The Use of the Body as a Focus in Recovery from Mental Illness | The Retreat at Sheppard Pratt

The Use of the Body as a Focus in Recovery from Mental Illness

December 17, 2010 —

The Use of the Body as a Focus in Recovery from Mental Illness:
Using T’ai Chi Principles in an Integrated Residential Treatment Setting

Written by:
- Robert Levine, Director of Movement and Meditation, The Retreat
- Ginevra Frank, Intern, The Retreat, and student of “Movement and the Mind”, educational studies at the University of Maryland, College Park

Over a summer of working intensively with Bob Levine, Ginevra Frank had the opportunity to reflect upon her growing understanding of the use of T’ai Chi principles in working with patients who struggle with difficult depression, anxiety disorders, substance abuse, and other psychiatric conditions. In a series of dialogs, she captured some of the wisdom that Bob had to offer from his decades of experience as a T’ai Chi instructor and the creative uses he has discovered for these principles in various medical and psychiatric settings.

Ginevra: Getting swept up in the hustle and bustle of daily life creates a constant battle to strive for balance. Not just the ability to stand on one foot for twenty minutes, but a balance that allows us to adapt without being easily knocked down or tripped up. We are looking for a balance that gives us a focus. From that platform, it seems we have a better chance of successfully tackling the complex storms brewing in our minds. Principles of T’ai Chi and body awareness offer an alternative approach to the psychopharmacology and psychotherapy of Western Medicine. What do people who come to the Retreat at Sheppard Pratt get out of their work with you that they have not been able to get before in other treatment settings?

Bob: Most people who come to the Retreat have suffered a cascade of events in different aspects of their lives that have left them unable to function comfortably or effectively on the path they had been traveling. They universally describe the confusion that results as a place where they constantly second guess themselves and their decisions to the point that they are anxious, depressed or some combination of the two. One decision is certain. They must temporarily stop the momentum, get some guidance in the form of psycho-therapy, and determine if they are on the right or wrong path. If it is the right path they may need help that will make the path easier to travel. If it is not the right path they will need assistance to find a better one. In addition to psycho-therapy they may be seeking pharmacological support to further help them on their journey by addressing a biological imbalance.

Although addressing the tendency to second guess oneself and using psychotherapy and pharmacology to get back on track is a perfectly reasonable perspective, from an Eastern point of view it would not necessarily be the ideal place to start treatment. The patients who come to the Retreat have been successful in their lives in many other arenas, dealing with difficult issues using intuition and reason. But now things are different. The cascade of events previously described has challenged them in a way that they haven’t been challenged before. They begin to second guess themselves and soon are unable to trust their intuitions. Their thought processes are now significantly skewed. They get blocked and the familiar ability to reason no longer works, thus leading to a pattern of despair. They begin to think “why me?”, “this is never going to end”, “there are no options”, “this is hopeless”, etc. When they think this way for a long period of time, they start to feel overly emotional or intense all of the time, 24 hours a day. They are unable to escape these hopeless cycling thoughts. After a while this drains them of the energy to do anything productive or anything that brings happiness or joy.

Ginevra: One of the most fundamental principles of T’ai Chi is that all anyone has is his or her body, and we are all equal on this basic level. Our body holds our emotions, our thoughts, our physical traits, and our spirit. All elements of our being are contained in our muscles, bones, and organs. If one aspect of our being is under stress, then the whole system is thrown out of whack consciously or unconsciously. If our thoughts are off balance, and constantly cycling, then our physical and emotional energies are drained and we feel sluggish and exhausted. Could you explain more about how you work with the body with patients who are suffering mental distress?

Bob: One basic tenet of many Eastern systems of thought is that as humans we are all equal, in essence, we are all in the same boat. The common factor that makes us all equal is that each of us has only one body. It is the home of our organs, but it is also where our thoughts, emotions and spirit reside. We have all experienced how our emotional, mental, spiritual and physical energies affect one another. The one body that we have has only a finite amount of energy. At times, specific thoughts, emotions or behaviors are getting the bulk of the energy while others are totally depleted. So often our energy is being directed to and utilized by the organs that support anxiety, heightened emotion and chaotic thinking. Thus the energy available to those organs that give us joy, perspective or a sense of calm is reduced. According to Chinese medicine, the organs that are getting over-energized are the kidneys and the liver. When the kidneys experience too much energy they signal to the adrenal glands which sit on top of them. The adrenal glands comprehend that there is a crisis and in turn send messages to the brain that trigger “flight or flight” responses. The liver then directs the muscles and joints to tense up in order to facilitate action. Activation of the brain also causes an increase in heart rate, uneven and rapid breathing, changes in the acid base balance and a host of other visceral reactions. The “fight or flight” has been activated, but there is no impending physical danger. Anxiety, heightened emotion, and chaotic thinking accompany the prolonged physiological response. With nothing to fight or flee, a third possibility arises instead. This possibility is to “freeze”. Freezing can have disastrous implications. It entails the rage of the “fight” coupled with the hopelessness and direness of the “flight”. The person appears trapped in a distressing physical and emotional state that has no purpose and from which there seemingly is no escape.

The Eastern approach to therapy therefore begins by assessing the body and how the body is utilizing its energy. It then looks at how that utilization of energy affects one’s emotions. Following that it assesses how that emotionality distorts and deviates ones thinking and how that deviation prevents us from having confidence in our decisions.

Ginevra: In order to manage this potentially overwhelming and intricate system, T’ai Chi offers a focal point, or center. There is a center for our emotions, in our heart, one for our thoughts, in our brain, and one for our body, two inches below our navel. One way to practice the art of focus and awareness is by standing outside and focusing on a point far in front of us. Focusing on a blade of grass allows us to only see that blade, but looking out at the mountains we can see all of the grass, rocks, and flowers in between. Focus can provide a peripheral awareness and sense of a larger picture. Internally focusing on our body’s center near our belly button, allows us to notice tensions elsewhere in our body. We become aware of much more than our immediate surroundings and ourselves. Could you talk about how you use these T’ai Chi principles in working with distressed patients?

Bob: T’ai Chi is an ancient martial art. The term marital art implies that there is an opponent and some process whereby one fights that opponent. A marital art would thus rely on forcefulness, speed and endurance. The winner would be that individual who was stronger, faster and lasted longer. However, Tai Chi as a marital art is wholly different. For example, it relies on relaxation rather than tension. Relaxation is necessary so that the Tai Chi practitioner can listen, respond and yield to his or her opponent. When this meditative martial arts protocol is followed the fight reaction transforms into a calm assessment of different ways to approach a situation and the flight reaction becomes a measured decision of when to leave a situation. Even if one freezes it can become an opportunity to be creative rather than something to be dreaded. Winning is not the object. Instead, in Tai Chi one is encouraged to be more aware of their body and how their body uses its energy. The aim is emotional equilibrium in order to think clearly, to have confidence in making decisions and to trust in one’s intuition. The person using T’ai Chi principles, works in consort with their “opponent”, not in conflict.

When life has become a battleground where the army has been fragmented, when one feels he or she has been cornered and thus can be ambushed at any moment, this clearly cries out for a more effective solution. Life thus needs a marital art based on a different set of principles, a set of principles like those outlined above. T’ai chi arose as a response to similar historical situations. The physical, emotional and mental dis-ease of the people of ancient China was presented in the Tao Te Ching by Lao Tse. He described how people experienced a dissipation of energy as well as a lack of any sense of control when they were not aware of what their goals were or how they would achieve them. He believed that when people took effect from everything everyone else said or did they became uncomfortable in their own skin. People would unfairly and constantly judge themselves and others. He portrayed these complex mental processes as a set of pressures that resulted from the fragmentation of the more ideal unified process of life into the “10,000 things”.

Simply said, T’ai Chi is a moving meditation that begins with stillness. The basic axiom is that the mind has to be in the body before the body should move. T’ai Chi also emphasizes the principle of “investment in loss”. This is a difficult concept that assumes that in order to gain control of our body we have to give up our strength. For example if our hand is in a fist we can’t move it until we relax it. In the same way to gain control of our relationships we have to give up force and adapt to the changes within the relationship. In order to gain control of our changing environment we have to give up our fixed beliefs and our insistence on what is right and what is right wrong. The training necessary to do this starts by focusing the mind in an imaginary place in our body where the center of equilibrium is experienced referred to as the tantien. This enhances not just the ability to feel the entire body simultaneously, but also produces an awareness of all the places that psycho-physical tensions are held. If done properly it allows for the rapid relaxation of all of the muscular tension that is unnecessary for whatever task is being done.

By practicing the T’ai Chi movements, the body, mind and emotions align, which allows the person to function as a unified whole. The result is a state of calm awareness and the sense of regaining the “sparkle” of living. It is only from this place, where the mind is focused and in charge of the body, that we can really listen, in the broadest sense, to what is going on around us. Then we are able to interpret information more objectively as “this is what is happening” or “this is what I have to deal with” rather than through the veil of our memories, judgments and expectations. With this type of interpretation we start to feel confident in our intentions and intuition and stop second guessing ourselves. The resulting demeanor that is at once calm and alert provides room for change while at all times being aware of how to neutralize danger. The feeling is that we are in the calm of the storm and if we embrace the unknown with equilibrium and awareness the storm may never come.

Ginevra: T’ai Chi offers a pathway in order to reach a state of calm. With our feet grounded and resting on the earth, we can watch how we move and relate to our surroundings and to other people. T’ai Chi can be incorporated into a daily routine in many different ways. One way is to practice the moving meditation poses in the morning to start off our day and keep the feeling of those poses and the meanings behind them in the back of our mind. Alternatively we might listen to our own breath and find stability and notice how our body feels and how we would like it to feel for the day so we can monitor whether or not it deviates from that starting point. Instead of reacting to stressful situations during the day, and tensing up, we can become an observer of our emotional state. Could you describe some of the ways you have found most useful in incorporating T’ai Chi principles into practice on the Retreat?

Bob: This process of listening to the body and thus the mind and emotions is the goal of every group and individual session I lead at the Retreat. We use a variety of exercises and meditations to gain some mastery of this stance. To get a taste of the experience one might try the following breathing meditations. Breathing is a good place to start because it is very difficult to control most of the biological triggers of stress – such things as increased heart-rate, the release of cortisol and other stress hormones, and changes in the acid-base balance of our blood. One system we can affect to serve our purpose is our respiratory system. Changing the way we breathe can reorganize and calm the autonomic systems and help in reestablishing a sense of harmony.

The kinesthetic image: The lungs are organs that hang from just below the collar bone down to the bottom of the sternum. They are separated from all of the internal organs (except the heart) by a large flat muscle called the diaphragm. When the diaphragm drops it compresses the internal organs and “inhales” air into the lungs. When the diaphragm rises it “exhales” and relaxes the internal organs.

Full body breathing: Sit in a chair or lay on a mat on the floor. Imagine your belly is a balloon. Place your hands partially on your lower ribs and partially on your belly. Exhale completely; feel the ribs contact as the balloon of the belly deflates. Inhale, keeping the upper chest still as the balloon of the belly and the ribs expand. Do this a few times until there is no strain. If the belly won’t go out on the inhale, consciously make it do so. Now move your hand to the side of your ribs and do the same type of breathing. The belly will expand out as before but now you are asking it to expand the abdomen and the ribs filling the sides as well. As before, do this until there is no strain. Focus on your back touching the chair or the floor. Do the same abdominal breathing but this time feel your back move against the table or chair on the inhale and relax away from it on the exhale.

If the breath is too shallow to move the sides or back try this:

Go through the same process from the beginning but after the exhale pause for a split second then continue to exhale, do that again before you inhale. Now inhale and when the balloon is full and you have inhaled fully, pause, then swallow and then inhale more. This fills the upper lobes of your lungs.
After doing this for a few minutes, stop and notice whether you are physically, emotionally and mentally calmer.

Tai chi breathing: Stand with your feet parallel, a shoulders width apart. Feel as if your feet are sinking into the earth. Unlock the knees, relax the hips and shoulders and focus your gaze on the horizon line. Let the arms and hands hang loose and relaxed and focus your attention in the center of the abdomen just below the navel (this is where the breath will initiate from). Exhale completely. This time as you inhale and the balloon expands allow the wrists to extend out and float up to shoulder height. Let the fingers hang down as the wrists rise. On the exhale let the wrists float down and move past the hands and fingers as they sink. Do this nine times and notice to what extent the muscles of your body have relaxed, whether your thoughts are clearer or more focused and check the intensity of your emotions.

The unified body is now moving to the rhythm of the breath. Breathing this way unifies the fragments of the body and mind. When the breath uses the diaphragm to compress and relax the internal organs it transfers the energy of the respiratory system to other body systems. When the breath comes from the center of the abdomen (the tatien) rather than the upper chest, our center of gravity shifts as well – from a precarious position, where we feel ready to topple, to a sense of equilibrium. When the hands and arms are reminded that they naturally rise on the inhale and sink on the exhale the rhythm of our movement is reestablished. The sum of this is a more responsive body, mind and emotion that functions as an integrated unit.

Ginevra: Thank you, Bob. It is clear that if we learn to listen to our body with all of our senses including our sense of equilibrium, we can center and focus our body, thoughts and emotional state. Incorporating T’ai Chi principles in our life takes time and practice. We can build the confidence we all need to calmly find stability in our thoughts and emotions. Through listening, we can feel safe in our own body, and then create a safety in our thoughts and emotions. Body awareness is a place from which to look, listen, and learn.