Acupuncture Physical Medicine and Psychosomatic Medicine

If a tree falls in the forest and no one hears it, does it still make a sound . . . or . . . If my blood tests, labs, MRI’s, etc. are all negative, does that mean there’s nothing wrong?

The field of Psychosomatic Medicine got off to an auspicious beginning, garnering much attention during the late 19th and early 20th centuries.  Original thinkers including Georg Groddeck, Sigmund Freud, and Wilhelm Reich, among others were at the forefront of the field generating interest, lively debate, and controversy with their theories and clinical work treating functional disorders such as hysteria, neurasthena, irritable bowels, and others.  Despite early promise and enthusiasm the psychosomatic medicine movement gradually lost momentum in the decades following its early 20th century renaissance.

A rose by any other name . . .

Patient’s are typically labeled “psychosomatic” when medical exams and diagnostic tests reveal no identifiable organic disease or structural defect, yet the patient still suffers symptoms of chronic pain, fatigue, vague visceral disturbances such as indigestion, or other nagging, lingering complaints.  In the past, these patients were often unfairly labeled crocks, malingerers, neurotics or hypochondriacs.  Many were sneered at for wasting their doctor’s time - often with the implication that their suffering was ‘all in their head’ and somehow their own fault.  Frustration with these patients gave the term “psychosomatic” a derogatory connotation.  However, the fact that a patient’s ailments defy easy diagnosis and treatment doesn’t make their symptoms any less real.  Pain is pain no matter what the cause.

Today these patients are more likely to be diagnosed as suffering from chronic fatigue syndrome, chronic pain, fibromyalgia, irritable bowel syndrome, immune deficiency syndrome, asthma and other functional stress disorders - a far cry from crocks or hypochondriacs, but still a challenge to treat effectively.  So . . . what do we do for patients with chronic symptoms but no identifiable organic disease or structural defect??

The Psychosomatic Problem . . . where the rubber meets the road

The problem with psychosomatic medicine (as discussed in “Bodymind Energetics,” by Mark Seem, PhD)  was that “ while psychoanalytic theory was of great value in explaining the psychological meaning of physical symptoms, it proved unable to clarify the physical mechanisms that would account for a particular psychological issue leading to specific physical and pathological processes”.  A great frustration of psychosomatic medicine was its difficulty producing effective interventions to treat the disorders it eloquently theorized and explained. 

When the Student is Ready, the Teacher Appears.  Acupuncture Treats Functional (Psychosomatic) Disorders.

What has been (re)discovered by modern American acupuncturists is that acupuncture holds promise as an answer to the “psychosomatic problem”.

Acupuncture, both in theory and practice, treats conditions that were once considered the realm of a ‘failed’ psychosomatic medicine.  In particular, the style of acupuncture known as Acupuncture Physical Medicine [APM] is highly effective at releasing myofascial “Holding Patterns”.  A Holding Pattern can be thought of as a kind of myofascial / muscular strait jacket that reflects a lack of free flow of energy in the bodymind.  Holding patterns become habituated in the bodymind as a response to the stressors of life (stress, injury, illness, trauma) and manifest as tight, rigid muscles, chronic pain, dysfunction, fatigue, and other functional stress disorders.  Acupuncture Physical Medicine is particularly well suited for untying these myofascial straitjackets, helping to break holding patterns, and allowing the bodymind to function more optimally with less pain and dysfunction.

Holding Patterns - When the Defense Becomes the Enemy

Physical Holding Patterns

During a whiplash the body is forcibly jerked, causing threat of serious injury.  In response to a whiplash, muscles seize up and spasm in such a way that immobilizes the injured person’s back and neck.  Immobilizing the spine is actually a defensive reflex to protect against further injury.  However, the muscles tend to remain stuck, tight and spasmed long after the trauma has passed.  This holding pattern easily becomes habituated in the bodymind causing pain, decreasing mobility, and limiting one’s quality of life.  In other words, the defense (spasmed muscles) against the trauma (the actual whiplash event) has now become the enemy.

Psychological Holding Patterns

Similarly, in the realm of the psyche, we develop ego defenses (defensive thought patterns) based on real or perceived threats to our well being.  Like a whiplash injury lingers on, ego defenses are also prone to overstay their usefulness, become habituated, and subsequently cause problems.  For example, if an infant is left alone for too long, it may experience an overwhelming sense of anxiety and fear of abandonment.  In order to protect itself from frustration and emotional pain, it develops an ego defense.  As Robert Firestone, PhD writes in “Fear of Intimacy”, “all children, to varying degrees, suffer emotional pain and anxiety that necessitate the building of defenses.  Defenses formed in childhood are temporarily adaptive in that they cut off anxiety, pain, and the fear of disintegration, yet they create subsequent problems. People’s defenses formed under painful circumstances, become the core of their neurosis and eventually may become more detrimental than the original trauma.  What once functioned as a survival mechanism remains in the personality as a dysfunctional, addictive habit pattern.”  I think of these as ‘psychological’ holding patterns - similar in concept to ‘physical’ holding patterns.

Holding patterns are restrictive.  They inhibit us from reacting to life spontaneously and naturally, thereby becoming obstacles on the path towards fulfilling our potential.  Physical or mental energy spent on sustaining a holding pattern is energy tied up and unavailable for creative expression and other positive use.

Connecting the Dots

Psychological holding patterns can also manifest as pain or dysfunction in the body.  For instance, holding nervous energy in the gut may eventually manifest as IBS (irritable bowel syndrome).  Many people hold stress or emotions, like anger, in their neck and shoulders leading to headaches or back pain.

People with a fear of verbally expressing themselves often clench their jaws.  Over time this may manifest as jaw pain or TMJ.  The mind body connection also works in the opposite direction - chronic muscular tensions have a restrictive influence on personality.  Stress in our lives effects each of us differently.  One man’s irritable bowel may be another man’s headache.  As Alexander Lowen, MD writes, “a person’s past is his body” and “there is no single key that will unlock the mystery of the human condition”.  Everyone is their own unique puzzle.  

The Body and The Mind . . . or . . .  One Bodymind

Western culture has long held on to the idea that the body and the mind are split from each other, existing as two separate phenomena.  Many people still strongly resist the idea that emotions or psychological factors can influence the body or cause physical symptoms.  To accept this implies we may have to be willing to examine our own ego defenses - which is never without a certain amount of denial.  Perhaps, in part, that’s why the early psychosomatic physicians had a hard time devising treatments integrating mind and body, not to mention the controversy and sometimes outright hostility they faced when their ideas and theories conflicted with those of the mainstream culture.  Throughout history, pioneers who challenged the then accepted beliefs of society were often subject to fierce criticism and sometimes worse (think Jesus, Socrates, Copernicus, Galileo, Darwin, Freud, Ibsen, Martin Luther King, etc.).  [This societal resistance to change is, in essence, like a holding pattern at the communal level]. 

The idea of bodymind unity has been present in classical acupuncture theory for hundreds of years.  Classical chinese medical theory recognizes excess emotions such as anger, fear, sadness, overthinking, shock, fright, and joy (i.e.  inappropriate giddiness or manic elation) as causes of disease.  This is not to say that one should consider acupuncture as a substitute for psychological therapy.  People who have histories of abuse, trauma or other psychological issues should seek appropriate counseling from a trained therapist.  The myofascial release of the bodymind’s holding patterns with acupuncture can be a powerful complement to appropriate psychological treatment. Of course not every tight muscle implies some big emotional trauma and not every frustrating, stressful event is going to cause physical pain or dysfunction. 

The real strength of Acupuncture Physical Medicine is that it puts the body and the patient’s actual lived experience of disharmony back into the treatment of functional disorders such as chronic pain, chronic fatigue, IBS, etc., and other stress disorders. 

“Hard & stiff will be broken.  Soft & supple will prevail”.  - Lao Tzu

Interestingly, Alexander Lowen, MD, devised a therapy called Bioenergetics which combines psychotherapy with myofascial release.  Perhaps he had the early psychosomatic physicians or the taoist philosophers in mind when he wrote that “The goal of bioenergetics is to help people regain their primary nature, which is the condition of being free, the state of being graceful, and the quality of being beautiful".    Not bad.

Timothy C. Rhudy, M.S., L.Ac. is a graduate of Tri-State College of Acupuncture in New York City.  Formerly an engineering geologist, and later an actor on the New York stage, Tim combines the pragmatism of a scientist with the thoughtful approach of an artist-philosopher in his treatment of each patient as a complex, unique individual.  For six years he was the staff Acupuncturist in the Cleveland Clinic’s Department of Pain Management.  He can contacted here.