Soul healing in psychiatry

In Latin, psyche means ‘soul’ or ‘spirit’ and Iatria means ‘healing’. Psychiatry, therefore, can be translated as ‘soul healing’. There is a saying in India: “When you talk from your reason and logic, you appeal to the other person’s reason and logic. When you talk from your heart, you appeal to the other person’s heart. When you talk from your soul, you affect the other person’s soul.” Logical communication takes place in a variety of ways in everyday life, while heart-based communication generally occurs between friends and loved ones as emotions are shared. Soul-based communication is a very personal and individualised process.

We communicate with our souls in many ways, like enjoying music, engaging in spiritual practices, forming deep bonds, or when we participate in activities with passion. The soul can be nourished in many ways, but the soul can also be damaged in many ways, particularly when we feel hurt or experience trauma. The philosophy of mind-body healing encompasses all aspects of the person, including the soul. Ideally in psychiatry, we need to be healing the soul as well as the mind and body, but do we? In reality, many members of the medical fraternity will discredit any psychiatrist who calls themself a ‘soul healer’. However, many great minds of the past recognised the value and necessity of a mind-body-soul approach to health and healing.

Thousands of years ago, Plato stated: “The cure of the part should not be attempted without treatment of the whole. No attempt should be made to cure the body without the soul. Let no one persuade you to cure the head until he has first given you his soul to be cured, for this is the great error of the day, that physicians first separate the soul from the body.” Hippocrates also recognised the inseparable connections between various aspects of the person, and described healing as an art in which healing of the body cannot take place without healing the soul. However, dominance of the scientific model in recent decades has seen almost a complete eradication of the soul in medical approaches.

What exactly is science? Thousands of years ago, man believed that the earth was flat. No one knew that the earth was round. Copernicus was bold enough to state the truth in the 16^th Century and was penalised by the authorities of that time. He was trying to show the world the truth of how nature operates. It was called science. When we study science, we are studying nature, and this is often forgotten. By its very own nature, science is also always evolving; another fact that is often dismissed. The rigors of randomised controlled trials (RCTs) indeed help us learn details of natural processes, and provide information that helps us to understand disease and direct care accordingly. However, if something is not yet corroborated by RCT, it does not necessarily mean it should be discarded.

Trauma as a mental illness

Traumatic stress is a major contributor to mental illnesses, and this is now widely accepted. A person’s vulnerability to mental health problems is influenced by psychological factors and biological factors, which include, but are not limited to, genetics.¹ Adversity or traumatic stress is one of the most important and detrimental risks to mental health.¹ Mental illnesses are often caused by the interaction between an individual’s vulnerability (genetics) and chronic stress caused by prolonged life events.¹

In 21^st Century psychiatry, there is a race to discover newer medicines and more effective molecules. The refusal within some sectors of the profession to look at natural approaches is costing the human population a lot of suffering, because we forget that in mental illnesses, we are dealing with aberrations in human physiology. These aberrations occur naturally under certain conditions. Therefore, many of the solutions to rectify these aberrations can also be natural.

Mental and behavioural disorders can be viewed as maladaptive behaviours that have been learnt either directly or through observing others.² The World Health Organisation (WHO) states that medicinal drugs address the symptoms of the disease, but not the diseases themselves or their causes.² Drugs are not meant to cure the disease, but to control symptoms. Newer psychotropic drugs have fewer side-effects, but are not more efficacious.²

Exposure to traumatic events in a lifetime is associated with many negative behavioural and physical effects that stem from mental illness, like depression and substance abuse, to physical effects such as asthma and high blood pressure.³ The psychiatric disorders that may result from trauma span a spectrum of disorders that include eating disorders, sleep disorders, and panic disorder.⁴ Childhood trauma significantly increases the risk of being diagnosed with a mental illness in later life. The most common disorder that children who have been emotionally abused will experience is anxiety. Trauma also increases the risk for psychosis, obsessive compulsive disorder, and bipolar disorder. Those who experienced trauma during childhood are 15 times more likely to be diagnosed with borderline personality disorder later in life, according to research.⁵ Childhood trauma and abuse sensitise the individual to subsequent stressful events, thus further increasing associated risks in adulthood.⁶

The role of the autonomic nervous system (ANS) in mental illness

Thoughts and emotions have a profound effect on the overall functioning of the person, and can trigger a cascade of physiological and psychological pathways which become highly detrimental if allowed to become chronic. When we experience actual trauma or fear, ruminate about past failures and traumatic events, or worry about future negative events, the pre-frontal cortex and limbic system are activated. This results in signals to the hypothalamus and brain stem that cause changes in the body through the ANS and the endocrine system – resulting in alterations of the usual homeostatic balance in the body.⁶

That autonomic arousal takes place when a person feels threatened is now widely known and accepted. Hans Selye was a pioneer in describing the importance of the pituitary-adreno-cortical axis in the stress reaction.⁶ Activation of this ‘fight or flight’ stress response is mediated via the hypothalamic-pituitary-adrenal-axis (HPA-axis); and through the secretion of adrenaline, noradrenaline, and cortisol, the body prepares itself to fight stress, resulting in multiple consequences which include metabolic, cardiovascular, and immune disruptions.

Traumatic stress starts this cascade of events in the body that affects all body systems, including the hormonal, digestive, reproductive, excretory, and immune systems. After the stressful event is over, a parasympathetic takeover occurs. It is an anabolic process and restores the body to a restful state. Blood pressure, pulse rate, cholesterol levels, glucose levels, and the immune system return to normal states of functioning. The transition process from an active, under-threat, catabolic sympathetic system, to an active, anabolic, parasympathetic system occurs spontaneously and smoothly in healthy individuals. This smooth transition is the hallmark of a healthy and balanced nervous.

In trauma and chronic stress, this transition is no longer spontaneous and smooth. The parasympathetic system fails to take over from the sympathetic nervous system. The ANS essentially gets jammed or blocked, which maintains this cascade of metabolic activities in the body that reverberates through all the physiological systems. Mood, sleep, libido, appetite, and many other processes become disturbed. This is known as mental illness. Incidentally, all of these issues are autonomic disturbances. A ‘trigger’ or a precipitating traumatic event is a point beyond which a person fails to function normally. This is the point of ‘jamming’ of the ANS.

Is the medical model the only scientific model of mental illness?

There are lessons to be learned from this physiological knowledge of the stress response and its effects on the mind, body, and overall being. A scientist studies how and why things happen in nature. The deeper a scientist studies a subject, the deeper they go into the understanding of how things happen in nature. This knowledge is necessary to align ourselves with natural processes, so that we can solve problems with and without medications.

In a healthy human body, the ANS runs smoothly. When a human being goes through the daily rigors of life, the sympathetic and parasympathetic systems balance each other out in terms of their respective needs. The contraction of the heart, for example, is a sympathetic activity. The dilatation of the heart is a parasympathetic activity. The expansion and contraction of the lungs are also affected by both components of the ANS. It happens spontaneously and without effort.

In human sexual responses, the arousal in both sexes is mediated through parasympathetic stimulation. This is through erection and dilatation of the penis and clitoris, and the expansion of the uterine cavity. The orgasm is mediated through a sympathetic response. Again, the sympathetic and parasympathetic systems spontaneously work together with ease. Likewise, during the sleep cycle, there are the stages of rapid eye movement (REM) and non-rapid eye movement (NREM). They alternate many times throughout the night. REM is a sympathetic activity. NREM is a parasympathetic activity. Yet again, there is coordination and balance in a healthy individual.

What we already know

The paradoxical effect of drugs was proposed many years ago. It was based on the observed unexpected effects drugs had on some human conditions. For example, and contrary to expectation, it was noted that when stimulant drugs were given to hyperactive children, they calmed down, and autistic children on the other hand, were stimulated by tranquilising drugs.⁷ What might be the reason for this paradoxical effect?

The sympathetic system must reach a peak before the parasympathetic system can smoothly take over and calm down the response. This is achieved by adding sympathomimetic drugs to their system. When sedatives are given to autistic children, parasympathetic stimulation reaches its peak to let the sympathetic takeover occur. In the past, psychologists have suggested that people who possess high sensation-seeking traits prefer activities that increase their arousal levels. Those low in sensation-seeking prefer activities that decrease their arousal.⁸

This may not be the precise way things happen, but it is a simpler way to appreciate how things are likely to be working in the human body. Is it a coincidence that a majority of psychiatric drugs have been adrenergic, dopaminergic, cholinergic, or anticholinergic? These drugs indicate that the major disturbance in the human body under traumatic stress is in the ANS. The smooth transition from the sympathetic to the parasympathetic, and vice versa, simply stops happening under stress. The stress of the trauma stimulates the sympathetic system and the HPA-axis. The cortisol overload and the successive disturbance in the hormonal system create havoc in the body’s physiology.

Physiological systems need help with medications to stop further deterioration in the physical and mental health of the individual. Medications help the jammed ANS to stop responding to emotional arousal. However, with ongoing medications in the body, the already jammed ANS is disrupted further. We are now moving away from letting the sympathetic and parasympathetic systems dance their dance.

According to the WHO, intervention for mental illnesses should have a determined duration for the time required by the nature and severity of the condition, and should be discontinued as soon as possible.² Once the goal of stopping the deterioration is achieved though, what do we do next? This question has many answers. It is beyond the scope of this article to explore all of those answers.

Are there other options in psychiatry?

Some research carried out on meditation shows that the practice stimulates either one or both parts of the ANS.^9,10 Arthur Janov, creator of primal therapy, stated: “The traits which make up the dimensions of parasympathetic/sympathetic are highly complex and exist along a continuous spectrum. A truly happy person has a proper balance between these two stages.”¹¹ Therefore, therapies that promote balance warrant investigation and consideration.

One of the many studies done on hypnosis suggests that it also works on the ANS.¹² Acupuncture also targets the system. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalances between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitters in related brain regions to alleviate autonomic response.¹³ This, and many other ancient practices, have been utilised for centuries to alleviate an array of physical, mental, and other issues. More modern approaches, such as sound healing (using binaural waves) and light healing, are generating positive results in some studies. Research into the alternative and complementary disciplines is ongoing, but it is difficult to carry out and is underfunded.

The alternative science of mental health

How can we then use this knowledge to help those who experience mental illnesses? There are many non-pharmacological ways to promote ANS balance, such as physical exercise, breath manipulation, meditation, imagery, and vagal stimulation techniques. However, these strategies must also be implemented with caution and due diligence. Meditation, for example, is often prescribed without taking into consideration how it might affect the individual patient. Despite the practice being relatively safe for most people, according to many studies, the individual nature and past experiences of each individual patient should be taken into account. In a study on mindfulness meditation, related adverse effects with negative valences or negative impacts on functioning occurred in 58 per cent and 37 per cent of the sample, respectively. Lasting negative effects occurred in 6-to-14 per cent of the sample, and were associated with signs of dysregulated arousal (hyperarousal and dissociation).¹⁴ Many of these therapies are poorly regulated, which also adds to potential risks. Bridging the gaps, investing in research, and improving regulations will all go towards a safer, person-centred approach to mental health.

When it comes to emotion, all roads lead to the ANS. Whether it is the generation, expression, experience, or recognition of emotion, the role of the ANS is critical.¹⁵ Any method of expression of emotions is an expression of the ANS. It is for this reason that many natural approaches, as well as activities like talking, play therapy, art therapy, or journal writing, can be effective in emotional healing and subsequently improve mental wellbeing.

Forward thinking

By relying on pharmacological approaches only for long-term care, we prevent the ANS from finding its natural spontaneity. Keeping the nervous system sedated with medications offers an emergency treatment for many acute and life-threatening situations – the current system of mental health all over the world emphasises the training of psychiatrists as emergency physicians. However, the concept of ‘emotional healers’ is not widely recognised. In fact, many psychiatrists still frown upon psychotherapies and alternative approaches to long-term mental health.

Further investigation and understanding of the mechanism of the ANS in the causation and healing of trauma, and of the effects of various approaches to balancing the system, is going to make the work of mental practitioners easier. I have been working with the ANS for more than 30 years to gather the material and observations for this article. I have developed a system using breath, imagery, and meditation to benefit patients and help them reduce their dependence on medications. I call it ‘subjective emotive brief therapy’.

I believe that in the future, the current practices of medicating mentally ill people for perpetuity will be looked upon as a primitive science. It will become common knowledge that each cell of the body stores memories of all life experiences, and that our DNA and physiology are affected by our behaviour and life experiences. This information may swing the path of emotional healing in a different direction, to bring more badly needed positive outcomes to those suffering from a range of psychosomatic, physical, and mental health conditions. As an empirical science, psychiatry will continue to recognise the evidence supporting ‘soul healing’, and move towards an evidence-based approach that recognises the value of ANS balance and all dimensions of the person.

Author:  Dr Pradeep K Chadha, MBBS DCP DPM PG Dip, Psychiatrist and Medical Psychotherapist