Originally published in Massage Bodywork magazine, April/May 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Fibromyalgia management is controversial today in both traditional and complementary medicine circles. Researchers and health care practitioners are seeing mixed results from a variety of cutting-edge protocols. Following are the details of one success story involving a combination of methods, and a summary of the resources which helped make it happen.
I was fortunate to have an opportunity to follow Mrs. M for a period of three years. Given a chronic problem, and her age (50), there were many variables to her condition. This article is a retrospective tale of our collaborative journey toward health.The Problem of the "Cure"
As with so many others afflicted with the disease, conversations with members of Mrs. M's fibromyalgia support group revealed a shared belief they had an "incurable disease." They apparently deduced this diagnosis from their physicians' inability to provide a "cure." By accepting the condition deterministically, any potential for optimism was defeated. This detrimental outlook confirmed a point made by Daniel Goleman in his book Emotional Intelligence: "Historically, medicine in modern society has defined its mission in terms of curing disease -- the medical disorder -- while overlooking illness -- the patient's experience of disease. Patients, by going along with this view of their problem, join a quiet conspiracy to ignore how they are reacting emotionally to their medical problems -- or to dismiss those reactions as irrelevant."1
Physician Joanna Vishio wrote, "It's the unknown that often makes people scared stiff."2
Facing the lack of definitive cure as a goal, Mrs. M and I began our search for moments of temporary relief. We discovered that gradually both the duration and the points of pain relief for her expanded and accumulated. She began to experience a process toward wellness, rather than a method for cure. As she made this translation of expectations, Mrs. M also began learning to let go of a massive, habitual tension pattern.
The uniquely American valuing of heroic (yang-dominated) medical interventions is part of our "frontier culture."3
The epitome of this mindset for fibromyalgia is the removal of the cranial bone to decompress brain tissue.4
Meanwhile, less dramatic (and less costly) interventions remain under-reported. One unfortunate consequence of the heroic approach is that the client expects the practitioner to deliver magic. Tragically, the client remains ignorant of his habit-level biomechanical problems and maintains a disempowered status with regard to his health.
When I met Mrs. M, she had been incapacitated for three years even though she had been compliant with all medical recommendations. As she and I studied her symptoms and speculated on possible causal factors, she gradually gained a more objective viewpoint toward her disease. Learning together became the therapy: we discovered her tolerance to physical and emotional pain. The mind-body interface became the healing space. In his book, Healing Back Pain: The Mind Body Connection
, John Sarno describes the use of awareness and education in his intervention with tension myositis syndrome, a milder form of fibromyalgia.5
As Sarno advocates, Mrs. M and I constructed the problem in such a way that she could feel entitled to a solution to her condition. The Intervention Strategy
My conceptual frame of reference was grounded in the neurophysiological stress profile so aptly described years ago by Kenneth Pelletier.6
The indelible imprint of early trauma history is now recorded in Linda Leuken's human study.7
The unresolved loss of Mrs. M's parents was the root of her stress pattern. Our goal was to create enlightened self-care to soothe deep wounding, a state of being to which she had adapted over the years. Mrs. M's change can be described in thematic steps:
1. Learning to feel without the habitual, cognitive filters.
2. Learning to let go.
3. Listening to the previously unacknowledged emotional language expressions as they are discovered in the body.
4. Having accountability for attitudes that exist as embodied habits.
5. Setting a goal: Self-management through awareness of limitations and new freedoms.Phase #1: The First Year
Feeling, plain and simple.
Unlearning the pain habit was a slow process. Sessions began with structural corrections using myofascial work. Just as her physical excursions of movement were limited, so was her imagination. Her entire being operated within the sympathetic nervous system range. Constriction was pervasive: hoarse voice, elevated blood pressure, frequent illness, tight-chested shallow breathing, tight jaw, furrowed brows and squinting eyes. She was a picture of John Upledger's description of the stress response as "the big spender," squandering her life energy.8
She existed at the adrenal-dominated alarm stage, and saw the world through tunnel vision. The autonomic emergency system kept her immune function depleted, making her physiologically off-balance.
Mrs. M began to discover through her illness that doing less was safe. Coaching for physical balance was the most effective awareness intervention used during this time. Her postural attitude consisted of a stomping walk and a calloused temperament, in short, a woman who had fought to get anything at all. The challenge was for her to feel expansion in muscular tissue and to bring her head up and look around. As her tissues thawed, she found enough energy available for her awareness to expand.Phase #2: Learning to Let Go
Or looking for a good night's rest.
The human being's difficult marriage of power and perception has a long cultural history. The ruler has often silenced the seer. Mrs. M seemed to be fighting that conflict alone, and the old control mechanisms had prevailed. Mrs. M saw her pain only in muscular terms. To gain a peaceful coexistence of these forces within her, Mrs. M required some parasympathetic tone. She needed to soften, to open the gaze and joint spaces, to expand the torso, to digest and to accept kindness.
The doorway to Mrs. M's interior perception came by way of a workshop I attended on Linda Burnham's System of Facial Rejuvenation. Mrs. M agreed to be my regular practice subject. RejuvSM, a system combining energy with carefully developed techniques of patterned strokes that activate major nerve centers on the head as a method of redefining and releasing facial features, became the method of choice for most of our sessions. Encompassed in the ideology are the concepts of presence (the need to be fully here in our hands and in our minds, bodies and spirits), trust, loving and communication. As Mrs. M's jaw relaxed over time, she began to share the stories of her life. Imprinted memories of unreasonable external pressures and punishments had dominated her formative experience. The emotional pain was more difficult to bear than the familiar body pain had been, yet she persisted with the process.
So how do you get to the parasympathetic cache? Rejuv proved sufficient. First, Mrs. M had never experienced an encouraging or tender environment in her childhood. The guarding and constriction around the shoulders, neck and head became an obsolete defense. She let go into the invitation to discover the experience of receiving comfort. Her attention moved from the body to the seat of perception and social awareness (brow and eye band of the head, and the face and throat, respectively). Mrs. M experienced the Zen-based concept of loving kindness, which is a foundation of this light pressure protocol. She responded by sensing safety. Thus the parasympathetic power was tapped. The autonomic switch had been thrown and was announced by gastrointestinal tract churning and gurgling. Repetitions of this experience gradually reversed the visceral conditioning of a lifetime. The body, seemingly unattended, continued to improve its natural elasticity and flexibility. The balancing of the visceral and musculoskeletal systems was now underway.
Our initial expectation of Rejuv was limited to the cosmetics of Mrs. M's stressed countenance. Instead, the work revealed more trouble, notably Kenneth Dychtwald's description of the deep-set eye problem and immobile neck.9
Her view of her world began to be more receptive with this work. The worried furrows at each brow melted as she became willing to let go of the worry habit. Issues were peeling away. Dyctwald's prediction came to be: "The throat is said to be the doorway that announces the beginning of an emotional and spiritual ascent into one's inner self."10
The heart-mind link had occurred, and was visible. Increased awareness brought its own momentum. Mrs. M gathered her life story in photos. We studied her facial character lines and celebrated recent improvements as victories.Phase #3: Fine-tuning the Attention
Facing the personal.
The useful explanations in Goleman's Emotional Intelligence added to my evolving confidence in Burnham's Rejuv method. Goleman's description of the prefrontal cortex's role in emotional memory suggested an explanation for the dense and painful area of Mrs. M's left brow and orbit. Goleman writes that the key "off-switch for distressing emotion seems to be the left prefrontal lobe. Neuropsychologists...have determined that one of the tasks of the left frontal lobe is to act as a neural thermostat, regulating unpleasant emotions. These prefrontal-limbic connections...are essential for navigating us through the decisions that matter most in life."11
This explained the furrowed, dense and painful left brow. My fingertips were working right over a link to the sympathetic loop through the amygdala.12
It seemed that the brow musculature was working to augment that intracranial area. To bring a calming influence to the locus of emotional memory deserves our serious attention as bodyworkers. Could this partly explain Mrs. M's rapid improvements after the use of Rejuv as a regular intervention method?
Again we were working with balance. Now Mrs. M became aware of the subtle balancing of how mental energy is expended. She began choosing whether to invest in an effort, or to simply let go. Her brow became less furrowed, even when she recalled her past pain. Through letting go, she had achieved the ultimate flexibility: her attention moved smoothly through her story, past and present. She learned to balance her projects according to the availability of her natural energy. Mrs. M faced her persona "The Strong Survivor," who had been driving her into exhaustion.Phase #4: Accountability
Autonomic conditioning takes a backseat.
"It is a very suicidal act to go on repressing your original face...You are not living; on the contrary you are simply acting... To be dishonest, to be insincere to yourself, is the worst punishment you can give to yourself."13
So said Amiyo Rhunke in Body Wisdom.
The habit-level had been inaccessible to Mrs. M without manual intervention to awaken her self-perception. The habit-level problem was complicated by longstanding, conditioned autonomic behaviors. She had perceived her lifestyle-in-overdrive as having a protective function. Perhaps even these notoriously resistant problems are accessible when timing and intervention strategy are selected to enhance emotional learning. Weekly Rejuv sessions brought about a softening in her viewpoints. Laughs came more easily.
The completion of this phase was in the awakening of insight. Mrs. M now sees externally without the anxiety-driven defenses. She sees internally, using insight to bring together a picture including both heart and mind. Her old barriers have transformed into healthy boundaries. Her family notices her honest, open gaze. The "worry wrinkle" between the brows is a less predominant feature of her expression.Phase #5: Terminal Goal
Awareness of balance as expressed in poise
I conceptualized the final step in this story with the wisdom of Robert Lewis, M.D. Using a Bioenergetic model, he emphasized the necessity of healing the mind/body split in this way: "As long as the respiratory wave does not move the protoplasm of our heads, our thinking will indeed be a superficial head consciousness (the mind as False Self), because it is not infused with the breath of life."14
First, Mrs. M learned to let her skeletal muscles experience expansion. Next, Mrs. M found her way to visceral openings. Finally, she learned to open up her head, neck and throat, using the Rejuv method. Poise and vitality became sustainable when she opened head and body to the breath rhythm. This means she doesn't choke off threatening feelings or impulses at the level of the throat. Her open face, clear sinuses and easy yawn demonstrate that her expansion potential can support her psyche. Following Jung's beautiful words, her rationality is no longer "won at the expense of [her] vitality."15Results
Through our three-year journey, Mrs. M's blood pressure records did not show the expected drop in autonomic arousal we had expected. Today, however, she has relaxed enough to become a non-smoker. With that change, blood pressure measures normalized. Her blood pressure no longer peaks with volatile bursts.
A full bouquet of healthy change is evident in Mrs. M. She had an opportunity to return to her dentist for dentures. Before our treatment episode, the professional had struggled to get the apparatus into her mouth. Recently the same procedure was repeated. The dentist was impressed with the ease of access and normalized sensitivity of the oral cavity. Mrs. M's lifestyle has softened too. She no longer exercises to exhaustion in order to find sleep.
Watching her in movement, she no longer moves intensely, nor at her old, breathless pace. Her soft core can open comfortably for breath, no longer strangled by the armored, striated surface layer. The frozen and breath-grabbing habits so clearly explained by Donna Farhi have been resolved.16
She now responds to softer, more visceral work, letting the breath draw her toward interior awareness.Discussion
Results like these may never be validated by numbers of clients. I never expect to have another client just like Mrs. M. Norman Cousins pointed to the value of the difference in viewpoint between scientists and artists. The scientist may need large patient "samples" for statistical validity. The artist, however, is free to celebrate the unique occurrence.17
Perhaps an accumulation of anecdotes will be recognized for themes that bring people toward wellness. The power of single case study is especially significant in those clients who have not found solutions through routine, though expert, medical attention.
Today the real hero in the healing journey can be recognized not as the all-knowing physician, but as the individual living his heroic journey. To paraphrase the words of Joseph Campbell: The hero learns to draw attention away from the distracting secondary effects and move to the causal zones in the psyche, where difficulties truly abide. The hero then clarifies and eradicates the problem in his own case. By meeting this challenge, the hero (in this case, Mrs. M) gains the precious attribute of discrimination.18
Perhaps at this time, Mrs. M became the steward of her own health.Summary
This case shows the effectiveness of moving from a myofascial treatment frame of reference into an energy-based approach, using the Burnham System of Facial Rejuvenation (BSFR). The timing of the transformation was serendipitous. I learned about the protocol and needed a volunteer client for practice. By then, with the myofascial work we had been doing, Mrs. M had learned how to relax her voluntary muscular system. BSFR offered much-needed comfort along with efficacy. Mrs. M then made healthy changes beyond what we had anticipated. The movement into the less accessible, autonomic realm of visceral and attitudinal movement proved to be profound.
Mrs. M progressed from a life dominated by body pain awareness into opening to her humanity. Mrs. M has grown beyond the mind/body dichotomy. Our profession may be healthy enough to do likewise.Postscript
Mrs. M continues Rejuv sessions along with exercise and close medical observation. She no longer reverts to the old pain pattern when her appointments are interrupted or delayed by other events. Today she enjoys frequent playful visits with her toddler grandchildren. She appreciates the role of Rejuv in bringing her to a new quality of life. Her mind no longer carries the misery of her earlier years, and her face projects optimism and contentment.Valerie Whiting, M.S, OTR/L, LMT, teaches at Roane State Community College and maintains a private practice in Knoxville, TN.References