important substrate to this process is to assist the unconscious brain in learning that that is actually a safe thing to do.

Chronic tension patterns in the head, jaw, neck, back and virtually anywhere in the body can be part of a long-term habitual and unconscious pattern of blocking the flow of emotion.

As a mind-body integrated therapist, my goal is to help patients become aware of their unconscious patterns (mental and physical) so that they can learn how to consciously and safely feel their emotions and bodily sensations and allow them to express freely.  When the brain no longer perceives emotions as a threat, the body can begin to learn to relax.  Likewise, learning to relax the body can assist the mind in relearning states of safety and nurturance.

Remember that all emotion is intrinsically innocent.  When allowed to flow, express and release, emotion does not “cause” pain.  However, chronically stuck emotions can contribute to a sensitization process in the nerves, muscles and tissues of the body and contribute to the experience of pain.

Depending on the level of negative early life experiences, trauma, or chronic stress that a person has been through, different amounts of time and support are needed to learn to work with this mind-body process.  Doing so through the lens of mindfulness – curiosity, compassion, acceptance, patience and loving-kindness is critical.  It begins with awareness, working with the sensations of the body, and a supportive environment. We can all learn to do this.  There are a growing number of mind-body integrated professionals out there. They come in different forms and settings – from PT’s and OT’s, to physicians, to yoga therapists – feel free to contact me if you are unsure how to look for one in your area.

The short series of quotes that I will paste below, says a lot.  I have regular discussions in my work with patients as well as in my teaching to other professionals around this topic.  Pain is an evolutionarily evolved way to alert us to real or perceived harm/danger to body and life.  Pain might be considered an interpretation of incoming sensory information as threatening or harmful.  The question is, it that interpretation accurate to the present reality, conditions and circumstances?  And, if pain persists, which we now know is linked to a process of physiological and neurological “sensitization” (much of which is located in the central nervous system (brain/spinal cord) and can be experienced in the absence of any damage or harm to the tissues where it is felt) can the physiology and the energy of that be unlearned?  Can that script be rewritten?

¨“Pain is normal.” (Consensus)

¨ “Pain is a decision by the (unconscious*) brain.” (Lorimer Moseley) (*added)

¨ “The fear of pain is often worse than the pain itself.” (James Gordon)

¨“Pain is less painful when we are confident we are safe…” (Unknown)

So, in this short post, I pose this question: how can we actively contribute to the biology of safety?  The answer must involve a whole person/living system approach – environmental, social, physical, chemical, nutritional, mental, emotional, spiritual, etc. (noting that even such distinctions, while necessary for semantics, imply separation between levels and it is all intricately stirred together in the same pot…)  I believe it is only in healthy relationship that we might begin to explore this question.  Blessings and prayers to all that are experiencing persistent pain,

As a professional with specialization in mind-body integration, I’ve come to believe that even the phrase “mind-body” can be misleading and can reinforce a split between the content of the mind and the experience of the physical body. The late Candace Pert, a well-known contributor to the scientific foundation of mind-body medicine and the fields of psychoneuroimmunology/ psychoneuroendocrinology, was fond of saying “bodymind” as one word and teaching that emotional biology is running (shared) with every organ system and cellular process in the body. Candace went on to teach, “Your body is your subconscious mind”. This suggests that everything that we call “mind” is found equally in various manifestations of the body. This might be considered a two-way street but that also causes a division in our thinking. A barrier to fully understanding and realizing this in ourselves lies in the fact that a large portion of this “bodymind” process is below conscious awareness, what psychology has dubbed the unconscious, and what others such as Dr. John Upledger chose to call the “nonconscious”. Others in the field of psychophysiologic research might call this the “adaptive unconscious” which is often more acceptable for those with a distaste for all things “psychological” (and/or for those who lack an understanding of the science that supports that our psychology is biological and not different from the biology that informs medicine and disease). There is a complex, endless and inseparable dynamic occurring here. In a simple understanding, when emotional energy, mental tension or situations beyond our control are experienced, the subconscious (the body) will express it for us, and there is a biological/physiological basis to this.  One might then say that the emotional energy or content may be happening outside awareness of the conscious mind but is still present and happening in the body’s physiology. If this is hard to follow, there is another way of looking at it. When one considers the word “feeling” we see that it is equally used for physical sensation as it is for emotion, for good reason… these two things are inseparably connected. Body awareness is inseparable from emotional awareness. Sensations alert us to the presence of emotions – what we are feeling. One can debate the chicken-egg theory with this, and historical figures such as Charles Darwin and William James had early opinions on the topic. Contemporary psychologists and mind-body specialists continue the debate. For myself, this also can easily get into debates on the definition of mind as well as debates in neuro-philosophy, particularly theories and beliefs on the origins of consciousness and the stark contrast that exists between pure materialists and pure dualists. I know of some very respectful and intelligent clinicians who scream bloody murder any time the mind is implicated in health and disease, and whom I’ve come to call the “dualist police”, and I can understand why (see the next paragraph). Having said that, and with respect for their valid concerns, I feel that approach is not accurate to the reality of human experience and the content of both the conscious and unconscious “mind” is physiologically and inextricably linked into all bodily processes and functions. For all things mind, regardless of its linear or non-linear origin, there is (or will be found) a neurophysiological correlate. Stress physiology is implicated in nearly all illness in one way or another. Stress is neither a weakness nor a flaw. It is normal. Normalizing the mind and our psychology is paramount in bridging this gap. Having compassion is critical. It is also important to remember that this is not the only factor… we must look at interactions – environmental, social, physical, chemical, nutritional, mental, emotional, spiritual, etc. Illness cannot be pinned on just one factor and it is generally not helpful to pin it just onto the label of “mind” or onto any other one causal factor. Exploring the mind is not an either/or question. It is both/and, alongside other factors that must be addressed such as Food as Medicine ( see www.cmbm.org ), epigenetics (environment) and so on. As for the neurophilosophical debate on the origins of consciousness, perhaps I will save that for another discussion!

So, to the point of this post: It has struck me from very early on in my career how often phrases are heard that point directly to the inseparability of mind from body, yet how little conscious attention is given to this. It might even be considered an elephant in the room much like the phrase, “Oh, it’s probably just placebo” (I’ll save that one for another post too!) It can actually be quite insightful to explore our bodily issues and symptoms from this perspective, but with one word of caution – to be careful of what I’ve come to call mind-body fundamentalism – which can bring a black/white approach as just mentioned (the antithesis of living systems theory, something I feel is critical in exploring the human experience of health and disease) as well as can destructively move into a blame/shame dynamic. I have seen time and time again individuals gain deep insight (that changes physiological processes and contributes to healing) in using this approach. With that said, here is a working list of phrases I have encountered in my work, and I invite you to add your own to the list:

What is so hard to swallow?

What or who is getting under your skin?

Can’t you stand on your own two feet?

I’m not sure where I stand (on this issue/situation).

I’m standing on uneven ground.

Can’t you stand up for yourself?

Get that monkey off your back…

Who or what is rubbing you the wrong way?

He/she is hot-headed…

Has the cat got your tongue?

What are you itching to say or do?

I am carrying the weight of the world on my shoulders…

Chew on that for a while…

It’s breaking my heart.

What is erupting to the surface that you cannot speak of?

My heart is aching.

I’m not digesting this situation very well.

Shake it off…

That warms my heart.

Jump with joy.

This is a pain in the ass.

He’s a tight ass.

You are a pain in the neck.

What do you need to get off your chest?

Break a leg…

What are you not stomaching?

I can’t stomach this…

I’ve got a gut feeling about this…

Let’s sniff it out…

I smell trouble.

Vote with your feet.

It feels like pulling teeth.

I’m going to pull my hair out.

What are you not hearing?

I was blindsided by it…

What can’t you see?

I’m a step behind you…

Jumping in with both feet…

What are your eyes itching to see?

He lost face…

White-knuckling it…

I am not holding my breath on this situation…

The news knocked the wind right out of me…

You make me sick…

It made my skin crawl…

I was all choked up…

My heart sank at the news…

She makes me bristle…

He lost his shit…

She regained her balance…

I had to bite my tongue…

She jumped in with both feet…

He was hot under the collar…

I received a cold shoulder…

He’s throwing his weight around…