Western Models for Eastern Ideas
Treven Pickett, Adam Sternberg
Clinical Health Psychology - Dr. Holmes
Fundamentals of Eastern Medicine
The philosophical basis of Eastern medicine is the understanding that everything in the world is a form of energy, called Qi (pronounced chi) meaning energy in Chinese medicine. It is believed by practitioners of Eastern Medicine that this Qi energy flows along certain pathways called channels or meridians. Meridians are the pathways in which our body's Qi circulates. The meridians, although traceable on the skin's surface, run throughout the entire body, transporting Qi to the organs, muscles, tissues, and bones. Thus, the meridians are closely connected with the tissues and organs in the body and play an important role in human physiology and pathology as well as in the prevention and treatment of illness (Stone, 1992).
The flow of Qi is said to regulate our physical, mental, and emotional well-being. Illness results when these meridians become blocked due to injury or the energy becomes unbalanced. Some Eastern doctors believe, for example, that too little Qi energy in the kidney channels leads to incontinence, or too much Qi energy in the liver can give rise to headaches. Thus, the treatment of illness in Eastern Medicine involves the doctor identifying where Qi energy is blocked or stagnated and finding ways to restore the flow of this energy along the proper pathways.
Dr. Edward K. Song, O.M.D., Ph.D. describes Qi as:
If applied specifically to the human body, there are several types of Qi: 1. Jung Qi is the Qi passed down to you from your parents and is found naturally in your body.
2. Jin Qi is cultivated by proper nutrition.
3. Won Qi is cultivated by regular exercise.
4. Hyul Qi is also called "blood energy" and is most directly cultivated (or disrupted) by the emotions. Proper mental conditioning is crucial to the maintenance of a good Hyul Qi flow.
5. Soon Qi harmonizes Jung Qi, Jin Qi, Won Qi, and Hyul Qi. Soon Qi helps to connect the other Qi's and circulate them properly throughout the body.
6. Sa Qi is bad Qi; it is cultivated during times of anger, jealousy, violence, etc... and is the only type of Qi that is actually harmful to you (Song, 1995).
Eastern Medicine deems improper Qi circulation a pathological disorder. Proper circulation of Qi, in essence, defines good health by Eastern standards. If Qi circulation is disturbed, eventually a disease will emerge. It is believed that good mental and physical conditioning generate good Qi. Good Qi is then developed and maintained by physical exercise (most Eastern sources recommend Martial Arts) and, when necessary, corrected by Eastern Medicine.
Another one of the underlying philosophies of Eastern Medicine is that everything in the universe can be described in terms of "Yin" or "Yang." Practitioners of Eastern Medicine conceive the Yin to be the substance of the body, the actual cells and chemicals. The Yin can be thought of in terms of the material of the body, known to exist in reality because you can touch it, see it under a microscope, or conceive of it in chemical equations. When applied to medicine in general, Western Medicine acts upon the Yin of the body. Oriental medicine, on the other hand, acts upon the Yang of the body. The Yang of the body is thought of as that energy which can not be documented using scientific evidence. Another way to say this is that Eastern Medicine acts upon the Qi energy to improve its flow.
It is said that the Yin and the Yang are always connected, such that acting upon the Yin will effect that Yang, and visa-versa. Within the disciplines of Eastern and Western Medicine, there is an enormous amount of time tested information that has its own logic and usefulness. In other words, both Western and Eastern systems have there place. Some believe that the greatest strength of Western Medicine is in its trauma care and therapies for acute problems, while Eastern Medicine excels in the areas of chronic problems and preventive medicine (Stone, 1992). An exploration of the various techniques and methods employed by Eastern Practitioners follows this overview. As many of the benefits of Eastern techniques are difficult to quantify, based largely on the properties of Yang, the overview which follows will not refer to an abundance of research literature that testifies to the viability of Eastern techniques. Just as the manipulation of Yang or Qi energy throughout the body is, by definition, simply believed to "exist" with little or no empirical scientific validation, many of the Eastern techniques can only been validated through case reports of illness remission following Eastern medical treatments, particularly in instances when Western Medical methods have repeatedly failed.
According to Eastern Philosophy, man is made up of three elements: Qi (life force or energy), the mind (or mental condition), and the physical body. While traditional Western Medicine focuses solely on the body, the Eastern medical doctor views each patient as an equal combination of these three elements. The Eastern medical doctor concerns himself with the notion of balance and harmony between each of these three aspects, never limiting himself to one or the other exclusively. The goal of Eastern Medicine is to restore a "healthy state of being" in more than just a physical sense.
Acupuncture and Acupressure
Acupuncture is an ancient system of healing developed over years as part of the traditional medicine of China, Japan, and other Eastern countries. The earliest records of acupuncture date back over 2,000 years and there are over 3,000,000 practitioners worldwide. The practice of acupuncture is thought to have begun with the discovery that the stimulation of specific areas on the skin affects the functioning of certain organs of the body. The practice of acupuncture has evolved into a system of medicine that restores and maintains health by the insertion of fine needles (between one and four inches long) into acupuncture points just beneath the surface of the skin. These acupuncture points are in very specific locations along various channels of energy. Moxibustion, the warming of acupuncture points through the use of smoldering herbs, is often used as a supplement and the needles may also be stimulated using a small electric current. Although Western Medicine has publicized Acupuncture as only useful in specific conditions, such as in the treatment of pain, it has been employed by Eastern Practitioners in the treatment of a wide variety of conditions. The strength of Acupuncture appears to be through its power to stimulate the mind and body's own healing response. Acupuncture is the preferred method of treatment for muscle and nerve disorders and has no risk factors or serious side effects. This technique has been used effectively on a variety of aliments including chronic pain, tension headaches, arthritis, ulcers, weight problems, and addictions (Murray, 1995). Acupressure is simply a method of manipulating acupuncture points with the fingers, hands, or elbows for various amounts of time. Acupressure is the preferred method of treatment for bone, joint, and muscle disorders (Stargrove, 1993; Stargrove, 1995).
Stress Reduction via Meditation
In the Eastern Medical model, stress is thought to originate from either internal or external sources. Internal stress is created by the inner workings of our bodies falling out of balance. The internal stress created from this imbalance may manifest as physical symptoms such as headaches, stomach aches, and other complications. External stress refers to the stress we experience as a result of our environment, be it work, home, or our relationships with other people. External stress can weaken the immune system and make the body susceptible to common diseases such as colds or the flu. It is believed that, in some cases, prolonged and intense external stress can even cause cancer.
Meditation is described by Eastern practitioners as seeking "mindlessness" in order to become more aware of their own Chi. Clearing their minds of conscious thought is achieved by focusing on a particular focal point such as their own breathing or a mantra. In this state of mindlessness, practitioners claim to become more aware of themselves, more connected to a collective existence, and attuned to their place in the environment. Effects have been claimed similar to those from acupuncture and martial arts, for example, reduction in anxiety (Kabat-Zinn, Massion, Kristeller, Peterson, Fletcher, Pbert, Lenderking, and Sanorelli (1992), increases in empathy (Pearl & Carlozzi, 1994), and improved quality of societal life (Assimakis & Dillbeck, 1995).
Western Explanations for Eastern Treatment
Since Eastern practices are guided by unseen, unmeasurable energies such as Chi, Western clinicians have traditionally eschewed Eastern medical practices for their inaccessibility to scientific explanations of the mechanisms of change. However, Eastern techniques boast positive outcomes equal to those achieved through Western methods according to Kaptchuk (as cited in Erickson, 1995). Perhaps it would serve students of Western models to explore the possible benefits of incorporating Eastern models into practice. What we intend to do in the following section is to elucidate the Eastern model, translate examples of Eastern practices into Western language, and finally offer ways to include a regard for the mind, body, and spirit in typical Western treatments. The examples we will draw from include acupuncture, martial arts, and meditation.
Western science explains these impressive results through observable physiological changes. Specifically, deep stimulation of a muscle's afferent pathway by the acupuncture needle activates a response by the nervous system. Increases in endorphins and serotonin, and decreases in norepinephrine are the result of this response. The change in concentrations of these neurotransmitters inhibits the transmission of pain, effectively raising the individual's threshold for pain (Han & Terenius, 1982; Murray, 1995). Many studies have evidenced the activity of each of these neurotransmitters by introducing their antagonists with the resulting increase or decrease in the analgesic effects of acupuncture. Both Naloxone (an opioid antagonist), and 5,6-dihydroxytryptamine (a serotonin antagonist) effectively block the analgesic effects, while diethyldithiocarbamate (a norepinephrine precursor antagonist) increases the effects of acupuncture (Han & Terenius, 1982).
While increased levels endorphins and serotonin have been associated with lower sensitivity to pain and reduced levels of norepinephrine with reduced arousal (Grilly, 1994), the alteration of these chemicals certainly has a much broader impact. The benefits of increased serotonin concentrations have also been associated with improved mood, sleep, and learning, and with decreased aggression. Endorphins have been associated with attention, primary reward, emotional expressions, and appetite among other aspects (Grilly, 1994). This suggests that the effects of acupuncture can have broad effects on pain, mood, and behavior.
While treatment of pain must take a pragmatic approach because the complete removal of pain sensitivity would be detrimental, one would hope for lasting effects. Evidence from the treatment of chronic pain suggests that these effects are temporary, subsiding within 30 minutes after treatment (Sheikh & Sheikh, 1989), however; evidence from the treatment of tension headaches suggests that benefits can not only be maintained four months after termination, but actually increase (Vincent, 1990). This suggests some enduring change, however; Western models fail to fully account for this change. Han and Terenius' (1982) review points out morphine, the exogenous correlate of endorphins, does not produce the same relief from chronic pain and naloxone does not always suppress the analgesic effects of acupuncture. Obviously some broader mechanism which includes the alterations of neurochemicals is needed to explain the analgesic and enduring effects of acupuncture. Eastern models would explain that Chi has been realigned and the individual has reclaimed harmony with his or her environment. A Western translation may be that the alteration in neurochemicals affects the person's mood and behavior in such a way as to improve his or her adaptiveness to the environment, thereby potentiating a reciprocally-reinforcing relationship.
It is difficult to translate the effects of acupuncture into techniques that a Western clinician can perform without actually using needles. Biofeedback and Transcutaneous Electric Nerve Stimulation (TENS) have utilized the acupuncture model, for example, in the treatment of chronic pain (Murray, 1995), but this requires technical apparatus to which an individual clinician may not have access. Bergman, Witzum, and Bergman (1991) describe conjoint psychotherapy and Shiatsu massage as effective in uncovering repressed emotions, but this does not add to the psychologists repertoire per se. An interesting report by Thoren, Floras, Hoffman, and Seals (1990) compares the neurochemical effects of acupuncture to those produced by prolonged rhythmic exercise. These results suggest that thought the individual is motionless, acupuncture treatment creates similar effects to physical activity. The next section discusses the effects of Eastern philosophy set to motion, specifically the martial arts.
The application of Eastern philosophy to physical training is formed from the same foundation of universal Chi. Martial arts are seen as bringing the Chi energy which flows through us into physical action. Just as acupuncture seeks to realign disrupted Chi, martial arts such as Tai Chi and Aikido are designed to bring the self, including this universal force within us, more into awareness through disciplined practice of physical techniques. The broad range of movements in Tai Chi, for example, require an individual to experience a full range of postures and expose them to muscle activities that may have been neglected. Re-experiencing these neglected activities allows an individual greater personal integration and, through awareness of Chi, greater contact with universal harmony.
The philosophy behind Aikido is the same, but this art adds the dimension of training with other people as a requirement. In Aikido, not only do individuals become more attuned to and in control of the energy within themselves, but experience how this energy affects others and how it is reciprocated (Murphy, 1992). Potential attackers are perceived as part of the universal harmony and thus seen, not as enemies, but as opportunities to enact universal harmony. The energy of an attack is neutralized by joining the opponent, unbalancing and turning them by maintaining centeredness, and harmlessly subduing the opponent (Don Lyons, personal communication, 1991).
Studies have reported physical benefits from Aikido, Tai Chi, and Qigong (a similar art) in cases of hypertension, insomnia, heart disease, ulcers, allergies, and asthma (e.g., Jin, 1989; Sheng-han, 1994). Psychosocial benefits have been reported to include lowered depression and anxiety (Jin, 1989), aggression (Glynn & Berta, 1991), and delinquent behavior (Trulson as cited in Fuller, 1988), and improved self-esteem, attention (Sheng-han, 1994), and social interaction (Gleser & Brown, 1988).
Western explanations attempt to quantify the beneficial effects into physical and cognitive changes. Jin (1989) showed a reduction of heart rate, norepinephrine, and cortisol and subsequent elevations in mood following one session of Tai Chi. Collins and Powell (1990) demonstrated an increase in alpha waves just prior to the breaking of board by a complicated karate maneuver. The authors relate the Eastern description of "no-mindedness" required for the break to a conditioning of an increase in alpha waves. Fuller (1988) suggests that practicing Aikido enhances perspective-taking skills where individuals are required to "literally and metaphorically take the place of their aggressor" and thus resolve conflict (Fuller, 1988, p.325). It is precisely this active and interactive learning that promotes improved self-awareness, feelings of control over the self and the environment, and confidence in one's coping abilities (Madden (1995) as well as improved socialization (Fuller, 1988).
These explanations are not dissimilar to many theories delineating the development of self-constructs. Piaget (1932) defined the beginning of organizing one's world by sensory-motor learning which promoted more complex organizations. It follows that the foundation of the organization of the self is based on sensory-motor learning. Perhaps returning to this non-verbal interactive learning can help strengthen or reshape early foundations.
The translation of these techniques into those usable by Western clinicians regards both the possibility for treatment for patients and potential techniques for therapists. The benefits of participating in a particular marital art have been delineated above, but include improved physical health with at least the possibility of restructuring some negative cognitions leading to improved adaptability and interaction with the environment.
More interestingly, the techniques taught by martial arts masters can be used as a metaphor by therapists within treatment sessions. General techniques required to subdue an opponent include the aim of using an opponent's momentum against them to harmlessly dispel the attack. Gleser et al. (1988) point out that resistance within a therapy session provides another source of impetus for change besides distress. The momentum a client builds in resistance to the therapist can be redirected towards positive change. Techniques that make this redirection possible are similar to the idea within martial arts of "joining" with the opponent, physically going in the same direction. This can be seen as a metaphor for understanding and taking the client's perspective. Watzlawick (as cited in Gleser et al., 1988) describes paradoxical directives in this fashion, namely joining the resistance and prescribing the dysfunctional symptoms. By "unbalancing" a client in this fashion, Watzlawick can "turn" the client onto more functional pathways similar to a martial artist harmlessly redirecting an opponent's momentum. The psychodynamic process of building to an interpretation has been likened by Seitze, Olson, Locke, and Quam (1990) to a quarterback leading a pass receiver to the spot of reception with a throw. In other words, interpretation exploits preconscious thought to lead a client to acceptance of a more functional understanding of themselves. This goal of greater self-awareness is also captured in the effects of meditation.
Western studies have revealed a number of interesting associations. MacLean, Walton, Wennberg, Levitsky, Mandarino, Wazari, and Schnieder (1992) showed optimal alterations of cortisol, testosterone, thyroid-stimulating hormone, and GH levels following an 16 week course in meditation. Jevning, Anand, Biedenbach, and Fernando (1996) demonstrated an increase in blood flow isolated to the cerebrum and decreased cerebrovascular resistance during Transcendental Meditation. This alteration resulted in the increase of central alpha waves and reduced metabolic processes such as consumption of oxygen and carbon dioxide. Jevning's et al. (1996) results suggest meditation produces metabolic and electroencephalographic alterations that promote increased awareness. One hypothesis that tries to explain increased self-awareness and especially a feeling of external connectedness concerns the lateralization of brain functions. Persinger (1992) describes the formation of self-concept as largely based on language localized in the left hemisphere. Survey results form Persinger's study showed that practitioners of Transcendental Meditation reported more "ego-alien" intrusions which the author explained as an increase in right hemisphere interaction described, including increased "theta bursts", during meditation. The role of meditation in integrating the two hemispheres explains an increase in self-awareness with the re-inclusion of previously neglected, non-linguistic information from the right hemisphere.
How can these ideas be put to use by Western clinicians. Teasdale et al. (1995) and Kabat-Zinn et al. (1992) suggest prophylactic cognitive "deautomatization". Mindful meditation that promotes un-analytical awareness of bodily states and cognitive thoughts. By un analytically recognizing all thoughts, for example, an individual resists thinking about him/herself and removes him/herself from negative spirals that can take normally minor emotional events and lead to depression and anxiety.
Our aim in this paper was to expose Western clinicians to the different philosophical and methodological approach to physical and psychological health espoused by Eastern models. Just as explaining the interaction between psychological and physical health can meet with resistance in some Western clients, Western clinician's may have a tendency to neglect concepts of a more spiritual nature. Though the two models appear discrepant, there are a number of ways to adapt Eastern methods to Western practice.
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