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by Alan Fogel
W. W. Norton, 2013
Review by Sandra Egege, MA (Phil). on Mar 25th 2014
It has to be said that Body Sense is, if nothing else, an interesting read. Fogel has an easy, engaging style and he manages to convey his ideas clearly and simply, even when the material is complex neuroscience. Body Sense is fundamentally a book about maintaining health and well-being. Fogel sets out to demonstrate 'how everyday life, as well as serious stress and trauma, can cause us to lose contact with our sensations and emotions,' along with the way our body moves and feels (p.1). As we develop and grow into sophisticated social animals, we gradually lose touch with our bodies. He claims that most of us, unless we are consciously involved in body-awareness activities like meditation or yoga, have stopped paying attention to what our bodies are doing and what they are telling us about our condition. We lose touch with our inner sensations, with the way our bodies feel, and with the way our bodies act and react. Our modern lifestyles in particular, put us in danger of losing touch with our body sense altogether, including our emotions.
So why does this matter? According to Fogel, this matters greatly because it affects our health and well-being, both physically and psychically. More than this, it has the potential to make us very sick. Stress, trauma, bad physical habits, or suppressed emotions for example, cause a (natural) repression of the body's sensations or natural reactions. If unaddressed, this suppression or repression can change the way the brain reacts to stimuli, leading to major ailments such as chronic pain, PTSD and arthritis to name just a few.
Fogel's message is that if we want to regain our health and sense of well-being, we need to pay attention to our bodies again; we need to reconnect, to (re-) develop our 'embodied self-awareness.' Embodied self-awareness is the directing of attention inside; it is being aware of one's body and body state in the present moment, using the interoceptive senses. Fogel contrasts embodied self-awareness with conceptual self-awareness or awareness of oneself through thinking or contemplating. He includes an informative Table (Table 2.1 on page 31) where he sets out the differences between the two forms of self-awareness. Conceptual self-awareness is linguistic and largely represents the story we can tell about ourselves, including both past events and future projections. Embodied self-awareness is grounded in the present moment and is always experiential; it precedes language. It is about the body now. Linking into or back to the body and reinvigorating its capacity to sense itself may well uncover problematic sensations and emotions that have been suppressed and which are the cause of our current ailments, such as a persistent stomach ache or chronic back pain. This renewed awareness of the body will open the pathway to restoration and health. As Fogel says, embodied self-awareness is 'as fundamental to health and survival as breathing and eating (p.15).'
One of the strengths of this book is the use of neurochemical and neurophysiological detail to illustrate the various mechanisms in the brain that make up the body's schema. Fogel spends a great deal of time describing how various parts of the brain interact to respond to stimuli to create the sense of an embodied self. In this way, he establishes the importance of interoception to our overall perception of ourselves and the world we inhabit. Like Damasio, he describes the intricate mechanisms of the body-brain schema, such as the dorsomedial and ventromedial prefrontal cortices, how these feed into our sense of self and our position in relation to ourselves and others. At the same time, he discusses other systems that lead to bio-behavioural responses, such as the autonomic nervous system or the hypothalamus, and the role they play in both expression and suppression of feeling and sensation. The sheer complexity of all these interacting systems, the roles they play in maintaining bodily stasis and how easily they can be affected or disrupted by our life choices is both exhilarating and intimidating. According to Fogel, we have the capacity to change the way we experience ourselves through changing our brain-body patterns of responses. We also, it seems, have the capacity to heal ourselves - if we can locate the original source of our illness and if we have access to the right 'body movement' practitioner or 'somatic psychologist.'
It needs to be noted here that Fogel is first and foremost a practitioner; he works with clients using a type of body therapy called Rosen Movement or Rosen Method Bodywork Therapy. He is obviously committed to this and similar techniques as effective tools for readjusting/re-establishing clients' embodied self-awareness to promote healing. He discusses in detail some of his and other practitioners successful case studies, presenting their symptoms, his (or another's) approach with the client, the gradual uncovering of some past trauma or suppressed feelings that connect with their current painful symptoms, and the gradual reconnection of them with that part of their body to enable healing. His own technique is to use touch and empathetic responses as a means of reconnecting them with their own bodies. This appears to encourage the client to direct their own attention 'inside' to locate the somatic or psychosomatic source of their problem, thereby re-engaging them with their interoceptive self. I can make no claims about the effectiveness of his treatment or the reality of the cases in question. He does, however, present a well-researched theoretical position that appears to support his practice; it sounds plausible.
Having said that, I do have one or two small criticisms of his text. Because Fogel's focus is ultimately on the practice of embodied self-awareness, he is quite categorical in his comments. He never questions the neurological data he presents nor the psychological or philosophical implications he draws from them. He presents the research as if it is a body of well-known unquestionable facts about how various mechanisms in the brain interact and produce certain somatic conditions and subsequent behaviour. Yet those of us with some knowledge in the field of neuroscience know that a lot of this research is new, is still developing and what it means in relation to conscious experience is highly contentious. His discussion of phantom limbs is a good example of this. He claims that a 'simple' alteration of body schema self-awareness can eliminate phantom pain by getting the amputee to 'emotionally reconnect with that missing limb in order for the brain to let it go and recalibrate the body schema (Box 5.1, p.163). For many amputees, it is not that simple and the causal pathway is still hotly debated. He goes on to say that pain is not a concrete thing. It is
the emergent state of embodied self-awareness across the entire threat and interoceptive neural networks that is the representation of ... the nocireceptive information (p. 163).
Pain is a state of mind. Thus, with the right therapy, it can be softened, shifted and ultimately no longer be experienced as pain. Again, there are other accounts of the neurology of pain that would disagree with this view. And while his techniques may reduce pain in some instances, there will be others where the cause is obvious damage and the pain will remain until the damage heals. The production of pain is no doubt a complex process, as is the experience of it in all its forms, but it is misleading to suggest that pain is something we don't have to feel. This contradicts his own claims about the role of pain to draw our attention to wrongness.
My other concern is with the complexity of the body itself. As Fogel himself explains, suppression is a natural reaction to stress or trauma. It is mostly healthy. Likewise, if we were on (body) alert all the time, we would run out of energy. It would be exhausting and would debilitate the very body one was trying to heal. The suppression mechanisms are there for a reason. They are designed to protect the body so that it can cope with the stresses and traumas of everyday life. So there seems to be a finely-tuned balance between normal suppression and health on one hand and abnormal suppression and illness on the other. How do we know when we have caused damage by failing to notice the suppression, by being out of touch with our bodies? Presumably not until we suffer from something. Then, again presumably, we assume this was abnormal suppression and we need a body practitioner to help us heal. I'm not happy with this scenario. It is also not clear how we can be preventative. But Fogel does want us to prevent damage. This is why he suggests that we need to foster embodied self-awareness all the time to remain healthy or to restore health. I'm not sure this is either practical or even wise. Not all suppression is negative.
A related issue is what counts as trauma or stress leading to negative suppression. According to Fogel, even a minor altercation with a parent when one is a child can lead to suppressed feelings or emotions that can be detrimental in the long-term. He relates the story of a two year old who had surgery, hence trauma, who later benefitted from therapy to unsuppress and restore normal bodily awareness. This is problematic because life is problematic. It means that everything and anyone is potentially hazardous or negative to one's health because it could cause stress leading to future problems. Yet some of those bodily reactions are natural. So while Fogel's position initially makes some sense, putting it into practice is not so straightforward. It seems we would have to assume that all our interactions are stressful, hence potentially harmful. This may be true but it seems it is also unavoidable and is just the effects of living and interacting in the world. It is life.
Fogel does raise some interesting issues and definitely gives one pause for thought. As I type this, I am aware of the tension in my neck, of the ache across my shoulders and the fizziness in my right leg caused by too long a period of inaction. It may be that I will end up with a sore neck and will need a chiropractor. I know I need to watch my 'computer body posture.' Can I do anything about it? Possibly. While Fogel has made me more conscious of the need to pay attention to my body and of the potentially horrendous consequences to my health should I not fix it, it leaves me more anxious than before. Can I fix my body? What of the mass of repressed emotions and traumas that I am unaware of that started when I was a baby? Will they give me cancer? Maybe they will. Have I made my children ill? Who hasn't been reprimanded when young or had an illness as a baby? If these can lead to massive reactions at 50, I'm not sure how this can be prevented or avoided. Be aware, yes, but let's not be paranoid.
© 2014 Sandra Egege
Sandra Egege, MA (Phil), ABD, Flinders University, Australia