The Vagal Path to Compassion
Students of biology or medicine will likely be familiar with one of the largest single nerves in the body, called the vagus or “wandering” nerve. The nerve emerges from the brainstem and is one of the most important contributors to the parasympathetic nervous system, having important effects on the heart, lungs and intestines. The vagus causes the heart to slow, the intestines and kidneys to become more active and the bronchi to constrict. The vagus also has profound effects on metabolism: it has been known for more than a century that stimulating the base of the brain with opiates can cause the release of glucose from the liver, an effect mediated by the vagus. The nerve is also involved in the interaction of the immune system and the brain.
In recent years a technique called vagus nerve stimulation has been found to help some people with intractable epilepsy or treatment resistant depression. Many of the techniques of yogic or Taoist breathing as well as some techniques for inducing altered states of consciousness by eye movements or stimulating specific points on the ears all revolve around vagal stimulation. Some of these techniques have been shown to produce a sustained reduction in blood pressure.
I would like to focus upon the effects of the vagus on the heart. The heart is a physical location of an aspect of our emotional functioning. In Chinese Medicine it is known as the repository of Shen or Spirit. The heart is more than just a pump. It is also an important endocrine gland, and there is some evidence that it is also a sensory organ, with a sophisticated system for receiving and processing information. The neural network within the heart enables it to learn and remember. The heart constantly communicates with the brain, influencing key areas involved in perception, cognition and emotional processing.
You or someone you know may have had a baby. In which case you or they will have had intrauterine cardiac monitoring. Normally the baby’s heart rate varies from minute to minute. Some forty years ago it was discovered that if that variation stopped, it could be a harbinger of doom. Obstetricians knew this, but the rest of medicine forgot about the observation until 1991. Since then there has been enormous interest in the phenomenon of heart rate variability (HRV), because if it is lost, it can be a potent predictor of health problems. HRV reflects the tone in the autonomic nervous system. If this system becomes unbalanced, it can have effects on most of the major organs.
In the Ageless Wisdom the vagus is called our psychic antenna. We all have one, but not all of us have relearned how to use it. Many psychic stressors can produce physical effects via the vagus nerve. When doing acupuncture or energy healing it is very common for the patient to get a slowing of their heart rate and abdominal rumblings, which are sure signs of vagal activity. Psychics often get problems with their intestines while working with people, not from upset, but because they are exercising their skills.
There has been some interesting speculations about the role of the vagus in social behavior. Researchers have found
that children with high levels of vagal activity are more resilient,
can better handle stress, and get along better with peers than children
with lower vagal tone.
There is a project underway at the University of California at Berkeley to see whether the vagus nerve might be the seat of compassion. Dacher Keltner is a professor of psychology and coeditor of Greater Good, a magazine about prosocial behaviors such as compassion and forgiveness. He has been examining the novel hypothesis that the vagus nerve is related to prosocial behavior such as caring for others and connecting with other people.
In his laboratory, Keltner has found that the level of activity in people’s vagus nerve correlates with how warm and friendly they are to other people. Interestingly, it also correlates with how likely they are to report having had a spiritual experience during a six-month follow-up period. Vagal tone is correlated with how much compassion people feel when they are presented with slides showing people in distress, such as starving children or people who are wincing or have a look of suffering on their faces.
Perhaps a key to compassion is to be found in the heart and the face.
Compassion is crucial to our survival. But compassion leavened with wisdom.
“Love and compassion are necessities, not luxuries. Without them humanity cannot survive.”
–The 14th Dalai Llama (a.k.a. Tenzin Gyatso, Tibetan Religious and Political Leader, 1935-)
“Out of compassion I destroy the darkness of their ignorance. From within them I light the lamp of wisdom and dispel all darkness from their lives."
–Bhagavad Gita
True Integrated Medicine
“Our body is a machine for living. It is organized for that, it is its nature. Let life go on in it unhindered and let it defend itself, it will do more than if you paralyze it by encumbering it with remedies.”
–Count Leo Tolstoy (Russian Writer and Philosopher, 1828-1910)
“The cure of the part should not be attempted without treatment of the whole.”
–Plato (Athenian Philosopher, 428-348 B.C.E.)
Have you ever woken up in the morning with a feeling that something’s not quite right, but you couldn’t quite put your finger on it? That is the feeling that we get if something is out of place. Our minds and our brains have evolved with a remarkable ability to pinpoint things in external space: it was once an important survival mechanism. As we became more complex, those same systems began to be able to tell when things were out of place in our internal environment as well as in our relationships. We are social animals and most of the cognitive systems of the brain are designed to aid and abet our social interactions.
The key to health is to have all of our systems working in harmony. It is absolutely true that 70% of human illness is a result behavior born of bad choices. We make those bad choices when we stop listening to our bodies and heeding our hearts.
People love to place us in categories. I am constantly being asked why all my work contains three parts: cutting edge conventional medicine, natural medicine and self-help. I’ve had people in the publishing business say, “Well, is it health OR self-help?” For me, the answer to that is yes!
We cannot attain health and wellness unless we have done some work on ourselves; we cannot heal ourselves and others unless we have something with which to do the healing. If we are fearful, and moving haphazardly through life with little self-control, it is hard to pay attention to your body, mind, relationships, subtle systems or spirituality. A physician too distracted to focus on and respect another person is unlikely to help him or her get better. A therapist without a strong sense of self would find it hard to help a troubled mind, and a spiritual teacher who had no personal experience of the Higher Realms of existence and no clear moral compass, could devastate the spiritual well being of a disciple.
When we talk about Integrated Medicine, people usually assume that we are only talking about integrating different types of treatment. Yet that is only part of it. We are also aiming to integrate the individual: to enable every aspect of the person to be acting in harmony. When all of our systems are in harmony, pulling together in the same direction, when they are listening to each other and communicating with each other, there is a free flow of energy and we achieve a state of coherence.
And it is this coherence that underlies our sense of health and well being.
For coherence is the key to resilience.
“The patient must combat the disease along with the physician.”
–Hippocrates (Greek Physician, c.460 B.C.E.- c.377 B.C.E.)
“Those whose consciousness is unified abandon all attachment to the results of action and attain supreme peace. But those whose desires are fragmented, who are selfishly attached to the results of their work, are bound in everything they do.”
–Bhagavad Gita
Combat Stress
The British Ministry of Defense has announced that it is going to pardon all 306 soldiers shot for cowardice during the First World War.
This is the culmination of a campaign that has been going on for years, after it was discovered that most of these soldiers were actually suffering from “shell shock.” From the historical records it seems highly likely that this was actually post traumatic stress disorder (PTSD). Some people have said that there’s no point in issuing posthumous pardons ninety years after the events.
I don’t agree. It’s virtually impossible for us to imagine the horrors of trench warfare, and I think that it’s important to recognize the terrible psychological consequences of it.
Hospitals in the United States are already beginning to see a great many cases of PTSD from the current conflicts in Iraq and Afghanistan. We know that there are some predictors of who will suffer from PTSD, but that given enough trauma, it can likely happen to anyone.
People Dangerous to Your Health
I found a terrific blog with the title “Warning: Bores and buffoons may endanger your health.”
Our ability to self-regulate is a limited resource that fluctuates markedly, depending on our prior use of willpower, tiredness, stress and our personal resilience.
A new study by a team lead by Professor Eli Finkel of Northwestern University has shown that poor social coordination impairs self-regulation. What does this mean? If you are forced to work or interact with difficult individuals you may be left mentally exhausted and far less able to do anything useful for a significant period of time. In other words, draining social dynamics, in which an individual is trying so hard to regulate his or her behavior, can impair success on subsequent unrelated tasks.
In the research, volunteers were asked to work in pairs to maneuver an icon around a computer maze, with one volunteer giving the instructions, the other moving the joystick. Those operating the joysticks were actors, primed to respond to instructions in slow, stupid, inefficient and generally irritating ways. What was interesting was that the effects were not mediated through participants’ conscious processes: they were almost entirely going on below the level of conscious awareness.
There is extensive literature on the consequences of social conflict. But until now, very little research has been conducted on the effects of ineffective social coordination. That has been a big gap in the research literature, particularly given the fact that most of the higher systems in our brains are dedicated to social functions, and since the earliest days of our hunter-gatherer ancestors, tasks requiring social coordination have been the norm. In our day-to-day activities we have to cooperate with other people. Ineffective social coordination consumes a great deal of mental resources and has high costs for subsequent self-regulation. This is so important, because self-regulation is essential to living life well. It is also essential to the existence of a well functioning society.
What to do with this new information?
Identify people who drain you. If you need to work with them, do it in short bursts, and give yourself plenty of time outs.
And continue to build your resilience.
There’s also one other piece, that we’ll look at another time. Some people may also drain your energy directly. You may have come across "energy" or "psychic vampires." They really do exist, though there is nothing supernatural about them, and they don’t have fangs or an aversion to garlic. In another post I’ll show you some techniques for dealing with those people as well.
The researchers have done us a great service by putting the entire paper on the departmental website. Access is free.
The Epigenetic Code
In Healing, Meaning and Purpose I reveal some of the extraordinary changes that are occurring in our understanding of genetics and inheritance. Even if you are currently learning genetics in college, it is quite likely that some of what your professors are teaching may already be out of date. I say that with the greatest possible respect: I find that in some of my fields of expertise, I am often having to update my teaching materials every week.
One of the remarkable discoveries that is generating huge amounts of new information is what we call epigenetics. This is the study of a form of inheritance that can occur without fundamental changes in gene sequences. This has to do with the idea that there is a second layer of programming on top of our DNA. A code that can change over our lifetimes in response to environmental change. Diet, hormones, chemicals in the environment, stress and even thought, emotion and behavior, can all change the ways in which our genes are expressed. Some of these epigenetic changes can be passed on to other generations. In other words, there can be an inheritance of acquired characteristics. Something that has been denied for over a century.
Let me give you a simple example. Studies of a particular species of mouse have shown that maternal diet has an effect on the coat color of the offspring. This was the result of what is known as methylation that altered gene expression. These changes in coat color were carried on to the next generation: the grandchildren of the mouse given the special diet. This created quite a stir, because it had been thought that epigenetic changes in cells are erased each time that a cell divides. Obviously that was not happening. We now have many examples of epigenetic changes being passed on to the next generation and the next. There are literally hundreds of scientific papers on the subject.
As I have written before in my last book and CDs, in articles and in reviews at Amazon and elsewhere, the traditional view of genetics has been one of genetic determinism. That we are all little robots whose entire lives are dedicated to nothing more than passing our DNA from one generation to the next. And the genes even dictated how we did that. I still know many gene jockeys who are convinced that the whole of human behavior will ultimately be explained by our genes, and that free will is therefore a myth.
I’m just as sure that they are wrong.
Let me give you an example. Identical twins have identical DNA, yet we have known for fifty years that one twin may get a genetic illness that the other does not. And the brains of identical twins, though they start out identical, quickly become quite different from each other because of the impact of the environment. Twin studies of mental illness have been going on at the Institute of Psychiatry in London since 1960. Every patient coming to the hospital is asked by the clerical staff if he or she is a twin. And there has been groundbreaking research on mentally ill twins at the National Institute of Mental Health for decades. And what have we learned? Though there may be a genetic component in schizophrenia, when we look at people with schizophrenia who have identical twins, only half of the twins have the illness, despite having the same DNA. The key difference is at the epigenetic level.
Marcus Pembrey from the Clinical and Molecular Genetics Unit at the Institute of Child Health, part of University College, London, has been at the forefront of the work on epigenetics. Marcus has had the opportunity to study the unusually detailed historical medical records of the isolated northern Swedish city of Overkalix. He and his colleagues found something astonishing. The grandsons of men who experienced famine during mid-childhood went through puberty earlier and had longer life spans, while the grandsons of men who were well fed in early childhood had an increased likelihood of diabetes. For females, the effect was similar but it was tied to the grandmother, rather than the grandfather. Presumably these responses are designed to adjust our early growth and reproduction to be ready for unpredictable changes adverse events in the environment. I would call this epigenetic resilience.
In a separate study done in Bristol in England, Marcus studied two generations of families, and found that fathers who had started smoking before age 11 had sons who were significantly heavier than average. There was no similar effect on daughters.
There is already some evidence that epigenetic factors may play a role in the development of bipolar disorder and schizophrenia. Many of us are becoming excited about the potential benefit that may flow from a better understanding of genetic and epigenetic mechanisms in major psychiatric disorders.
There is a new journal called, appropriately, Epigenetics that contains a treasure trove of important information. The editor is Moshe Szyf, form McGill University in Canada, and he recently pointed out that one single gene could have as many as 700 epigenetic programs associated with it.
His own research has linked epigenetic change to social interactions: the way in which we behave toward one another can lead to a change in how our genes operate.
Rats whose mothers groom and lick them when they are young grow up to be much calmer than rats whose mothers neglected them. There is, of course, nothing surprising about that. We all understand the importance of good child rearing. But what was surprising was the finding that epigenetic changes are the cause. By nurturing their young, the rat mothers activated a gene that suppressed the creation of cortisol, one of the stress hormones.
Pups who were neglected did not have that gene activated, so they produced more cortisol and were therefore more stressed out.
Knowing this, the researchers were able to increase the well-nurtured rats’ stress by injecting them with methionine, an amino acid commonly found in food supplements.
Here we have proof that the link between food and mood is not just due to transient chemical changes in the neurotransmitters of the brain, but that a chemical in our diet could cause fundamental changes in the way in which our genes work. In this case a rat’s emotions and state of mind. The implications for all of us are extraordinary.
Since 2003, a consortium of public and private firms in Europe has been working on the first Human Epigenome Project (HEP), and it hopes to have completed 10% of the map by the end of this year. As you can see, it is a lot more complicated than mapping the human genome, and epigenetic codes are constantly moving targets. The first reports from HEP have indicated that at least 20% of the genes studied so far can have their behavior modified by the environment. The food that we eat, the chemicals that we ingest and the attitude of our parents and peers can all change the way in which our genes function.
As Marcus Pembrey has said, “Child care has a whole new meaning.”
This is all crucially important, because one of our most important discoveries has been that human beings have been undergoing extremely rapid physical as well as psychological and social change, and that is one of the reasons why the Laws of Healing have been changing over the last century.
Beating Burnout
I have been getting a number of requests to re-post some of my materials about burnout.
This is a summary of some of the information that we cover in our corporate wellness seminars. For people who are interested, we have also created a Powerpoint slide set, together with reference materials which are available for purchase from our website.
So let us begin at the beginning and ask:
What is Burnout?
This may seem such an obvious question, since the term “burnout” has become part of everyday language, but it is still the topic of a great deal of research.
The best definition of burnout is “a prolonged response to chronic physical, emotional and interpersonal stressors at work.” It is defined by three dimensions:
- Exhaustion
- Cynicism
- Inefficacy
It is more than just an individual experience of stress: it has to be seen in the larger organizational context of people’s relationship with their work.
It is often the case that individuals miss all the signs in themselves.
So what are the main symptoms of burnout?
- Worrying, particularly at night
- Trouble sleeping
- Feeling unappreciated or “used” at work
- Feeling less effective or competent than you used to
- Easily angry or irritated
- Dread of going to work
- A feeling of being overwhelmed
- Recurrent stress-related physical symptoms like headaches, or back pain
- Watching the clock and counting down toward the end of the work day
- Rigidly applying riles without considering more creative solutions
- Automatically expressing negative attitudes
- Finding excuses to be absent from work
- Alcohol or substance abuse
We need to ask questions about conditions at work. For instance whether individuals are asked to work extra long shifts, go without breaks and lack clear guidelines.
Who is at greatest risk?
Helping professionals and people who have great responsibility for others, such as airline pilots and air traffic controllers.
Although there are some psychological predictors for who are more likely to suffer from burnout, with enough stressors just about anyone can become a victim of it. Some people have claimed that burnout is a physical illness resulting from exhaustion of the adrenal glands, but the research doesn’t show that. Burnout is primarily a problem of the system in which you work, interacting with your body and your mind. So now let’s look at how to transform yourself from victim to victor.
The major risk factors are:
- Feeling powerless
- Being caught in conflict
- Having inadequate information
- Lack of central visions
- Incoordination of the team
- Overload
- Boredom
- Alienation
- Ambiguity
- Conflict of values
What are the Solutions?
Dealing with burnout needs the help of all workers and the organization as a whole. Sometimes it also needs the help of an outsider. I was once working in a very unhappy place, in the days long before I realized that I had the power to change things myself. A psychologist friend working in the then new field of systems theory, told me that the problem was not with individuals, but that the whole system was “sick” and disorganized and what was needed was a system overhaul.
The opposite of job burnout is job engagement. If you feel that you are engaged in doing something valuable, for which you are appreciated, you are far more likely to have a satisfying life and enjoy doing your job well. There is good evidence that participation, engagement and autonomy are powerful predictors of health outcomes.
First, at the personal level:
The keys to preventing burnout are represented by the acronym REAP:
Resilience
Engagement
Autonomy
Participation
- Evaluate your personal goals and priorities: what do you really want to get out of life, and even more importantly, what do you want to put in to life
- Ensure that you have established your own core values, your purpose and your meaning. (My book and CD series Healing, Meaning and Purpose spends a lot of time on helping you do exactly that.)
- Attend to your own health, through exercise, nutrition and sleep. (I have worked with countless individuals with burnout, whose problems largely evaporated once they were diverted from the coffee, soda and snack machines. Remember the close relationships between food and mood.)
- Make sure that you have some outside interests. Not just things that further drain your energy, but something that you enjoy.
- Learn some specific stress reduction techniques. (I also have some suggestions for doing so in my book.)
- Are you a micromanager who has to do everything yourself? If so, then it is a really good idea to learn to delegate. And don’t take on responsibilities that are not yours. (It took me years to learn that one: I was such a slave to perfectionism, that I always thought that I had to everything myself. Bad mistake)
- If your find yourself expressing negativity, work on substituting a positive word for every negative one.
- Learn to forgive yourself if things are not going well, and use reversals as the fuel to power you to achievement: it’s what I call “silver-lining:” How to find the positive in any negative situation.
- Try to form a support group or see if you can arrange for an outsider to some in and help you.
- Are there some specific skills that you need to build and develop?
- Can you tailor or change your job?
- Develop detachment
Second, at the organizational level:
- Evaluate overall work performance: if it declining, it may be an early sign that staff members are being afflicted by burnout.
- Consider changes in managerial practices, to move away from the dominator to a partnership model.
- Research has indicated that there are six key areas in which mismatches may lead to burnout: workload; personal control; appropriateness of rewards; sense of connection; sense of fairness and a conflict of values. So it is a good idea to break down any analyses and interventions along these lines.
- All the evidence suggests that a combination of managerial change and education are the best way to head off and to deal with burnout.
- There is also some research showing that a values-based spiritual program to prevent and deal with burnout. The recommendations include a short time for silence, visualization, reflection, active listening, appreciation creativity and playfulness.
What is very clear is that burnout is not just a personal problem; it is something that can affect an entire organization, and has to be tackled as an organization. If it is not, then in these difficult times in health care, we are going to have ever more tired and disillusioned people trying to care for sicker and sicker patients, and just not having the resources to do so.
Transcending Overload and Burnout
There is an important notion that is rarely even talked about. Why does stress and burnout exist? Is it simply bad overloaded wiring in the brain and bad overloaded wiring in our relationships and in our places of work? Well, yes, that is of course correct. But there is also something else: burnout occurs because multiple sets of systems are failing. Nature abhors a vacuum, so from the ashes of these failed systems a new and improved you can emerge. Remember the ancient story of the Phoenix that emerges from the flames. And you might know the statement by Richard Bach: “What the caterpillar calls the end of the world, the master calls a butterfly.”
We need to discard broken systems so that our true self can emerge.
I would like you to think about burnout as a state of consciousness that you are ready to outgrow. You can practice the psychological band-aids, or you can accept the invitation to grow.
There will inevitably be some transition pains, but that is to be expected as the new you is being born. This is also a good time to do an exercise that I recommend in Healing, Meaning and Purpose, and it is to establish where each part of you – Physical, Psychological, Social, Subtle and Spiritual – lies in terms of the Memes of Spiral Dynamics. If you do this exercise every few months, and at times of transition, it can provide powerful proof that the burnout is actually presenting you with a unique opportunity to grow.
Artificial Light and the Biological Clock
Many of the things that we do to babies and young children have been called into question in recent years.
The debate about doing an excessive number of fetal ultrasounds and high tone deafness seems to have gone away for now. Though not disappeared: there is a paper in the week’s Proceedings of the National Academy of Sciences that revisits this important issue. Then there was the realization that doctors were not good at recognizing and dealing with pain in very young children.
And now there is another one that has worried me for years: what happens to babies who are exposed to constant high levels of light? Doesn’t it damage the development of normal circadian rhythms?
I have just seen a study that seems to confirm some of those fears.
Investigators from Vanderbilt University in Nashville examined the impact of exposing babt mice to constant light. The main biological clock is in the brain, and is located in a region called the suprachiasmatic nuclei (SCN). It is responsible for orchestrating an orderly internal physiological and behavioral cycle. It influences the activity of virtually all our organs, including the brain, heart, liver and lungs. It egulates the daily activity cycles that we call circadian rhythms.
When the mice are exposed to normal variations in light the cells of the SCN quickly become synchronized, and a normal circadian rhythm is established. Constant exposure to light disrupted the development of the SCN and prevented the animals from developing normal circadian rhythms.
This is far from being an academic exercise: each year around 14 million premature babies are born worldwide, and many are exposed to artificial lighting in hospitals. If their biological clocks are not allowed to develop normally, we would anticipate that they would, in later life, have less psychological resilience, and to be prediposed to sleep and mood disorders.
I could conceive of a way to test that experimentally by looking at records of people wth those problems. Secondly, we need to see if reducing unnecessary light exposure would have a real benefit for babies, and for the children and audlts that they will become. I would be astonished if exposing babies to a natural spectrum of light and a natural light cycle did not have enormous benefits for them as they grow up.
Friendship and Psychological Distress
“To lose a friend is the greatest of all losses.”
Publilius Syrus (Syrian-born Latin Writer, 1st Century B.C.E.)
Severe and persistent mental illnesses are one thing, but there are many, many more people who are miserable and unhappy, without that unhappiness necessarily getting to the level of an “illness.” The offices of primary care physicians and therapists are full of people in genuine distress for all kinds of reasons.
I first began to think about this many years ago when a woman came to see me and promptly announced, “I’ve come for psychotherapy. I’ve been in therapy for seventeen years, and I want some more.” I wasn’t being in the slightest bit flippant when I responded by asking her if, after seventeen years, she really felt that it had offered her anything? She looked at me blankly, and it soon became very clear that what she needed was not more therapy, but a friend to talk to.
There has been another puzzle: why is it that women are more likely to develop depression than men? The most profound gender difference in mood disorders begins to emerge after puberty, so it would be easy to attribute it all to hormones. But that would be a mistake.
I recently pointed out that there are some fundamental differences in the ways in which men and women interact: women tending to be more relational and men tending to be more transactional. The female sense of self tends to be more entangled with her relationships, while a man’s self-worth and sense of self is more often associated with his achievements. Most of these differences begin to emerge in early puberty: when girls talk to their friends, their conversation tends to be more emotional and to be concerned primarily with relationships, while boys tend to be more reserved and to discuss facts, statistics and achievements. There is some evidence from research in different cultures that these different styles seem to be the norm throughout the world. Yes, there are of course plenty of people of both genders who behave differently, and so it is more accurate to relate these differences to the male and female factor or essence, rather than getting it confused with anatomical differences.
Emotional language tends to put more strain on a relationship, and it is well-recognized that girls’ relationships turn over much more rapidly than boys’ ones. An interesting hypothesis proposed some years ago by Professor Sir David Goldberg, is that this high turnover in relationships may lead girls to experience more disappointing experiences in their social networks, and it is this string of disappointments that predisposes young women to depression.
A happy, healthy, dynamic network of friends is a cornerstone of developing and maintaining psychological resilience. Without them you become progressively more vulnerable to the reversals that affect all of us from time to time.
“A friend might well be reckoned the masterpiece of nature.”
–Ralph Waldo Emerson (American Poet and Essayist, 1803-1882)
“To know how to live in a brotherly way with those around us is to be rich, for each of us, with our face, eyes, voice and thoughts, contributes something alive, something warm, which nourishes everyone.”
Omraam Mikhaël Aïvanhov (Bulgarian Spiritual Master, 1900-1986)
Social Supports, Sense of Coherence and Recovering from Depression
After writing about the importance of trying to establish a personal sense of coherence, I was just able to look at an important piece of research.
The authors are from Sweden, a country in which, from my experience, there is still a great deal of social cohesion, despite all the experiments that have been going on there in recent years.
So unlike countries in which there are terrible social supports for everyone, they had the opportunity to study the good and the bad.
Though only a small study, the conclusions are unsurprising but important. They were looking at people with a first episode of major depression, and 71% of the patients had recovered at follow up.
The sense of coherence scores were low at baseline, although the patients who recovered significantly increased their sense of coherence. Another factor of importance for recovery was a significant increase in social support.
It is intuitively obvious that social support is an important part of the restoration of a person’s sense of coherence. It can be used in interventions that include the patient’s family or close social network in combination with support to assist the patient to view his/her situation as comprehensible, manageable, and meaningful, thereby promoting or improving health.
The bottom line: professionals need to identify people’s strengths and weaknesses so that the support and interventions provided can be tailored to meet the needs of each individual.
And one of the best ways of staying healthy is to maintain your social supports, to provide them for other people, and to work on increasing your own sense of coherence.
Resilience, Misfortune, and Mortality
Much of the development of the ideas of Integrated Medicine has been driven by the idea that a truly effective holistic medicine does not simply integrate different modalities to achieve health and wellness, but is also aimed at integrating all the different aspects of a person into a coherent whole. That was the real reason for choosing the term “Integrated” medicine in the United Kingdom, though “Integrative” and “Integral” medicine are ultimately all aiming for the same thing.
This is quite different from simply adding some acupuncture, an herb or some relaxation therapy to a conventional medical program. Its aim is not so much getting someone better, as to give the whole person – physical, psychological, social, subtle and spiritual – what he or she needs to be able to get themselves back on an even keel, so as to be able to deal with future challenges as they arise. And not just deal with them, but to use challenges as springboards to growth and development.
The whole idea of this system of medicine included an extra dimension that had often been left out: the interaction between the person in trouble and the practitioner. We are social animals, but even more than that it looks as if we are highly interconnected from cell to soul. We have to take into account the impact of a therapeutic interaction on the clinician, as well as the influence of the clinician’s psychological, subtle and spiritual makeup on the individual.
The development of this system of medicine had many parents. One was the American-born Israeli sociologist Professor Aaron Antonovsky who first generated the idea of salutogenesis: the study of the factors that support human health and wellness. He was one of the first to show that people who were relatively unstressed were far more likely to be able to resist illness, compared with stressed people. His interest was not just in what causes disease, but what are the roots of health.
He returned to and discussed, developed and applied an idea that had been around since the work of Sigmund Freud and Roberto Assagioli: that was that our experience of well-being constitutes a Sense of Coherence (SOC). He defined the sense of coherence like this:
“A global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected.“
Two recent studies seem to indicate that this concept of coherence is fundamentally correct.
Researchers in Cambridge in the United Kingdom have reported a population-based cohort of 20,921 men and women completed a postal assessment of their lifetime experience of specific adverse events and a measure of their sense of coherence. Those with a weak SOC reported significantly slower adaptation to the adverse effects of life experiences, compared with those with a string SOC, and were more likely to die prematurely. Although the size of the effect was not large, the results suggest that SOC is a potential marker of an individual’s adaptive capacity to deal with social stress, which is predictive of mortality
The second study was a systematic review from Finland. I like the way in which the study was done, and it came to this conclusion:
“SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion.”
So what does this mean for you?
Developing a sense of coherence is a most critical factor in creating and maintaining robust health and ability to adapt to change, be it in health, stress, your relationship or at work.
How do you do that? Healing, Meaning and Purpose spends over a hundred pages or several CDs explaining the most up to date ways of doing exactly that using a process known as Creative Self-Integration.
I do hope that you take the opportunity to sample some of the techniques for yourself.
