12] “Shaking the Blues Away”: Energizing Spiritual Practices for the Treatment of Chronic Pain
Amy B. Wachholtz and Michelle J. Pearce
If you would lose your weary blues Shake ’em away
—Original words and music by Irving Berlin, 1927; revised edition: revived by Ann Miller in Easter Parade, 1948
While there is a great deal of research supporting the use of meditation and quieting spiritual practices for the treatment of chronic pain, there has been less mention of those practices that energize and focus the spi- rit in the effort to decrease pain. In this chapter, we will explore the use of energizing spiritual practices to reduce the experience of chronic pain. This will include a review of multiple religious cultures, including Native American and Pentecostal Christian, which will provide a unique insight into this relatively unexplored area of pain management. We will also briefly discuss how physical activation may positively affect the physiological pain pathways and the perception of pain. Finally, we will discuss how other individuals may begin to integrate these practices into their own pain management techniques.
An unknown author once wrote, “Pain is inevitable; suffering is optional.” This inspirational quote suggests that we are able to both influence and transcend our experience of pain. Pain is not a one-to- one relationship between the tissue damage and the pain sensation. Instead, we are active interpreters of our pain sensations. We make these interpretations through the filter of our belief systems, and resulting emotions and behavior. Chronic pain is more than simple tissue damage.
Instead it is a multidimensional experience. Biological, psychological, social, and spiritual factors each affect the individual’s interpretation of the pain experience. Chronic pain is a complex disorder that often defies traditional treatments. The ongoing experience of chronic pain can span years of an individual’s lifetime and severely impede the qual- ity of life for that individual. While certain pharmacological options can be very effective in treating pain, most often have secondary side effects that patients would rather avoid. Given the intractable nature of chronic pain, patients may choose to take treatment into their own hands by seeking out alternative pain control methods, which may include integrating spiritual beliefs and practices into their pain man- agement regimen. There is a wide range of individual experiences related to chronic pain and the potential harmful interaction between pain and suffering. These complex interactions, the need to better manage negative pain experiences, and the desire to improve treatment for chronically ill populations, makes chronic pain a critical area for further study.
Pain is often best described within the framework of the bio- psycho-social model of disease. This model seeks to understand the impact of chronic pain holistically on individuals via the biological, psychological, and social aspects of their lives. Rather than just focus- ing on disease, this model advocates treating pain by recognizing com- plex multifaceted interactions that comprise individuals’ experience. These may include interactions with their environment, social interac- tions among other individuals, biological interactions with nonspecific disease factors, and bidirectional pathways that occur among each aspect of the bio-psycho-social parts that make up individual experi- ence. Specific to the treatment of pain, the bio-psycho-social model may also account for the experience of pain without an identifiable patho-physiological etiology.
Specifically, in the context of the bio-psycho-social model, the gate control/neuromatrix theory of pain identifies a construct that explains how spiritual beliefs and practices influence the pain experience and may contribute to improved pain management by describing the impact of psychological (descending pathways) and moderate biological (ascending pathways) pain factors.1 It has become widely accepted that the experience of pain is not a simple equation of: X tissue damage = X level of pain. The biochemical transmission of pain cannot fully explain the pain experience for the patient. Instead, these theories identify multiple descending pathways that integrate cognitions, emotions, and behavior, which, in turn, influence the perception and interpretation
of pain by modulating (up or down) the individual experience of pain, all of which occurs in real time. The psychological and biological states interact to create the experience of pain. This theory facilitated the dis- covery of the relationships among psychosocial factors, such as negative emotions, social support, sense of self-efficacy, coping strategies, and reports of pain.2
Both of the models described above (gate control/neuromatrix models and the bio-psycho-social model) elucidate the role of the individual as an active interpreter of the pain experience and the immediate and direct impact that psychological states play in mediat- ing the experience of pain. They also provide a framework as to how psychosocial variables may be used to treat chronic-pain conditions. In addition, the bio-psycho-social-spiritual model expands on the original bio-psycho-social model by integrating spiritual and religious variables, and identifying the role that these variables may play in modulating the pain experience. The bio-psycho-social-spiritual model recognizes the disruptive impact that pain can have on biologi- cal status, psychological health, interpersonal interactions, and spiritual well-being unique to the individual. Since spirituality is an additional coping resource that may affect some patients’ pain experience, inte- grating spirituality into the gate/neuromatrix model is a natural exten- sion of this model. However, the valence of the spiritual practice may impact the direction of the relationship between spirituality and pain sensitivity/tolerance. In a positive relationship, spirituality may reduce the pain experience because individuals feel support from a higher power (e.g., “God is with me in my struggles”), they may have cogni- tions that reduce stress (e.g., “God would not give me more than I can handle”), or they may use religious/spiritual practices to distract them from pain or create reduced physiological reactivity to pain (e.g., spiri- tual meditation), and/or provide social interaction (e.g., attendance at worship services). Negatively, spirituality may increase the pain experi- ence by increasing stress among those who view the experience as a pun- ishment from God/Higher Power, or feel abandoned by God in a time of need.
HISTORICAL AND RELIGIOUS CONTEXT
Multiple cultures throughout history and around the world have used music and dance as integral components of health and healing ceremonies. In this section we will explore only a few examples from
around the world, although we would encourage those who are inter- ested in pursuing further information to consider the anthropological literature, which provides rich descriptive detail of how cultures use energetic music and dance rhythms as a source of healing traditions. In the context of this chapter, we define religion and spirituality as aspects of “ideas, beliefs, groups, or institutions associated with a higher power” (p. 311).2 We define dance as intentional, purposeful, rhythmic movements, outside of typical motor movement, that are designed to express a thought, an emotion, or an experience. Dance may be supplemented by music or drums, but can also stand alone with no other accompaniment.
NATIVE AMERICAN—LAKOTA
Arguably the most famous Native American example of spiritual dance and pain is the Sun Dance. While many of the Native American cultures based in the Great Plains region celebrated variations of the Sun Dance, in this section we will be focusing on the Lakota Sun Dance tradition. Traditionally, the Lakota tribe engaged in the Sun Dance ceremony in conjunction with the annual community-wide buffalo hunt. The annual celebration culminated in the Sun Dance in which the honored dancer(s) was pierced with a stick through small slits in their back or chest. The stick was woven through the slits and a rope tied to each end of the stick. The rope was then attached to a sacred tree. The dancer would proceed to dance around the tree for multiple days. During this time he (although dancers could be male or female, they were generally male) would forsake food and water. The dancer would continue to dance until the skin tore, thereby releasing him from the tree. This ceremony not only caused identifiable tissue damage, but to the outside observer it would also be considered unnecessarily, and perhaps gruesomely, painful. However, to the Lakotan dancers, the pain was welcomed, and many times the dancers reported experiencing no pain at all. They understood that the pain was sacred and necessary to help the dancer reach a holy world, as they believed the dance continued the process of rebirth or regeneration, subsequently ensuring the prosperity of the community.3 The preced- ing preparatory celebrations, the context of the pain experience, and the postcommunity celebrations of the dancers, provided an energiz- ing spiritual environment that left little room for the experience of pain.
PENTECOSTAL/CHARISMATIC CHRISTIANITY
Pentecostalism, often grouped with Charismatic Christianity (Pentecostal/Charismatic or P/C), is the second-largest and fastest- growing Christian group in the world, behind Catholicism. According to the World Christian Database, in 2006 there were 580 million Pen- tecostals and Charismatics in the world, with much of the growth occurring in the global south. Many point to the 1906 Azusa Street revival in Los Angeles as the start of Pentecostalism. Services at Azusa Street did not resemble the typical Christian religious service: wor- shipers shouted, danced, fell into trances, wept, spoke in tongues, and gave interpretations of these tongues into English. Ecstatic and paranormal religious experiences were the norm.
Pentecostalism has been described as an experiential religion, one that involves the entire body. It emphasizes feelings and demonstra- tions of God’s power over thought and contemplation, and encour- ages the loss or yielding of self to God, which is manifested or represented in various somatic forms. It has also been argued that these ecstatic experiences are an important part of evangelic activities that continue to promote church growth.4 These religious experiences or gifts of the Spirit are believed to be given by God to equip his peo- ple for service. Pentecostal ecstatic somatic experiences include glos- solalia (speaking in tongues), prophecy, being slain in the Spirit, miracles, deliverance, and divine healing. Although the purpose of these experiences is not the reduction of pain, as we will discuss later in this chapter, individuals often report experiencing no pain when they encounter noxious stimuli in this ecstatic state.
MUSLIM (SUFI)
Within Islam, dance is a very important spiritual practice—particularly within a branch of Islamic practice called the Sufism. The Sufi move- ment began shortly after Muhammad’s death and focused on the mystical practices and ideas of Islam. Although Sufi was initially a term indicating any mystical practice, it soon became associated with the eschewing of the external world to create growth in the spiritual world.
One specific aspect of these practices is what has become known as the Sema or the “whirling dervish” dance. A Dervish describes an indi- vidual who belongs to a sect of Islam called Tariqah, which is known
for its extreme ascetic practices. A Dervish is similar to mendicant priests/friars and hermits in Christianity and to sadhus in the Hindu and Buddhist traditions.
Within the Dervish sect exists the Mevlevi order. This is a group of Sufi priests who perform the moving meditation—the whirling dervish dance. The whirling dervish dance originated in Turkey stemming from the songs and teachings of Lord Rumi (1207–1273). Within this form of dance, there are multiple layers of symbolism that represent the rotation of the planets around the sun and the passage of blood flowing from the heart. Even the clothing symbolizes the movement toward spiritual enlightenment and receiving the gifts of God; the dancer’s hat is the gravestone of the self or ego, the flowing white skirt symbolizes the shroud of the self, and the black cloak (which is removed prior to danc- ing) represents the casting off of mourning and the spiritual rebirth of the dancer. Dervish dancers feel that the process of dancing helps them to shed external needs, such as hunger and pain, and become closer to God. The dancers generally move to the music of a reed flute. Fittingly, the flute is a symbol of human pain, indicated by the holes in the flute. However, despite (or because of) the holes in the flute symbolizing pain, the flute makes beautiful music. For the Mevlevi order this provides a powerful metaphor for how pain can be transmuted into something beautiful and a means of growing closer to God.5
MIZO—INDIA
Mizo culture refers to a group of people primarily geographically located in northeastern India. In the Mizoram language, the term Mizo means “people of the hill.” Their culture is originally based in Mongolian groups who moved into the area in the seventh century. While the Mizo people were originally Buddhist, Christian missions during the eighteenth and nineteenth centuries led to mass conver- sions, with approximately 87 percent of contemporary Mizos identify- ing themselves as Christian. Initially, Mizo cultural forms of dancing were banned and related to pagan or animist practices. However, recently the Mizo Christian community has reintegrated the cultural dance practices into their worship services. The contemporary Mizo Christianity is a blended form of worship that includes traditional cultural practices.
According to Dr. Lalrinawmi Ralte, a Mizo Christian apologist and an expert on feminist hermeneutics, Mizo dance is an empowering and
leveling experience; especially in the context of a revival ceremony, dance plays a central role.6 Sacred dance in Mizo culture disregards gender, social status, and age. Everyone in the religious community is involved in the dance, and the dance expresses the community’s spirituality. Dance theology in the Mizo culture includes dance as a healing expression within the community. It allows the community to respect the body as a sacred dimension of the individual. It is used as a way to heal or cope with both emotional and physical pain. For example, women dance to celebrate the joy of birth even in the midst of labor pain. Dance is also used as an expression of hope in God to ease the pain of a medical condition. Dance is used in the Mizo Christian community to strengthen the body and the spirit to overcome injury at both the individual and community level to create a healthier, more holistic spiritual healing experience.
CURRENT ENERGIZING SPIRITUAL PRACTICES
CHARISMATIC WORSHIP AND HEALING
The Pentecostal service begins with a lengthy time of singing and music that often follows two stages. During the first stage, called “Praise,” the songs are fast-paced, energetic, and function to stir up the congregation. During the second stage, called “Worship,” the songs are slow-paced, soft, and function to turn one’s attention to God and enter into a state of devotion and openness to “the moving of the Spirit.” Some have stated that the goal is to become filled or possessed by the Holy Spirit, which is evidenced by the way they dance, sing, and speak in tongues. It is not uncommon for worshipers to enter an altered state of consciousness during worship, or to fall backward, which is called “being slain in the Spirit,” when prayed for by elders of the church. In some Charismatic churches, such as the Toronto Airport Christian Fellowship (TACF), known for the “Toronto Blessing,” individuals report experiencing unusual physical phenomena, such as animal-sounding noises, ecstatic states and tran- ces, violent shaking and shuddering, and altered states of conscious- ness, as well as significant, transformative inner experiences resulting from feeling the intimate love of God.7
Pentecostalism has been described as providing a message of hope for
those who are ill or in emotional or physical pain. The somatic manifes- tations are understood as signs that God is healing—spiritually,
emotionally, socially, and physically. Emphasis is placed on receiving spiritual healing, which is secondary to emotional and physical healing. Emotional pain and fears are believed to manifest somatically, and thus “inner healing” is believed to often have a beneficial effect on physical health. A study by Poloma and Hoelter8 among 918 individuals who had visited the TACF revealed that measures of spiritual healing were significantly related to the measures of inner, mental, and physical heal- ing. Interestingly, a significant minority of Americans (10–30%) claim to have experienced a miraculous healing and many of these individuals are part of the Pentecostal/Charismatic tradition of Christianity.8 Polema7 has suggested that the time of worship and prayer at TACF releases a natural power (called chi, kundalini, or prana in other cultures), as well as a range of human emotions that influence and promote mental and physical health.
Despite the possible effectiveness of decreasing pain through ener- getic spiritual practices, it must also be noted that some dangers are also present. A small number of individuals have sued their churches or pastors for “slain in the spirit” injuries, claiming that the worship- per was “slain” and fell with no one to catch them. This has resulted in several individuals falling to the floor, or off of podiums/alters, causing or exacerbating injuries. There is disagreement within various religious circles as to the validity of the spiritual experience if an indi- vidual is hurt, stating that if the individual was truly slain in the spirit, they would not have been injured. Regardless of these discussions, it is important to know that during states of hyperarousal and altered con- sciousness, it may be possible for individuals to injure themselves or exacerbate an existing injury, but not feel this pain until after they have returned to their usual state of consciousness.
SPIRITUAL EDGEWORK: EXTREME RITUAL PERFORMANCES
Many have argued that religion is a socially constructed way for individuals to gain a sense of power and control, including power over pain. Bromley9 argues that when practitioners engage in a ritual prac- tice that risks physical and emotional injury or death, they experience a sense of empowerment and control because of their believed connec- tion to a source of divine power. Bromley calls these types of rituals “spiritual edgework.” Three examples of spiritual edgework rituals that put the practitioner at risk of injury, pain, and death are fire walk- ing, fire handling, and serpent handling.
Fire-handling has a long history dating back to 1200 BCE. In modern times, fire walking has been practiced across the globe: by Native North Americans, shamans of north Asia, mediums among the Bataks of Sumatra, and Haitians in their Voodoo or Santeria ceremonies, to name just a few.10 Fire walking, as an organized and marketed practice in the United States, began in 1978 by Tolly Burkan, and has increased in popularity in America through the New Age movement. It is used as a means for individuals, generally urban professionals, to over- come fear and experience a sense of empowerment, control, and self- actualization. The working metaphor of fire walking is that if you are able to walk on fire, then you are able to face and overcome any limita- tion or problem you are experiencing in your life. As such, fire is trans- formed from being a source of danger and harm to that of a healing force producing wholeness.
Practitioners are instructed to maintain a specific physical state by breathing deeply, walking normally, and clenching their right hand to represent a feeling of power. Tony Robbins, a fire workshop leader, asserts that one must program one’s self with positive, overcoming com- mands and be in a “totally focused state” before stepping on the coals, otherwise one will be burned. The fire walk usually takes only a few sec- onds and covers 8 to 14 feet of coals. People usually report experiencing no pain and often report feeling ecstatic when they finish.
Recent scientific explorations of fire walking, as well as fun experi- ments such as those carried out on the Mythbusters TV show on the Discovery Channel, have identified the physics and power of belief related to walking across 1,000°F coals. As displayed by Mythbusters, after a preparatory class on the physics and a strong trust in the phys- ics behind fire walking, walkers may gain the confidence to walk slowly and evenly so that the pressure on the foot is balanced. If they have the necessary conviction, the walker will not stomp the feet,
increase downward pressure on the foot by running, or have a psycho- somatic reaction that makes the feet perspire since these actions would enhance heat conductivity and allow the person to be burned. How- ever, individuals who are not given this preparation and confidence, through either spiritual means or physics education, are likely to walk over the coals improperly, frequently resulting in burns. While the physics may prevent the individual from being burned while walking over hot coals, it is the belief that you cannot be burned that allows for the proper technique, and courage, needed for the applied physics to protect the walker.
A small minority of Pentecostal Holiness churches in the South cur- rently practice a ritual called fire handling in the context of their serv- ices. Services are usually several hours in length and involve energetic dancing, singing, shouting, speaking in tongues, and prophesying. In a heightened collective emotional state and vigorous motor activity, members light torches and touch the flame to parts of their body and clothing for up to 10–15 seconds.10 Fire handlers believe that they are able to touch the flames without being burned because of their faith in God and because of the power of God, called the “anointing of God,” that comes upon the individual, making them immune to the fire. Worshipers assert that they can apply the fire only to the parts of their body that the Spirit directs them to and only for as long as the Spirit is upon them, otherwise they will be burned. Participants describe the anointed state as feeling numb, feeling cold, experiencing a good cold shower, and having hands like a block of ice. It is likely that participants are in an altered state of consciousness when they are “under the anointing.”10
Serpent handling commenced in the United States around 1915 in
the Church of God, a denomination in the Holiness movement, in the hills of eastern Tennessee. It was primarily practiced by rural Christians of lower socioeconomic status. This practice was popular in the 1920s, but was infrequently practiced by the 1930s. There are a few independent Holiness churches that still practice this ritual. The ritual is also seen as evidence that because of their faith in Jesus Christ, they too will be victorious over death and have eternal life. As with the other types of spiritual edgework, serpent handling pro- motes a sense of empowerment and control among practitioners.9
Much like fire handling, serpent handling occurs in the context of intense singing, shouting, dancing, loud music, prayer, and preaching. Serpent handlers have explained their ability to handle poisonous snakes without injury or death by being protected by an anointing from God to carry out his commands. They believe that the Holy Spirit takes control of them, and report feeling sensations such as, energy, joy, peace, physical numbness, tingling in the hands, and elec- tricity. Handlers speak of the importance of waiting until they feel God’s anointing before picking up a snake, and of putting the snake down as soon as they feel the anointing lifting. To do otherwise, they state, is foolish and will result in injury. Injuries are regarded as caused by fear, improper preparation, and ego. It is not uncommon for a han- dler to be bitten; however, there have been only a small number of injuries and deaths as a result of this practice over the years. Engaging
in this practice has been described by practitioners as evidence of their obedience to God, of his favor and blessing, and the truth of the Bible.
CONTEMPORARY ROCK MUSIC
Not all individuals who experience spiritual elevation to escape the impact of pain on the body are members of a group or even use these practices as part of a faith tradition. Arthur Coleman, a psychiatrist, struggled for seven years with chronic back pain. He described how he tried multiple forms of physical treatment, physical therapy, medica- tions, chiropractic manipulation, and massage. Yet despite all of these treatments, his battle with chronic back pain continued. Finally, after an eye-opening experience with his son that emphasized how opioid analgesics were damaging his cognitive and social abilities, he began searching for alternative medicine practices. He began to use “strong rock music” and drumming as a way to override his pain experience.11 It created a feeling of elation that would disintegrate the back pain and allow him to not only escape the pain temporarily while engaging in his “rock music therapy,” but to also provide him with relief after he walked away from the drum set. Only by using the intense practices of rock music and drumming was he able to provide the cognitive dis- traction, and physiological relaxation that helped him continue to cope with his pain.11
PATHWAYS LINKING ENERGIZING SPIRITUAL PRACTICES AND PAIN
Across a number of cultures, music has been used to induce strong emotions, dissociative states, trances, and altered states of conscious- ness.12 Uplifting, energizing spiritual music may have a positive impact on the mind, body, and emotions. As we know from the neuromatrix theory of pain, positive changes in any of these domains may effectively decrease a person’s experience of pain.
SEROTONIN PATHWAYS
Physiologically, religion and/or spirituality may potentially impact the pain experience through multiple pathways. However, much of the research on pathways has focused on decreasing arousal and
quieting the spirit. Specifically, research has identified that serotonin receptor density is correlated to spiritual activities. Since serotonin is related to both mood and pain regulation, if spiritual practices affect serotonin release/uptake, these practices may have a causal relation- ship to changes in both mood and pain.13 Negative spiritual thoughts (e.g., “God is abandoning me”) can increase pain sensitivity, and neg- ative spiritual practices can increase pain sensitivity, decrease pain tol- erance, and create a depressed mood. Since spirituality is an active coping mechanism for both neuroscientific and a psychological mod- els of pain, a greater understanding of how and why individuals use their spirituality to cope with pain could be a critical ingredient in improved treatments for individuals suffering from chronic pain. While the empirical literature validating the use of intense spiritual activity for pain relief is rare to nonexistent, there are a number of bio- logical pathways that support the theory that this form of pain relief not only is possible but can be very effective.
ENDOGENOUS OPIOID PATHWAYS
There is a high density of endogenous opioid receptors in brain areas related to auditory, kinetic, and visual perception. The neuroendocrine opioid system is linked to areas of the CNS that are involved in the transmission, processing, and integration of pain, auditory, and kinetic perception, as well as to areas involved in affective states. The physio- logical “fight or flight” responses to danger or excitement are converted into endorphins. Endorphins are biochemically very similar to mor- phine; thus in these situations, the human body essentially releases endogenous morphine. Like morphine, endorphins result in diminished pain and a sense of euphoria. This is similar to the “runner’s high,” described by distance runners or frequent exercisers. Prince14 asserts that the vigorous motor activities in dance and the fine tremors that almost always accompany nonhypnotic trance phenomena activate the release of endorphins, which generate and maintain the analgesic effect. This analgesia is then supported by the auditory and visual stimuli and rhythmic sounds that are also associated with trances and reduced pain.
When opioids bind with the mu opioid receptors, a number of neuro- nal changes occur, which influence pain perception, motor behavior, mood, and autonomic responses. In contrast, kappa opioid receptors are implicated in stress and dysphoria. Thus when an individual is
experiencing ongoing stress, such as suffering from chronic pain, they are more likely to have elevated activation of the kappa opioid receptors. Therefore, when the release of endorphins shuts down the kappa opioid receptors and activates the mu opioid receptors, the individual would likely feel an even greater “rush” than an individual not experiencing chronic pain. These endogenous opioids exert their analgesic effect by inhibiting pain impulses at the level of the spinal cord from being trans- mitted to the brain, where sensory signals are registered as pain. Endog- enous opioids can be activated by intense emotional states and vigorous physical activity. They can also relieve psychological pain by inducing euphoria and triggering altered states of consciousness.
HYPERAROUSAL AND ALTERED CONSCIOUSNESS
The praise and worship component of Pentecostal services and other services that have similar characteristics elicits not only a strong emotional experience, but also physiological arousal. The cognitive appraisal of the physical arousal further enhances the subjective expe- rience of the emotion. The energizing religious service includes a number of activities that can lead to hyperarousal and altered states of consciousness—clapping, dancing, swaying, raising arms, singing, glossolalia, jumping, repetitive lyrics, and energetic music—to gener- ate enthusiasm and leads to a greater likelihood of experiencing an altered state.15 Indeed, research has shown that movement, noise, group setting, sensory overstimulation, repetitive lyrics, and instru- mental music have all been used to induce a state of hyperarousal, which leads to altered states of consciousness. Not surprisingly then, when participants have been interviewed about their experience in services they use language related to a trancelike state, such as “feeling light, losing track of time, sensing electricity in their body, numbness, and feeling like one’s body was on fire.” Interviewees also stressed the importance of focus to achieve a “successful” worship experience, and often prepared themselves for the time of worship by praying or medi- tating before the service began. The physiological arousal and cogni- tive reappraisal of their experience can act as a powerful analgesic to motivated participants in these religious worship services.
Altered states of consciousness, whether due to hypnosis, meditation,
trance, or religious experience, are the result of similar psychological and neurophysiological factors. Research has shown that a number of conditions may generate an altered state of consciousness: reduction
or increase in external stimulation and motor activity, emotional hyper- arousal, rhythmic sensory stimulation, focused hyperalertness, relaxa- tion, and various states such as sleep deprivation and exposure to extreme temperatures. Stress, exertion, hyperventilation, and hypogly- cemia all result in increased adrenaline secretion, and increase one’s sus- ceptibility to rhythmic auditory and visual stimulation.16
MOCK HYPERSTRESS HYPOTHESIS
Prince14 proposed the mock hyperstress hypothesis, which asserts that artificial threat situations (e.g., nightmares, psychoses, ecstasies, trances), although potentially disturbing, are actually helpful healing states because they generate the release of endorphins. Many times the individual will then experience a deep state of peace and euphoria, commonly interpreted as divine intervention. The hyperstress hypothesis may also help explain the elevated emotionalism observed in energizing religious practices cross-culturally.
Emotionalism is a foundational characteristic of energizing spiritual practices. Indeed, energizing spiritual practices are designed to elicit certain emotional experiences and behaviors. Across the multiple cul- tures that engage in energizing spiritual practices there are a few common themes. All of these practices involve rapid music or drum- ming. Research has consistently demonstrated that music elicits spe- cific physiological changes through activating the nervous system.17 Extensive research on music has documented that fast-tempo, percus- sive, rhythmic, and loud, dynamic music is arousing and causes increases in heart rate and muscle tension, creating an escalation of activity in the sympathetic nervous system. In contrast, slow-tempo, melodic, legato style, and soft, dynamic music decreases arousal and leads to decreases in heart rate and muscle tension, as well as increases in skin temperature and skin resistance. These characteris- tics are related to parasympathetic nervous system activity, the body system that creates physiological relaxation. Researchers have also suggested that when an individual listens to music, he or she internally mimics the expression, and the physiological feedback induces the same emotion in the listener.
In addition to the activation of endogenous opioids, a physiologically
based theory has been offered to explain how fire handlers can hold their hand in the flames, without burning themselves. Ample research has demonstrated that the experience of pain is not a linear function of
the objective stimuli or degree of tissue damage (e.g., hypnosis as a sub- stitute for anesthesia, soldiers in war reporting no pain until after the battle, shark attacks during which there is no immediate pain). Psycho- logical factors, such as beliefs, attitudes, expectations, attention, anxiety, and conditioning, play an important role in the perception of pain. Given these findings, it has been asserted that fire walkers and fire han- dling church members can handle the coals and flames without injury because their beliefs and expectations in the trance state influence their neural activity, initiating the release of neuropeptides, and mobilizing a protective nervous system process.10 As with Prince’s mock hyper- stress model, the element of danger causes a release of stress hormones, creating increased muscle tension and resulting in vasoconstriction. The coldness and numbness that the handlers report—which notably is the only place to which they touch the flame—is a result of peripheral vasoconstriction, and is one of the factors that inhibits inflammation and damage.10
APPLICATIONS FOR MENTAL AND PHYSICAL HEALTH PRACTITIONERS
While scientific research has largely focused on spiritual practices that calm the spirit, we feel that the concept of energizing spiritual practices has been largely overlooked in both clinical practice and the research literature. Across a number of disciplines, there is early research beginning to show the benefits of energizing practices.
DANCE THERAPY
The value of physically energizing practices to manage chronic pain, which may involve energizing the spirit as well, has begun to receive recognition. For example, research has shown that dance therapy is efficacious for the treatment of rheumatoid arthriti.18 In this study, “vigor” improved while pain and depression decreased after a 16-week program of “enthusiastic dance-based aerobic exer- cise” in a program called EDUCIZE. Other research in dance therapy has supported this earlier research by showing positive mental and physical health benefits to patients with chronic pain. While there is currently limited research addressing whether these benefits can be explained solely by increased physical activity, the findings do suggest
that increasing physical arousal for short periods over a number of weeks can create a decrease in the pain experience.
MUSIC THERAPY
Similar to research emphasizing calming spiritual practices, the majority of music therapy research focuses on decreasing physiological arousal, and emotional reactivity to stress. Calming music therapy has been strongly tied to spiritual experiences in palliative care and pain medicine as means to strengthen the spirit and to enhance spiritual well-being. However, a recent study focused on the physiological arousal related to emotionally powerful music, which was differentiated from loud music and fast music. The emotionally powerful music was shown to increase physiological arousal based on vasoconstriction and skin conductivity biomarkers.19 In other areas of music therapy, actively participating through the production of music, clapping, drumming, or free body movements to melodic or rhythmic sounds appears to create better physical and emotional outcomes than passive listening to music or standard physical therapy. Even the rapid beating of the drum during periods of intense breakthrough pain can provide a physical release of the pain sensation. Music therapy sessions that involve active partici- pation and emotionally powerful music are similar to the energizing spiritual practices described in previous sections. The emotionally powerful music in worship and healing services engages the listener and may facilitate the psycho-physiological hyperarousal that decreases the experience of pain.
CHARISMATIC WORSHIP AND MUSIC
A recent study examined the emotional effects of the P/C style of music and worship. Miller and Strongman20 found that participants in a P/C church had a significant increase in positive mood directly before the service, which increased during the time of worship. In the second part of their study, they compared a P/C group and a non-P/C group’s reactions to religious and secular music. They found that the P/C group had a stronger “energetic” and “awesome” emotional reaction to the religious songs than did the non-P/C group. They concluded that music facilitates an emotional experience in a P/C church through familiarity and associations to music, and that music plays an essential role in shift- ing the mood of the worshipers.
PSYCHOTHERAPY
In the field of psychotherapy, there are also lessons to be learned from energizing spiritual practices. In both psychotherapy and bio- feedback for chronic pain, increasing patient arousal to states of hyperarousal and the impact of this arousal have been vastly under- studied. Health psychologists specializing in pain management often use calming psycho-spiritual practices to help a person increase their emotional control, improve their feelings of self-efficacy, and decrease their experience of pain. Entire books on topics such as pain manage- ment, decreasing stress, and improving mood are focused on decreas- ing physiological arousal. While these tools are certainly useful, and have been repeatedly empirically validated, it is quite possible that psychotherapists have been missing out on another significant poten- tial resources. It is possible that energizing practices may be effica- cious as well. Rather than encouraging decreased arousal, we should once again begin exploring, both clinically and in research, the value of cathartic arousal.
Some support for this assertion has been found in the exercise literature. The aerobic-activity research literature shows that moder- ate physical activity (and corresponding physiological arousal) is asso- ciated with decreased depression and anxiety, both of which impact the experience of pain. While we are limited in the conclusions we can draw, and we cannot identify if there are unique characteristics to encouraging energizing spiritual practices, it appears that it is a topic worth exploring with patients. It may be particularly useful with patients who report feeling bored or frustrated, or have difficulties with those activities that decrease physiological arousal such as meditation.
CONCLUSION
It has been argued that as children we learn when and how to express pain from watching others. We also learn what to do to decrease pain. One may choose to attribute the modification in pain intensity to the power of expectations, otherwise known as the placebo effect. For example, it is possible that observing others overcome painful condi- tions creates expectancies that participating in these rituals will also provide relief. Or, one may attribute this learned control over pain to cultural factors, consistent with the bio-psycho-social-spiritual model
of pain. From the review of literature above, it also appears likely that spiritual factors—both meditative and energizing—play a role in the modification of pain.
However, if an individual feels a relief of chronic pain, is the meth- odology of that pain relief important? As the famous Buddhist quote states, “There are many paths up the mountain”; and when patients are struggling against the mountain of chronic pain, the more path- ways available, the better for the patient. These pathways may include traditional pain medications, or medications affecting pathways we know to be involved in the pain interpretation process. These path- ways may also include physical manipulation therapies such as occu- pational therapy, physical therapy, chiropractics, and massage. The paths also include multiple complementary medicine techniques, such as acupuncture, herbal treatments, and Reiki. However, we cannot neglect the spiritual pathways, including the entire pantheon of both energizing and calming practices. Given what we know about the neu- romatrix theory of pain and the downward suppression of pain signals through cognitive, behavioral, and emotional states, it is possible that these highly focused, energizing, and elevated spiritual states also create a physiological pathway that down regulates the pain signals, providing partial or total pain relief.
Moderate physical exercise of various types has been recommended for chronic pain patients as part of a multidisciplinary pain manage- ment program. The physiological arousal caused by exercise could be part of the formula that explains the pain benefit of energizing spiritual practices. However, simple movement alone is not likely to explain the overwhelming sensations and altered states of conscious- ness reported cross-culturally by participants in energizing worship services and spiritual practices. As this chapter demonstrated, there are more questions than answers regarding the role of energizing spiritual practices. But as this field continues to develop and engage new ideas for the treatment of chronic pain, it will be exciting, and dare we say energizing, to empirically discover the answers to these questions.
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CHAPTER 13
