Psychosynthesis and the reduction of suffering in medical patients
by Richard Schaub, PhD, and Bonney Gulino Schaub, RN, MS, PMHCNS-BC, NC-BCEach of us without exception is vulnerable to change and loss. This normal state of vulnerability is aggravated when we become ill. The 1994 inclusion of physical illness as a potential traumatic stressor in the fourth Diagnostic and Statistical Manual of Mental Disorders has led to studies of PTSD in medical patients. Loizzo, Charlson and Peterson point out, however, that the viewpoint which classifies the traumatic reaction to illness as a disorder demonstrates a bias: “…the bias cognitive-behavioral and psychodynamic therapies share with our medical system as a whole. That is, the failure to acknowledge illness, aging and death as existential features of the human condition, rather than…intrusions to be eliminated, avoided, or denied”. To address the existential anxiety aspect of illness, Loizzo et al offer a contemplative program based on “Indo-Tibetan” practices to help cancer patients to feel “…empowered to face the enormity of the challenge”. Loizzo, Charlson and Peterson’s work extends earlier blends of Eastern spiritual practices with Western healthcare. Examples include: the neurologist and psychiatrist Roberto Assagioli’s integration (psychosynthesis) of Buddhist insight meditation and visualization meditation with psychotherapy; the cardiologist Herbert Benson’s distillation of Indian mantra meditation (Transcendental Meditation) to evoke the parasympathetic “relaxation response”; the microbiologist Jon Kabat-Zinn’s focusing of Buddhist mindfulness meditation on pain management and stress reduction, now referred to as MBSR - mindfulness-based stress reduction. These pioneers have been instrumental in encouraging further uses of Eastern spiritual practices in Western healthcare. This article builds on these medical-spiritual integrations. It covers four areas for the health professional’s consideration:
- Greater awareness of the existential anxiety present in each patient’s experience - which we term vulnerability
- The use of specific transpersonal practices derived from Assagioli’s psychosynthesis for alleviating the degree of a patient’s vulnerability-anxiety as he or she goes through treatment and recovery
- Case studies that illustrate the effects of these practices
- The need for a psychosynthesis-trained specialist on every treatment team
Greater awareness of vulnerabilityHealth professionals are consulted everyday by patients hoping to heal the crisis of illness. In addition to the anxiety of a sudden change in health, struggling with symptoms, going through diagnostic testing, deciding on the best treatment, dealing with the side effects of treatment, and the course of post-treatment recovery, the patient has anxiety about an uncertain future that may include pain, disability, dying, and the end of hope. Compassionate professional responses to a patient include reassurance, cautious optimism for a good treatment outcome, possible referral to a hospital social worker or chaplain and, if necessary, anti-anxiety medication. This article adds the reality of an existential aspect to the patient’s clinical picture: illness forces us to face the fact that change and loss are an inevitable part of life. This fact of vulnerability is an underlying source of anxiety, which is typically ignored in the treatment of illness. Referred to by philosophers East and West as the “human condition” or the “truth of impermanence,” vulnerability-anxiety is ultimately linked to the awareness that our life is temporary, a fact we try to deny . Serious illness breaks down this denial and exposes us to our underlying vulnerability-anxiety. Bruce, Schreiber, Petrovskaya and Boston chose the term “groundlessness” as a way to summarize the vulnerability-anxiety statements from patients at their medical center. Bruce et al. further reported that a severe form of groundlessness can occur in patients who thought they had a religious faith but lost it when they became seriously ill. Loss of confidence in religion and loss of religious affiliation are now extending into 25 percent of the United States population, particularly among young adults, and this loss of religious support adds to the vulnerability-anxiety struggles in our patients. This article advocates that we include this deeper anxiety and suffering in our assessment of a patient’s experience and learn how to respond to it to enhance recovery. The outlook and skills of psychosynthesis give us one proven way to respond.
Transpersonal resourcesThe ego-based personality has no answer for “the human condition” and the “truth of impermanence” since the ego-based personality itself is impermanent. The vulnerability-anxiety aspect of the medical crisis calls upon us to go beyond our personality (i.e., transpersonal) and to awaken our transpersonal resources of peace, wisdom, purpose and oneness. Though we haven’t been educated about these transpersonal resources, they objectively exist in dormancy in each person without exception. As is demonstrated in the case studies, these resources can be awakened within a single meeting with a patient. Recent publicity reported on the profound effects of the hallucinogenic drug, psilocybin, to reduce anxiety by increasing transpersonal experiences in patients with cancer at the NYU Medical Center. This article reinforces the importance of such experiences but focuses on non-drug interventions—psychosynthesis skills—that guide patients into their transpersonal nature.
The first step: Moving from fear to choiceInsights from neuroscience (Hoelzel, Carmody, Vangel et al., 2011) and Assagioli indicate that there is an observing aspect of the brain-mind which notices and is conscious of thoughts, feelings and body sensations but is distinct from those thoughts, feelings and sensations. Hanson (2009) refers to this observing consciousness as "the executive center of the brain," and Assagioli refers to it as "the observing self or 'I.'" Hanson describes this observing consciousness as part of the brain. Assagioli believes our brain participates in this consciousness and utilizes it but that its source is universal. In either case, this observing consciousness, in its executive brain function, is capable of both:
- Noticing thoughts, feelings and sensations
- Deciding if it will engage with any of them or not engage
- We all have a healthy, normal and active fear center in our brain which is trying to help us to survive and sends signals of anxiety when it perceives threat
- Our normal brain is biased in favor of paying attention to anything negative in order to survive
- First turning toward our thoughts, feelings and sensations
- Noting the nature of them (e.g. worry)
- Consciously and deliberately deciding to turn attention away from them.
Case study in disidentification: LarryLarry, a 35-year-old with a diagnosis of HIV positive, was referred by his physician to the psychosynthesis institute because of displays of extreme fear and anger in the hospital clinic. He had refused medication for his fearful and angry episodes, rightly asserting he was having extreme feelings because of the extreme situation he was in. He was first trained to follow his breathing and to say out loud anything that was coming into his awareness from moment to moment. After several minutes of this, he was instructed to verbalize internally whatever he was noticing. The technique was then shortened to:
- Following his breathing
- Noting internally with a single word whatever he was experiencing
- Returning to his breathin
- Consider his breath as his center
- To be interested in whatever thought or image or feeling or sensation pulled him away from his breath, away from his center
- To keep his attention long enough on the off-center experience to know what it was, e.g., worrying
- To mentally note, “Worry"
- To then return his attention to his breath, to his center
Accessing the transpersonal resources of peace and wisdom“Transpersonal,” meaning beyond the personality, refers to the deeper resources in human nature beyond the habitual patterns of the personality. The transpersonal resources featured in this article are inner peace and inner wisdom. First used in 1905 by the “father” of American psychology, William James, the term "transpersonal" gives health professionals a neutral way to refer to the higher and deeper resources in human nature without resorting to spiritual and/or religious language. The Swiss psychiatrist Carl Jung and Assagioli both used “spiritual” and “transpersonal” interchangeably. With an understanding of the objective existence of the transpersonal resources in each person, the health professional can help patients to
- Disidentify from vulnerability-anxiety thoughts, feelings and sensations (as in Larry’s case)
- Learn how to directly experience their innate transpersonal resources.
Case study in inner wisdom: ClydeOne of the first author’s early clinical experiences with the profound transpersonal resources of peace and wisdom took place in during the first onset of the HIV-AIDS epidemic. A patient named Clyde called our psychosynthesis institute to say that he was diagnosed with AIDS, was already extremely ill and was struggling terribly with fear and anxiety. This case study describes a single home visit and transpersonal session that took place in Clyde’s apartment. When the author arrived, Clyde could barely manage to come to the door and then quickly retreated to bed. He was under the covers, shaking, when the session began. He said he had been searching desperately for some way to calm himself, but nothing was helping. He’d given up on anti-anxiety medication because it made him feel worse once the medication wore off. Clyde was asked if he had any religious or spiritual belief. He said he had rejected his childhood religion because it rejected him due to his homosexuality. He said he wondered about reincarnation but didn’t believe in it, basing his interest only on the feeling that he had “been here before.” The author used this as a starting point for an inner wisdom practice. With Clyde lying prone on his bed and the author in a chair by the bedside, Clyde was guided to follow his breathing. Then, utilizing the reincarnation metaphor, Clyde was asked to imagine another man in another time and place who was also following his breathing just as Clyde was doing now. Clyde’s breathing began to slow down and his eyelids were fluttering, a physical sign that vivid inner imagery was taking place in his imagination and causing rapid eye movement (REM). Nothing else was said to Clyde. Usually, an imagery meditation practice such as this lasts a few minutes at most. Clyde remained still for twenty minutes. There was a palpable feeling of peace in the room. Clyde then slowly opened his eyes and began to relate what he had experienced:
“I felt my body sink deep in the bed. I felt a great heaviness and peace. The itching from the medication went away, and it’s still gone. I saw an image of a young man. I saw him become ill. I saw his flesh begin to fall off him, until a skeleton was all that was left.
“Then his flesh reappeared, and his life force returned. He was the same healthy young man I first saw. But soon, the flesh began to come off him again, his life force left him, and he became a skeleton again. At that point, I saw an old man behind him, and I realized that as the old man moved his hand to the left, the flesh came off the young man, and as the old man moved his hand to the right, the life came back to the young man. I watched this with great feelings of peace. I felt that I was being taught something very important. I can’t even say the peace was in me, because by the time I was watching this I had absolutely no sense of my body at all. My body was gone. My body had dropped away. I was free. I was floating free. I had no fear at all. I was free.”In psychosynthesis imagery practices, the images that are generated in the patient’s mind are considered to be uniquely personal and unnecessary to interpret by the health professional. It was clear that Clyde had connected with an inner wisdom which was advising him to let go as a way of reducing his suffering and increasing his peace. Clyde told his closest friends about his wisdom experience and made them promise to guide him to his “wise old man” when he was dying. As his illness progressed, Clyde was hospitalized. After a few days as an in-patient, he stopped communicating. Although he was not in a coma, he remained unresponsive to visitors who assumed that this was a neurological or emotional consequence of his approaching death. One night, as his friend Paul was leaving Clyde’s hospital room, the nurse told him that she didn’t think Clyde would live through the night. Remembering his promise, Paul returned to his friend’s bedside and began to guide the unresponsive Clyde to his inner wisdom. As Paul finished and sat back crying, Clyde spoke up and said, “Don’t worry. Clyde is already gone.” He died peacefully thirty minutes later. Case study in inner wisdom: Hilda Hilda was a 77 year-old Holocaust survivor who was being treated for a recurrence of lymphoma. Six years before, when she was first treated, her husband had been there to support her. But he had since died, and now Hilda did not think she would have the strength to go through it again on her own. Hilda said that the emptiness she felt in herself had become frightening to her. “I have no strong feelings, no delights, no disappointments,” she said. “Nothing matters. That is not life; that is a terrible stagnation. A sleep condition. I have to get out of this, but how?” She then went on to talk about herself as a young woman before she left Germany. She would face her problems by cutting herself off from the world, going off by herself “to a lonely place in the heather” to contemplate and find solutions to whatever was bothering her. She was guided to close her eyes, relax, and go back to the heather. This is how she later described the experience in a letter:
“I transported myself mentally to a suburban train heading to the heather. It’s a beautiful summer day. The passing landscape is hazy, impressionistic. I get off at the heather station and walk down a long, gray, wide, very dusty road with deep ruts created by heavy wagons. There are no cars on this squalid road.
There are hardly any people. A few old fenced-in farmhouses to the right and left. Maybe no one lives in them. I walk on and see a little side path leading directly to the heather. I take the path and after a while even that ends. I go on, slowing down because of the thickness of the heather, and continue through this unlimited, unending heather field broken by only a few birch trees. This is real wilderness without man’s interference.
Finally I sit down near some trees. How wonderful.
I decide to lie down and look at the cloudless, silky, pale blue sky, draped like a dome over the horizon. A very gentle wind caresses me and makes the little gray-greenish leaves of the birches move slightly, maybe talking together about the intruder—me—who lies so motionless. A few butterflies flutter around, busy bees hum and collect the nectar from the flowers of the heather and move gracefully with the wind. Everything is peaceful and disconnected from the daily crazy world. What a glorious day.
But I did not come here for adoration. I came to find my purpose, to feel better. I have to start searching. I fall into a deep sleep. I become a turtle, a little gray, insignificant, unnoticeable turtle, head inside under an impenetrable shell. Cut off from the lovely outer world.
I have to go down a chute, deep into the uncontrolled conflicts within me, past the vanity and finding excuses for everything I do, past the lies I tell myself, until I come to my own core, bare and naked, where my innermost soul begins. I sink deeper into sleep.
What is my problem? Is it the relationship between me and my family? Is it the relationship between friends and myself? Why do I suffer so much defeat despite wanting success? What is the destructive chemistry inside me?
I believe these are questions without easy answers. But to put the questions into words is already a cleansing.
Slowly I begin to wake up from this kind of trance. My hair sticks to my face. I smell the strong, good, earthy soil on which I lie and I love it. The sun is high in the sky now. Somehow I feel sweaty but good about myself, and I start walking again. Far away I see a herd of sheep with a shepherd. When I pass him, we greet one another.
Moving over this lovely, purplish, unending carpet of heather, I suddenly come to a big swimming pool filled with clear green water in the middle of nowhere. At the edge stands a short, white-haired, dark-skinned man who says hello. We talk a bit and he invites me to swim in his pool. I tell him I am a poor swimmer. I lose my breath easily from fear and would never let go of the ground beneath me.
He finally persuades me to swim across by promising to jump in immediately if I lose my breath or get panicky. Somehow I trust him and slowly submerge myself in the crystal clear water.
Swim,” he orders me. It is a command. I have to follow. I swim across, making sure he is still standing on the edge. I come to the far side of the pool and decide to stop.
Turn and swim back—swim, swim. You can do it.” I listen to him and do the exercise several times without stopping. I never did such a long swim before in my life and I didn’t have any breathing problems.
Finally I get out of the water and can hardly believe it was me who accomplished all this swimming. What kind of man was he to give me all this unexpected power and confidence? I don’t know. I never see him again.
This achievement on that day gave me such an immense, beyond-any-words feeling of happiness that I will and never could forget it. I finish my trip by picking a huge bunch of heather for my grandmother, who preserves it for a year by pouring boiling water over it and keeping it dry in a vase.
When I open my eyes I really feel at peace. What a beautiful day.”Hilda was definitely not someone who would have believed in a natural inner wisdom. Her life experience, in fact, had taught her quite the opposite—that there was very little of positive value to be found in human nature—and she probably could have filled an entire book with her negative opinions of religion and spirituality. And yet, despite her lack of belief, Hilda most assuredly connected with her transpersonal nature that day and derived great benefit from it. Through her experience, she was once more able to connect with a love of life and to believe in her own possibilities. Ultimately, the experience is what gave her the strength to begin her treatment.
Case study in inner wisdom: CatherineAt 57 years old, Catherine, like Hilda, was referred because of a refusal to seek treatment for a recurrence of cancer. In the assessment, she described herself as a devout Catholic. She said she had too much anxiety to even consider going back for more testing, possible surgery, and follow-up chemotherapy. She felt like the anxiety was ripping her whole sense of self apart. But she was also refusing anti-anxiety medication, saying that she wasn’t “crazy” and wouldn't take pills to solve her problems. Catherine was first trained in mindfulness meditation because of its extensive documentation of effectiveness in reducing stress. After several tries, she interpreted the mindfulness process as trying to flatten and deny her emotions, and she wasn’t motivated to practice it further. Utilizing the information that Catherine was a devout Catholic, she was next guided into a scene in her imagination in which she met a Catholic sacred figure, the Blessed Mother (Mary), and told the image about her anxiety. She at first softly sobbed but then began to smile, opening her eyes a few moments later with the excited declaration that “the Blessed Mother held me.” Catherine proceeded with her medical treatment, utilizing this inner image as a source of courage whenever she felt anxious and afraid. In the words of this article, she had found the replacement for her vulnerability-anxiety.
Evidence-based transpersonal experiencesThe neurologists Newberg & D’Aquili identified a special brain state, an experience of oneness and bliss, which they called absolute unitary being (AUB). The discovery was based on their brain scan research with advanced meditators. They speculated that AUB may actually be the singular goal that very different religious and spiritual traditions cross-culturally are trying to experience. While evidence for AUB can be linked to neuroscience, we should also be open to the vast “evidence” that exists in the cross-cultural meditative and spiritual descriptions of AUB. The Vedanta tradition within Hinduism is one example, a philosophy and skill set that greatly influenced Assagioli. In Vedanta, the entire universe is energy which is aware. The direct personal experience of this all-pervading consciousness is called satchitananda: sat is being, chit is knowledge of truth, ananda is bliss. The famous chant of OM (or written as AUM) represents the vibration of this universal consciousness. Other names for absolute unitary being (AUB) are the Tao, heaven, paradise, liberation, union with God, satori, illumination, unitive consciousness, enlightenment, nondual awareness. Among some modern scientific terms, there is subtle energy, underlying implicate order, and one mind also pointing to universal consciousness. In these perspectives, awareness itself is not produced by the brain or body and is not limited to the brain or body. Rather, the view is that our brain-body is participating in an all-pervading, interpenetrating field of universal energy which is aware. Assagioli put it, “Spiritual realization is the direct experience of the part of your nature which is identical to the great energy pervading the universe." Figure 1, below, lists some of the AUB-like experiences and benefits that patients have described.
FIGURE 1. just pure awareness, endless, boundless feeling solid like a rock lightness of being a sense of spaciousness serenity and contentment laughing in a very deep way quiet joy pervading all things feeling unity with all beings having an instantly understood inner vision, an illumination feeling an extraordinary inner silence inflows of inspiration a sudden and important creative breakthrough liberation from fear equanimity deep compassion and connection a "psychic" experience that causes awe a deep feeling of gratefulness a clear sense of inner guidance awareness of other lives in other places loving all persons in one person feeling oneself to be the channel for a stronger force to flow through only bliss everywhere merging with a work of art and the artist’s intention the delight of beauty from (Schaub & Schaub, 2013, pp. 128-129)Commenting on our transpersonal potential, pioneering physician Larry Dossey made this point:
“…it is clear that the transpersonal view is not a philosophical plaything, but a perspective that is required by both widespread human experience and empirical findings, and which has the potential to revolutionize the dismal, modern view of our origins and destiny. This recognition is timely. As part of a larger consciousness, we have access to all possible wisdom and creativity, which we sorely need if we are to confront the many challenges we face as humans on a fragile planet.”And Schaub & Follman summarized some of the surprising effects of transpersonal experiences reported by patients:
“Something of fundamental importance has happened to me. There are no memories to compare this experience to. The experience is its own immediate memory. The experience means more than I can presently understand. There is a desire to be true to the experience, to affirm it, to protect it. There is a reticence about telling the experience to anyone who will criticize it. The experience is difficult to take in because I sense its potential to change me.”