Studies of the backgrounds of these patients revealed that many parents were unaffectionate. Their mothers tended to be demanding women who dominated their households. Affection was conditioned upon the child's compliance and achievement. There was frequent blaming of the child. Ethnic studies showed that the prevalence of the disease was four times greater in Jewish men than in other men, three times greater in Jewish women and rare in Black Americans (see Wenner 1977)

   My insights into this disease developed out of three sessions with a young woman whom I will name Mary, who suffered from it. She was about twenty years old, a college student, majoring in music and the girlfriend of one of my other patients. He had suggested her coming to see me in the belief that bioenergetic analysis could help her. Although he had told me that she had a problem with food and was quite thin, I was surprised when I saw how thin she really was. She weighed about l00 pounds, but it was not only her thinness -- she was about five feet two inches tall -- but her youngness that struck me. She had the body of a pre-adolescent girl. Her face, too, was not that of a young adult, but more like that of an adolescent. Her emotional immaturity was obvious. Fortunately, her relationship with my patient was helping her grow to womanhood. It was obvious she needed to develop psychologically, emotionally and physically.

   One other physical feature was striking. About four years ago, she had been operated on for the illness and a portion of her intestine had been removed. That portion was the most inflamed part of the gut. Its removal helped relieve some of her symptoms for a time but the operation left her with a big scar down the center of her abdomen. She had not healed well, but had developed a cheloid about twelve inches long. A cheloid is granulomatous scar tissue. This outcome made one suspect that she didn't have the energy to rebound from the trauma of the operation in a healthy way. This idea of a lack of energy was manifest in the thinness of the body and in her shallow respiration. Her illness had not improved with the operation and I was afraid that another operation would be more traumatic and prove less satisfactory than the first. Since her symptoms had not diminished, it was suggested by her doctors that she undergo another operation. It was this prospect that motivated the patient to seek a consultation with me.

   I approached this case with some ideas about the kind of emotional problems that could affect the intestines. A situation of inordinate fear in which one feels helpless could cause a hyperactivity of the gut resulting in a spontaneous evacuation or diarrhea. To put it vulgarly, fear could cause a person to "shit in his pants." This patient suffered from diarrhea when the condition exacerbated. The diarrhea accounted in part for her loss of weight and her inability to gain weight. I would have no hesitation in describing this young woman as a frightened person, but while fear was an important factor in her condition, I did not see it as the dominant one. The abdomen and the intestines are involved in the emotions of crying and laughter. We speak of a belly cry or a belly laugh when either of these feelings is strong enough to engage the abdomen in the emotion. Strong may not be the right word; deep seems more appropriate. In belly crying or laughter, the energetic wave producing the sound extends into the lower abdomen. The sound has an "up" quality in the laugh, a "down" quality in the cry. The muscles of the face are pulled upward when the feeling is one of laughter and downward when the feeling is sadness.

   But what happens when the laughter or crying persists inordinately long? In laughter one feels as if his sides would split. The convulsions are so strong that one is overwhelmed and rolls on the floor, helpless with laughter. Although laughter is a joyful experience, it can become painful when the muscles become tired and the body doesn't have energy to support the convulsions. At this point the laughter will spontaneously stop since there is nothing funny about being in pain. Normally crying, like laughter, releases the body from a state of tension through the convulsive discharge. In crying the tension stems from painful feelings due either to some injury, a loss of someone one or something loved, or a need for love, that is, for closeness and contact with a love object. Adults will cry more from a sense of loss while babies and young children cry from need. The crying of babies has been regarded, therefore, as a call for help. A baby will cry when it is hungry, when it is uncomfortable, or when it wants to be held. To a young baby, love is a warm and quick response to its need.

   Like laughter, crying can go to the point where it becomes painful. Adults generally, will stop the crying at this point because they are frightened of the pain. In babies and young children, however, it is the pain that causes the crying. This pain is the internal tension that develops when a strong, biological need for closeness and contact with a nurturing and protective person is frustrated by the absence of the person or by the inability or the refusal of that person to meet the need. In this situation, the child can only continue to cry both as a call for help and as a means of releasing the tension which is insupportable. And the crying will continue as long as the frustration persists and the child has the energy to react. That energy, however, is limited, even if the child on an organismic level mobilizes its reserves. When that limit is reached, the crying will stop and frequently, the child will fall asleep out of exhaustion. In sleep and through sleep it renews its energy reserves which is a primary function of sleep.

   The sequence of events described above is not unfamiliar. It occurs every time a baby who is put down to sleep cries to absent or deaf ears. Some parents say that this is the way to teach a child to go to sleep by itself. They know that sooner or later the child will stop crying and fall asleep. It always does because not to do so would place the child in risk of death. The child doesn't make a conscious decision to fall asleep; sleep is a natural body reaction to a condition of extreme exhaustion. But the lesson that one has to go to sleep alone is not learned so easily. With sleep the child's energies are somewhat restored so that the next night when the need arises again, the child will again cry out of frustration and for help. This time the exhaustion will occur more quickly and sleep will happen sooner. It doesn't take many such experiences to teach a child that crying will not serve to bring the parent and that it might as well first fall asleep. The parents may say that the child has learned a lesson but at this early age, the learning has not occurred on a conscious level. The experience has been largely a bodily one which can be interpreted as "crying threatens survival, so don't cry."

   When a lesson is learned on this level, it becomes structured into the body. Tensions develop so that deep crying which can threaten survival will not happen. These tensions develop in two areas of the body: the throat and belly. A constriction develops in the throat which doesn't allow a deep sob to take place. The constriction also serves to limit the feeling of longing; that is, to reduce the intensity of the impulse to reach out for closeness and contact. If this impulse is blocked or restricted, the feeling of need is diminished and there is no or very little burden of pressure from the possible frustration. Not to want is a way to avoid being hurt. The constriction that occurs in the belly is in the intestines at the other end of the line that runs from mouth to anus. Since impulses are energetic waves which flow through the body, the damping down of an impulse requires a rigidification of the medium. For example, a wave will flow through water but not through ice. This is the general principle. The experience which I believe reflects the reality is the feeling that the guts are wrung out and in knots. It is as if every bit of moisture was wrung from the guts leaving them dry and twisted like a face towel that one has wrung dry. In this condition, it is almost a physical impossibility to make a loud sound.

   I was not surprised, therefore, that Mary could not cry about her illness despite the pain and suffering it was causing her to say nothing of its gravity. As we talked, she smiled and giggled lightly. She could not let herself feel the depth of her misery since she believed, on an unconscious level, that her survival depended on the suppression of her longing and her pain. Yet it was this very suppression that was now threatening her life for the tension in her gut due to the suppression of feeling was so severe that the tissue was breaking down under it. The inflammatory process must be seen as her body's attempt to deal with this breakdown, that is, to heal the damaged tissue. That, of course, is the function of every inflammatory process. In my opinion the tension in her guts had to be released if an effective healing was to take place. That meant that she had to express her sadness and pain by crying. Mary understood the logic of this approach and was willing to try it.

   The technique I used was to have her breathe as deeply as possible, that is, abdominally, while I massaged her tight abdominal muscles. With my encouragement she was able to cry a little which, she said, made her feel better. It was evident that she had to reduce the tension in her whole body which was also tightly contracted. She did some kicking on the bed and the grounding exercise which induced some vibrations in her legs. I suggested that she do these exercises at home and I arranged to see her again.

   In the second session we were able to talk at some length about her childhood. She was an only child. Her mother, she said, did not want to spoil her and told her that she never picked her up when she cried as a baby. The "never" was emphasized. From Mary's body structure, which could be characterized as oral, it could be surmised that her oral need for closeness and contact with a warm, supportive and nurturing mother was not fulfilled. As a little child or baby she was in a trap. Deprived and frustrated in her longing for love, she cried her heart out. But the more she cried, the less response she got. When she could cry no more, she gave up her attempt to gain love. To have persisted may have cost her her life. Quite unconsciously, or perhaps quite consciously, she followed an old maxim -- if you can't fight them, join them. It's a maxim of survival. Joining meant being the good, quiet girl her mother demanded. She could make no demands on her mother, she had surrendered her rights. Being good also meant that she had to stay in line, behave properly and cause no trouble. If she couldn't get love, she could get approval for being what "they" wanted.

   On the outside, it might seem that Mary had come to some resolution of her conflicts. She went to school, did well, and so her parents had no complaints. But one can't live without love. As Mary grew into adolescence and young womanhood, the longing for love welled up in her. But given the experiences of her early childhood, Mary could not express the desire for love without opening the deep wound in her being from those early traumas and feeling the pain and despair embodied in the tension. Although the conflict never reached consciousness, it flared in her guts as an inflammatory process. Investigations have shown that the onset of the disease frequently follows an experience that could provoke crying. The following have been reported: loss of a close relative, loss of self-respect; struggling to complete a class; and the inability to find a solution to a personal problem (Wenner I977).

   It might seem that just getting Mary to cry could help her overcome her illness. But her condition posed another problem; namely, that her energy level is so low that she lacks the energy to fight back. The lack of energy is evident in her body: it is underdeveloped and underweight, it is contracted to a point where any deep breathing is almost impossible, there is an absence of vibrancy and charge in her tissues and in her eyes.

   One of the reasons why the psychosomatic approach has been relatively ineffective is its failure to comprehend the energetic factor. Knowing that the victim of Crohn's disease is a dependent, compliant personality who is afraid to express anger doesn't explain the illness. There are many individuals whose personality profile would show the same traits but who do not become physically ill for that reason. The onset of a somatic illness denotes a breakdown of the integrity of the tissues and this will only happen when the physical stress upon those tissues becomes more than they can support. The first step, therefore, is to determine the specific tensions which are responsible for this breakdown. If the tension is in the muscles of the upper back, it would not be directly responsible for a breakdown of gut tissue. In Crohn's disease we are dealing with enormous chronic tension in the muscles of the gut and abdominal walls. But this is only the main locus of the tension. As we noted, Mary's body was severely contracted and her breathing was shallow indicating extensive muscular tension throughout her body. It is this tension which robs her of energy and keeps her in a state of relative exhaustion. One has to address the problem of this exhaustion if one is to help Mary recover her health.

   Hans Selye has pointed out that there are three stages in an organism's reaction to a state of distress. The first is called the alarm reaction, which may end in death if the trauma is severe but which, if survival occurs, proceeds into a second stage, called the stage of resistance or of adaptation. In this stage the organism seems to hold its own against the stressor agent and shows no signs of illness. However, if the stress continues, the acquired adaptation of the second stage is lost and the organism enters the third stage, that of exhaustion. In this stage, breakdown occurs which will end eventually in the death of the organism. We can translate these stages into bioenergetic terms. The alarm reaction is the initial response to the trauma and represents the attempt to remove the traumatizing agent and recover from the trauma and shock. If the noxious agent cannot be removed, the organism must adapt to the continuing presence of the stress by mobilizing its reserves of energy. As long as these reserves exist, the organism can adapt. When these reserves are exhausted, breakdown must occur.

   If this analysis is correct, Mary's recovery would depend upon: (1) removal of the stress, and (2) rebuilding her reserves of energy. What is the present stress? We know that the original stress was the pain of longing for a mother who did not respond with love and support but with demands. One of these demands was the injunction not to cry. There were other demands, however. They included performing well and achieving. These demands were still operative in Mary's case because she had accepted them as reasonable and right. And her mother was still in the picture with the same demands. Mary's exhaustion was so great that she even had no difficulty sleeping at night. But when I suggested that she give up some of her school work, she resisted the idea. Not to succeed posed a danger which we can assume was the loss of her mother's love. Mary had to recognize that this love was never available to her and never would be. All she could get was approval and the cost of this approval was high.

   I have become increasingly aware that many psychosomatic illnesses follow a similar pattern, namely, an initial severe trauma with its alarm reaction, a period of seeming adaptation, and then, the onset of the illness when exhaustion supervenes. The patient generally denies the exhaustion, seeing the illness as some new trauma. He struggles to get back to the stage of adaptation when he thought he was well; that is, he continues with all his old patterns of behavior not realizing that these patterns are the stress which is breaking him down. On the other hand, patients who realize how tired they are, and who change their life style for one which allows for rest and renewal make a significant improvement. It seems to me, therefore, that a major emphasis in the therapy should be upon the patient's need to give up the effort and the struggle to adapt, to impress or to conform. This does not mean that the analysis should not take place nor that body work should be avoided. Both should be done within the context of the understanding that illness equals exhaustion.

   Lynne Parsons sent me a report of a case of Crohn's disease which she treated for a short time. Her analysis of the illness complements what I have written and is so well presented that I am adding it to my report. The following is in Lynne's words.

   I saw Wilma, a thirty three-year-old widowed black woman with two teenage daughters ten days post op for a bowel resection because of Crohn's disease. The medical social worker had referred her because she appeared depressed.

   Physically, I want to stress how frail this woman appeared, not as sturdy or as big as her two teenage daughters. Her large brown eyes stood out because of her dark hollow sockets, and she appeared doll-like in that she was frail, listless, yet pretty. She spoke very quietly and slowly and in every manner appeared like someone who has just had major surgery.

   During our first interview I was struck with the flatness of Wilma's affect, until the point where she began to talk about the events of her husband's terminal illness. At this point she began to cry and although it was soft, and the tears were few it was my impression that this was because the pain was so deeply felt that it physically hurt her to be so sad. I felt hopeful that progress could be made when she did cry and when she seemed so moved by having an attentive listener.

   She told this story: Wilma was the eldest of four children in an intact family. Her father divorced her mother because of her "nagging" when the children were almost grown but stayed in touch with the family. In her late teens she married a man eight years older who wanted to love and care for her and who did that to Wilma's great satisfaction for nine years. She told the story of her marriage in a most romantic fashion. She and her husband were living in the south when he, a manager of a meat storage locker, got pneumonia and died. Wilma returned to Chicago because of her family and was able to get a comfortable apartment because of her two daughters' social security benefits.

   Wilma had been hospitalized for a major depressive disorder five years earlier for one month. The precipitating incident was not clear. Hospital records showed that her younger brother had been diagnosed as a paranoid schizophrenic on several admissions.

   The initial clinical fact that excited me about Wilma was that she remembered her excessive stools and cramping beginning shortly after her husband's death. Her mother would chide her to get a hold of herself as if she could change her bowel symptoms through will power.

   Though Wilma dated other men, she felt that her dead husband couldn't be matched. The relationship with her father was vague; however it seemed very significant that Wilma brought him to our third session. I invited him in and he talked about his belief that his daughter had always had too much stress because she had taken over a lot of responsibility for her siblings as well as her mother. Wilma said very little while her father talked. It was my impression that she had brought him, without realizing it, to say the things she couldn't express.

   Wilma was staying near the hospital with her mother for her convalescence and she had contemplated making this move permanent in order to help out her mother financially. However, the third week she told me that she felt it was impossible to stay with her mother because she always told her what to do and was angry and suspicious about her coming to psychiatry. What did she want her to do; I asked. Her mother felt Wilma's problems would resolve if she would put her faith in God.

   I invited her to bring her mother in (and her daughters, too) since Wilma was asking for me to explain her need for treatment to her mother. At this meeting Mother did all the talking and presented herself as a fundamentalist who knew the answer for everything.

   The conflict with her mother proved too much and Wilma moved back to the other side of the city. This put her an hour by public transportation from the hospital. She began to fail appointments, or when she did come, she was late. Though she looked thin and frail, and frequent stools were still a problem, she began to pursue various self-improvement activities in earnest. She would promise to make an appointment and then fail, though often calling to talk to me unexpectedly. Eventually I lost contact with her.

   I heard about Wilma five months later when a social worker from a state hospital called and said Wilma was being discharged and had asked to see me for follow-up. She had, in fact, become hypomanic and been admitted in poor physical condition. She had been placed on anti psychotic medication. Though Wilma disliked the fact that the drug "slowed her down," she remained on it for the remaining five months of my internship.

   In my follow-up work with Wilma, my concerns were not treatment but maintenance. Her affect was now always somewhat elated and bland. Everything was nice. We would review her activities together; I trying to discern something about how intact her judgment was and whether she was eating and sleeping enough. She remained very attached to me in a child-like way. She often brought things to show me that she was proud of, and no doubt my delight in her cleverness in getting things for herself and her children through the public system pleased her enormously. I called the hospital when Dr. Lowen asked if he could include my remarks in his article. I found that shortly after I left, Wilma had stopped coming to the clinic once again.

Reference
Wenner, Herbert. 1977. Psychobiology and Human Behavior. NY: Elsevire.

[Source : Bioenergetic Analysis - The Clinical Journal of the International Institute for Bioenergetic Analysis, Volume 2, Number 1, Summer 1986, pp.1-11]

Disclaimer : This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.