Contemplative Practices in Action 10] Zen and the Transformation of Emotional and Physical Stress into Well-Being

 10] Zen and the Transformation of Emotional and Physical Stress into Well-Being

Sarita Tamayo-Moraga and Darlene Cohen Roshi

A fierce and terrifying band of samurai was riding through the countryside, bringing fear and harm wherever they went. As they were approaching one particular town, all the monks in the town’s monastery fled, except for the abbot. When the band of warriors entered the monastery, they found the abbot sitting at the front of the shrine room in perfect posture. The fierce leader took out his sword and said, “Don’t you know who I am? Don’t you know that I’m the sort of person who could run you through with my sword without batting an eye?” The Zen master responded, “And I, sir, am the sort of man who could be run through by a sword without batting an eye.”1

In Zen lore, there are many stories about Zen masters who face disaster and hardship without blinking an eye. Sylvia Boorstein, cofounding teacher of Spirit Rock Meditation Center in Marin County, California, recounts this classic Zen story, “Without Fear” in a talk on fearlessness. Zen masters such as the one in the story have reached an equilibrium that could be described as happiness that is not dependent on external circumstances. This ease is based on fearlessness and a total acceptance of the present moment in which the practitioner is released from attach- ment to wanting reality to be different from how it is. This deep kind of release means one is less and less controlled by external circumstances. What is unique to Zen is the fact that for Zen, this kind of equilibrium

 

is achieved not by rejecting the world, but instead by completely accept- ing the world. This complete acceptance of the world is intimately related to how one perceives the world.

This stance is not negative or passive. Instead, it is dynamic and results in emotional well-being that translates into increased physical well-being although it is absolutely not a wonder drug. Zen masters and students get cancer, go through divorces, lose children, etc. They are still human, but the difference is that they accept that reality rather than reject it. Therefore, the way Zen practice transforms suffering and results in well-being is different from what one might accept. It is not a magic wand for getting what you want. Instead, Zen practice slowly wears down the ego and cultivates stability, wisdom, and com- passion. The Zen practitioner is less and less controlled by external circumstances.

The medical world has turned its attention to many forms of medita- tion because of their seeming power to improve mental and physical health. Mindfulness in particular has received increased attention because of its capacity to aid those with mental and physical ailments and enrich lives.2 Scientific research is now documenting the physiologi- cal changes that result from meditation in general and Zen in particular.3 Neurobiology in particular is the area in which increasing research is being done on how meditation changes the brain. In effect, preliminary research suggests that Zen seems to rewire the brain and the nervous system.4 Where science, psychology, and Zen seem to be meeting is the changing how one perceives transforms the mind and body. For Zen and psychology what transforms is suffering and for science what transforms is the brain and nervous system.

THE ALLURE OF ZEN “SERENITY”

Zen is now used to sell things. One can buy a “Zen” phone, have a “Zen” spa day, or even buy “Zen” perfume. President Obama is some- times described as “very Zen” in articles about his calm, unruffled demeanor in the midst of conflict.5 The power of Zen’s promise of tranquility, coolness, and serenity seems to have captured the minds of marketers, advertisers, and journalists. What marketers have tapped into is actually an ancient concept—the Brahma Vihara of upeksha or “boundless equanimity.”6 The Brahma Viharas are the different faces of love in Buddhism. The literal translation of Brahma Vihara is bound- less abode. The other three are maitri or “boundless kindliness,” karuna

 

or “boundless compassion,” and mudita or “sympathetic joy,” which means happiness for others  in  their  happiness.7  Zen  Master Robert Aitken describes the Brahma Vihara of boundless equanimity as a “broad, serene acceptance of self and others” that accepts even their and our own faults.8 This “broad, serene acceptance” is what people want but cannot figure out how to get. Furthermore, it is at the heart of how and why Zen practice in its ancient and modern manifestations has the potential to transform the suffering of emotional and physical stress into peace, joy, and liberation. The problem is that this equanim- ity does not look the way people think it should because it is about let- ting go of how you want things to be in order to make room for what is actually in front of you, your own direct experience of the present moment.

The Vietnamese Zen Master Thich Nhat Hanh describes equanim- ity in the following way in his book, Teachings on Love: “The fourth element of true love is upeksha, which means equanimity, nonattach- ment, nondiscrimination, even-mindedness, or letting go.”9 Thich Nhat Hanh’s interpretation of this fourth Brahma Vihara expands on Aitken Roshi’s understanding because Hanh emphasizes letting go as part of the equanimity. This letting go is incredibly difficult and is why zazen, or Zen sitting meditation, is at the heart of Zen practice and the foundation of all the transformation attributed to Zen. Why is that? Because when you sit zazen, you notice, accept, and let go of everything that arises, no matter what. Shining the light of awareness on more and more of one’s life gently transforms you and your life. Off the cushion, the practitioner manifests this process as mindfulness and letting go. Such an approach leads to a life of radical acceptance and oneness with life circumstances. She or he learns how to include more and more of her or his experience. Soto Zen also emphasizes ways in which to get knocked out of concepts into direct experience. Dualistic thinking traps us into rigidity and keeps us from seeing real- ity as it is. Thus, this kind of practice emphasizes a nondual way of living that is fluid in which concepts are tools rather than prison bars. This fluidity increases the ability to respond instead of react.

The entire point of Zen practice in particular and Buddhist practice

in general is to transform suffering into peace, joy, and liberation. Thus, each section on Zen practice and the Buddhist concepts that are at the basis of this practice will aim to explain how it is supposed to transform suffering by changing how one perceives and relates to the world, others, and oneself, how this process of transformation is linked  to  alleviating  stress,  and  finally,  how  this  transformation

 

actually changes the body itself, in particular the nervous system and the brain. Finally, since both authors are priests in the Soto Zen tradi- tion, and Darlene Cohen is in addition a Roshi or Master in the Soto Zen tradition, the authors will primarily concentrate on Soto Zen when discussing the practice of Zen, rather than its venerable sister tradition, Rinzai Zen.10

TRANSFORMING STRESS BY CHANGING HOW ONE PERCEIVES THE WORLD

There are many teachings and practices in Zen that relate directly to changing one’s perception and how that change results in skillful means, or effective action that transforms suffering. These include not-knowing mind, karma, oneness with one’s experience, continuous practice, impermanence, and direct experience. All of these can be summarized as seeing things as they are—just this. Therefore, percep- tion is everything in Zen. Buddhism teaches that how we see the world directly affects how much we suffer. Modern mind-body medicine emphasizes the same point. In this section, we will interweave the work of mindfulness guru Jon Kabat-Zin and ancient Zen Buddhist practices in order to explain how and why this kind of transformation eases suffering in general and the suffering from stress in particular.

Jon Kabat Zin, the scientist who is a pioneer in the use of mindful- ness meditation and practices in health care, defines stress in the following way:

The popular name for the full catastrophe nowadays is stress ... It unifies a vast array of human responses into a single concept with which people strongly identify.     stress occurs on a multiplicity

of levels and originates from many different sources     Stress can

be thought of as acting on different levels, including the physio- logical level, the psychological level, and the social level    In the

vast middle range of stressors, where exposure is neither immedi- ately lethal, like bullets or high-level radiation or poison, nor basi- cally benign, like gravity, the general rule for those causing psychological stress is that how you see things and how you handle them makes all the difference in terms of how much stress you will experience.11

Thus, we see immediately that perception plays a vital role in mini- mizing reactivity to stressors and in fact in reducing the number of things we might see as stressors. Thus, perception itself can either

 

increase or decrease our level of stress. Since Zen is all about changing one’s perception in such a way as to transform suffering, right away we can see the link between Zen and stress reduction.

Kabat-Zin further describes the link between stress and changes in perception in the following way:

So it can be particularly helpful to keep in mind from moment to moment that it is not so much the stressors in our lives but how we see them and what we do with them that determines how much we are at their mercy. If we can change the way we see, we can change the way we respond.12

This process of changing the way we see, which then results in changing the way we respond, summarizes Zen practice. The primary activity for this process is mindfulness. Mindfulness is the bridge between Zen, psychology, and science. In Zen, mindfulness is simply noticing what one is actually doing, thinking, feeling, sensing, perceiving, etc., without trying to change it. Because this task is far more difficult than it appears, Zen practitioners meditate as the core of their practice. Literally, they are learning how to return to the present moment, how to notice what is in the present moment, thus increasing their capacity to notice more and more of their experience, and cultivating the ability to tolerate what they notice without changing it, judging it, pushing it away, or clinging to it. This has the potential to result in a soft, flexible mind that is clear, forgiving, compassionate, and wise.

This retraining of perception that is fundamental to Zen practice intersects with psychology and neurobiology because how we see our circumstances affect our mental and physical health. Kabat-Zin’s work on mindfulness and stress relief demonstrates that stress can just as easily arise from a misperception or thought instead of from what is actually there or happening. He describes this process as follows:

As we have seen, even our thoughts and feelings can act as major stressors if they tax or exceed our ability to respond effectively. This is true even if the thought or feeling has no correspondence with “reality.” For example, the mere thought that you have a fatal disease can be the cause of considerable stress and could become disabling, even though it may not be true.13

Thus, even if one is healthy and well with no sign of disease, the mere thought that one might actually be ill, which is not reality at that time, can cause stress.

 

This example demonstrates how not seeing what’s actually there (health) but instead fearing what might be there (sickness) leads to suffering. One perceives what one imagines instead of what is actually happening and even though it is not happening, one suffers all the same.

If this mode of misperception remained only in the realm of psychology and did not affect the physical body, then perhaps it could be forgotten or dismissed. However, past and current research on the physiological impact of stress shows that this is not the case. The fol- lowing classic description from Kabat-Zin is that of the fight-or-flight response that occurs when a person perceives a threat to his or her well-being:

When we feel threatened, the fight-or flight reaction occurs almost instantly. The result is a state of physiological and psycho- logical hyperarousal, characterized by a great deal of muscle ten- sion and strong emotions, which may vary from terror, fright, or anxiety to rage and anger. The fight-or-flight reaction involves a very rapid cascade of nervous-system firings and release of stress hormones, the most well known of which is epinephrine (adrena- line), which are unleashed in response to an immediate, acute threat .. . The output of the heart jumps by a factor of four or five by increasing the heart rate and the strength of the heart-muscle contractions (and thereby the blood pressure) so that more blood and therefore more energy can be delivered to the large muscles of the arms and legs, which will be called upon if we are to fight or run.14

It does not matter whether there is an actual threat or not; all that is required for the mental and physical response of fight or flight is for the person to think there is a threat. Those who are overly stressed then enter a cycle of remaining stuck in this fight-or-flight cycle to the point that they see everything as a stressor and threat. Buddhism teaches that humans tend to categorize the world into that which they desire and that which they wish to avoid. Science and psychology teach us that humans can get stuck in this method of categorization to the point that they see more and more of their life circumstances, the people around them, etc., as a threat to their well-being, even if that is not the case.15 Thus, most of the suffering that arises from stress comes from getting stuck in a mode of perception that keeps inspiring the physiological fight or flight.

 

What is it about Zen that provides this mechanism of change in per- ception? One primary mechanisms is the not-knowing mind, as described by Mu Soeng:

The Zen tradition has tried to comprehend this wisdom through the now formalized teaching of not-knowing. Not-knowing is the intuitive wisdom where one understands information to be just that—mere information—and tries to penetrate to the heart of the mystery that language and information are trying to convey. All we have in, in normal human conditioning is second-, third-, or fourthhand information. In our ignorance, we treat these units of information as self-evident truths and fail to investigate our own experience directly. The not-knowing approach is not a philosophi- cal or intellectual entertainment; it is a doorway to liberation.16

Zen provides a way to see the world and oneself as only information. This neutral way of seeing removes the charge of seeing something as a threat or as a support to be chased and held onto. It circumvents the fight or flight reaction and thus the physiological cascade of events that stress initiates in the body.

How is this related to happiness that is not dependent on external circumstances? Because when one sees external circumstances just as information, then one is no longer controlled by them. The clarity that comes in the wake of not being controlled enhances one’s ability to respond instead of react. Thus, Zen and mindfulness actually change the body, especially the brain and the nervous system. These changes will be explicitly linked to neurobiological changes in a later section.

So how does Zen practice help us see things as information rather than something to run toward or away from? Zen teaches us that one can have a painful experience or loss without stress. One simply has the experience. Thus, Zen is not about getting rid of feelings of any kind, but is instead about living life in a way that leaves “no trace.” Thus, your feelings, thoughts, emotions, and perceptions come and go and you experience them, but when they are gone they leave no trace because you have fully experienced them, fully accepted them, and fully let them go.

The next Zen story is often used to exemplify how “no trace” or oneness with circumstances is about fully and completely having one’s experience. Francis Cook used this story in his commentary on Soto Zen’s founder Dogen’s essay on karma:

 

A young monk was disillusioned with Zen when he heard his revered master scream in pain and fear as he was being murdered by thieves. The young man contemplated leaving Zen training, feeling that if his old master screamed in the face of pain or death, Zen itself must be a fraud. However, before he was able to leave, another teacher taught him something of what Zen is all about and removed his misconceptions. “Fool!” exclaimed the teacher, “the object of Zen is not to kill all feelings and become anes- thetized to pain and fear. The object of Zen is to free us to scream loudly and fully when it is time to scream.”17

This extreme example of oneness with circumstances or one’s karma is supposed to wake us up to another facet of equanimity, which is that responding appropriately to circumstances is not about not feeling. Instead, as exemplified by the story, the point of Zen practice is to free us to laugh when we are supposed to laugh, scream when we are supposed to scream. Much of Zen practice is about getting kicked out of concepts and ideas into direct experience where everything is just information. Dwelling in direct experience frees one to respond appropriately. When one unites with the experience or rather just is the experience, then one is free no matter what the circumstances. Zen tends to use extremes to make important points about the transformation of suffering.

One of the reasons that everything does not flow, especially in the face of a crisis, is that instead of having a direct experience of our life, we want a theory about our life that will make our life the way we want it.18 Then when life does not turn out to match our theory, we suffer in subtle to gross ways. Having plans about what we want in our life and how we want it to be is not the problem. The problem is staying attached to the outcome and our expectations. Thus, believing that a theory about our life is the reality rather than our direct experience of our life sets us up for suffering. Staying stuck to the outcome we want does not enable us to see our life as it is. In fact, we are then con- trolled by our expectations and thus miss the opportunities that are not part of our plan. Thus, we exist like ghosts, neither here nor there.

ONENESS WITH CIRCUMSTANCES AS A WAY TO TRANSFORM SUFFERING AND STRESS

In Zen, everything is an opportunity for awakening. Therefore, every single event, experience, thought, feeling, etc. is valuable and

 

useful, including suffering. The operative classical teaching we will focus on in this section is oneness with circumstances (acceptance of karma) as a way to be free from circumstances. Directly related to this classical teaching is Kabat-Zin’s emphasis on turning toward one’s suffering rather than pushing it away or escaping from it. The irony is that one cannot release or transform what one denies or is not aware of. In a classic Zen poem, “Song of the Jewel Mirror Samadhi,”19 this process of witnessing without acting on aversion or desire is described as “Turning away and touching are both wrong, for it is like a massive fire.”20 Not touching and not turning away in Zen focus on not chang- ing oneself or one’s experience, but instead witnessing it.

Again and again, Zen emphasizes that when you impose yourself on what is in front of you, you do not see it as it is. When you impose yourself on yourself, you do not see who you are. Thus, the act of imposing yourself impedes clear perception and encourages reactivity. How then can we allow things to be themselves? We can do this by being as completely present as we can. As we cultivate the ability to include more and more of our experience, we become less reactive and more responsive. This is the transformation that occurs through self-acceptance and letting go, which turns out to be a very effective strategy for dealing with stress.21 Things become what they are and you become who you are.

In the Genjo Koan, Dogen-Zenji, founder of Soto Zen, writes, “Yet

in attachment blossoms fall, and in aversion weeds spread.”22 That to which we are attached we see as a flower and yet that flower still falls and decays. That to which we are averse appears to us as a weed and it seems to multiply despite our best efforts to kill it. The way one does not touch or turn away and how one loves one’s weeds is exemplified by the next koan (a puzzling question or story that is designed to knock people out of concepts into direct experience), which is exactly about how this activity is manifested as oneness with circumstances. We will see that the essential ingredient is a simultane- ous unity with circumstances and freedom from circumstances that stems from constantly returning to one’s direct experience. Returning to direct experience is what changes one’s perspective—not the other way around.

The following koan from Dogen’s essay “Spring and Fall” illustrates how direct experience can cut through categories and alleviate suffering:

A certain monk asked the great master Tung-shan, “When the cold or heat arrives, how can one avoid it?” The master answered,

 

“Why don’t you go to a place where there is no cold or heat?” “Where is this place where there is neither cold nor heat?” asked the monk. Said Tung-shan, “When it is cold, the cold kills the monk; when it is hot, the heat kills the monk.”23

So—what is the place where there is neither cold nor heat? Direct experience. Oneness with experience, regardless of what it is. This is simply being as present as possible to whatever is happening, both inside and outside oneself. This is not touching, not turning away. The mystery of Zen is that by doing this, one transforms suffering. The closest words that get to it is that by doing this, one stops strug- gling to force things to be different and stops struggling to maintain comfort and ideal circumstances. Dropping the struggle itself allows one to rest and creates the possibility of clarity because one’s personal agenda is finally, if not out of the way, at least not the dominant lens through which the world and self are seen.

But as we all know—it is much harder to get to that place than we think. And the kind of effort we think it takes is not that at all. It is actually zazen effort. So, we do not actually work to be free—we work to notice when we are not free—when we are free—and we sit zazen to practice not separating from our experience, no matter what it is. Dogen then continues—“when it is cold, be thoroughly cold, and when it is hot, be thoroughly hot.”24 By affirming one’s conditioned- ness, one becomes free from one’s conditionedness.25

So how does one affirm one’s very conditionedness? What does Zen teach about that and how does it happen? It happens because when you are present to what is in front of you and to yourself, you are actually affirming it. Being present to our direct experience, especially in zazen, teaches us that everything changes and that we have no con- tinuous self and that our perspective is limited. Thus, we can then see the world differently. Scientific research now teaches us that this shift in perception is also a physiological shift. In the section on Zen and science, we will see that there are actually pathways in the brain and nervous system that shift when one’s autobiography or personalized lens on the world drops and one sees what’s there without oneself in the way. The change is physiological because our lens on the world is actually a pattern in the brain and nervous system.

 

ZEN AND WELL-BEING FROM A SCIENTIFIC PERSPECTIVE

Now that we have reviewed some ancient practices that Zen teaches and uses in order to achieve well-being, we will move to some current scientific understandings and hypotheses of what is actually changed in the brain and nervous system through these practices and others like them, primarily Zen and its practice of mindfulness. Really what we will be looking at is what could be described as a modern-day, scientific understanding of karma, namely behavioral,  perceptual, and emotional patterns that are inscribed in the nervous system and brain from our up-bringing, our social, national, physical, monetary, familial, etc. context. What Zen seems to do is unwrite or at least fade this physically inscribed karma and rewrite a new physical karma that does not necessarily erase the old karmic pattern but instead bypasses it.

How does this relate to the alleviation of stress? Basically, stress responses can inscribe pathways in our brain and nervous system.26 And if we get stuck in stress reactivity, then the pathway becomes more and more entrenched and harder to change. Therefore, from a neurobiological perspective, Zen practice and mindfulness practices in general, because they are about rewiring us into well-being, can also be directly applied to stress pathways and responses if only because Zen provides a way to build an alternate pathway. The specific rewir- ing that seems to take place according to current research is that one moves from perceiving the world through one’s autobiography to instead perceiving the world through selflessness. This switch has a physiological component, which James Austin, MD, describes as mov- ing from egocentric perception to allocentric (other-centered or self- less) perception, which has literal correlates in the parts of the brain that perceive and then react to that perception.27 Therefore, in this section, we will focus on how Zen and mindfulness rewire the brain and nervous system in general, with a special focus on how this relates to stress in particular.

James Austin, MD, has made how Zen changes the brain the focus of much of his career, specifically in the books Zen and the Brain, Zen-Brain Reflections, and Selfless Insights in addition to many papers

 

and other research. As a medical doctor, a Zen practitioner of many years, and a neurobiologist, he has a unique perspective from which to uncover much of what happens to the brain in zazen and mindful- ness practices. He writes,

A Zen perspective has been available for centuries.  But  until recent decades, the scientific community did not understand the message, or it chose to ignore it. How can Zen make its age-old contribution to the study of consciousness? By inviting us to ask the naı¨ve and seemingly incredible question: what is this world really like without our intrusive self-referent self in the picture? Putting it another way, let’s suppose a brain drops off all its sub- jective veils of self-consciousness. What, then, does the rest of its awareness—and its pure, objective consciousness, perceive?28

Where this links back to Zen and the brain is that Zen’s focus on bypassing one’s personal agenda in order to have a direct experience is just the kind of change that facilitates clear perception as docu- mented in James Austin’s books on Zen and the brain. One does not actually have to drop one’s personal agenda. Instead, all one has to do is cultivate the ability to return to one’s direct experience of the present moment over and over again. Such a cultivation also fosters the ability to include more and more of one’s experience. Eventually, one’s personal agenda is just one facet of how one perceives the world. How does this intersect with stress? As seen earlier in this article, stress is an emotional and psychological response to a stressor. How- ever, emotions are hard to change and often not subject to reason. Basically, by turning to the present moment over and over again, we are providing ourselves with an alternate focus while our brain is in tumult, until it calms and we develop new nerve pathways. Science shows us that this shift of focus to the breath and the present moment

actually calms the firing of maladaptive neural pathways.29

Zen teaches us, as we saw earlier, that the less we see our world just as information, the less effective we will be in it and the more con- trolled we will be by circumstances. However, what we see here is that we are controlled by external circumstances precisely because we are con- trolled by internal circumstances, NOT the other way around. Thus, if we can change these, we have more of a chance of not being controlled by external circumstances. These internal circumstances are encoded in our brain and nervous system. Since our brains and nervous system are wired to perceive the world in the way that we have been taught

 

and that we remember from past experiences, most of us walk around with a perceptual filter that does not see things as they are. This per- sonalized filter causes us to select and reject material based on our memories and conditioning in terms of what has helped most in the past, or simply what we have learned from our roles models and/or society and/or family. Thus, we’re already wired to walk around with a personalized filter. But, in addition to faulty perception, we are also wired emotionally by our own genetics, our environment, our upbringing, etc. This emotional wiring is intimately related to how we perceive. Thus, if what we perceive is already filtered by our wir- ing, then changing the way we respond or react depends on changing our perception. And yet, these seem to be locked in a mutual embrace calculated to keep us from doing just that. So how is this related to stress, and how is it related to Zen?

Basically, zazen, or sitting meditation, provides a format to watch ourselves react to our own thoughts, perceptions, emotions, and sensations, in a safe, closed loop. Because we are silent and still while we watch the cascade of reactions and thoughts, we eventually see how we are the source of our warped window on the world and that our window might not match what is in front of us, or even match our direct experience. From a neurobiological perspective, what this does is calm the firing of the neurons that access memories.30 Zen and its practices provide a way to bypass our internal circumstances because Zen practice is about just noticing those internal circum- stances and not changing them. It turns out that the very act of non- judgmental attention enables those internal circumstances to slowly stop dominating us if only because we finally realize we do not have to act on our thoughts and feelings and we will still survive.

According to Austin, the good news is that the brain is plastic and can change, and new nerve cells and nervous system pathways can be born and old ones can be changed or wither away.31 The bad news is that experientially, one needs to be able to withstand the pull of the old pathways and habits while building the new ones that are more fruitful and less maladaptive. This requires stability, which comes from regular meditation and mindfulness practices, which is strength- ened by sitting with a group and working with a teacher. However, Zen practice and other forms of mindfulness meditation provide a way to change these maladaptive pathways—remember back to earlier in the chapter when we discussed not-thinking and its role in seeing everything as simply information rather than seeing everything only

 

in terms of desire or aversion. It changes the overconditioning of the limbic system if only because we watch everything that pops up while silent and still and we begin to see the web of self and memory that we impose on what is in front of us. These changes happen indi- rectly in Zen practice.

In particular, preliminary research and speculation upon the research by Austin suggests that the very mechanisms by which Zen for centuries has relied on changing perception in order to transform suffering deac- tivate an overconditioned limbic system.32 The research in his three books is extensive, highly technical, and very specific. For that reason, we will be concentrating only on some key aspects that reflect how changes in perception change the brain and nervous system.

First, we will concentrate on the pathways in the brain that have been linked to overwhelming anxiety and fear that then lead to reactiv- ity without choice. The seat of these emotions in the brain seems to be the amygdala in the limbic brain, which is a “gateway” from the limbic brain to the neocortex and other parts of the brain. Austin describes its primary function in the following way:

It [the amygdala] codes for the potential emotional, social, and survival value of an arousing stimulus, then relays this informa- tion elsewhere where it can serve matching responses appropri- ately and be consolidated into potentially  useful  memories .. . The amygdala is not activated each time we consciously judge whether an ordinary stimulus is pleasant or unpleasant. However, emotional states of extreme anger or fear almost always activate the normal amgydala. The amygdala also becomes more acti- vated during the readiness to act, psychological conditioning, autonomic arousal, release of “stress” hormones, and when our attention is heightened.33

Austin goes on to describe a study in which participants were asked “to maintain their negative emotion after they viewed a disturbing ‘nega- tive’ picture.”34 Activity rose in their amygdala, and those who had reported having a negative worldview had the highest increase of activity in this part of the limbic brain.35 The amygdala has a strong influence on the neocortex and on our actions and on our responses to stressors. Austin suggests that Zen practice helps loosen the domi- nance of the amygdala on the neocortex and reactivity in general:

Unstated in Zen is a major premise of long-range meditative training: diminishing the unfruitful influences that the amygdala

 

has on other regions, higher and lower (part VII). Yet these per- sonal liberations usually evolve at a glacial pace, much too subtly to seem practical, recognized more in hindsight than at the time. On the background of such incremental change, could a deep crevasse open up suddenly, an event that cuts through every knot- ted problem in the psyche, from top to bottom?36

If Zen practice is to have an influence on an important seat of extreme fear and anxiety and instantaneous reactions to those overwhelming feelings, then the next place to look is at the phenomena of fearless- ness and awakening in Zen practice. Austin focuses on kensho, a “see- ing into the essence of things, insight-wisdom,”37 as an experience Zen practitioners have that can point to what happens in the brain. Satori is the term reserved for “a deeper, more advanced state of insight-wisdom.”38 Austin hypothesizes that kensho and satori result in a state in which perception is primarily allocentric and that the fear-based self through which we see the world drops away.39 If true, such experiences would reduce “the resonances of fear in the amygdala and other limbic and para-limbic regions.”40

He goes on to hypothesize further that repeated experiences of ken- sho and satori continue to change the brain. In the brain, there are “other-referential attentional and processing functions” and “pathways that are Self-referential.”41

Simply stated, his theories based on current research imply that Zen strengthens “other-referential” pathways, or Selfless pathways in the brain rather than “Self-referential” pathways in the brain. Thus, the problems alluded to earlier in the chapter about how to get around per- ceiving the world through memory and our autobiographical Self now have a tentative answer. He then goes on to explain how mindfulness and bare awareness contribute to a more clear perception of the world:

Unfortunately, our biases distort perception. They cause us to remember false information .. . the more directly we integrate our earliest perceptual messages—the simpler ones that first register seeing and hearing—with our medial temporal lobe memory func- tions, the more likely we are to record details accurately and remember an event in ways that consciousness might regard as valid, at least tentatively. Otherwise, greater degrees of uncertainty arise, and will persist.

The world is like a Rorschach ink blot test. We insert the imaginary projections of our subjective Self into everything we

 

see there. The simplest way to gather valid factual information is by learning to observe the world mindfully, unjudgmentally, clearly, using the other-referential ventral pathways that bypass the intrusive filters of Self.42

Returning one’s attention to the present moment seems to reinforce allocentric pathways in the brain while continuing to try to force the world to fit into one’s veil of memory and autobiography reinforces Self-oriented pathways in the brain. Austin is attempting to explain and understand from a neurobiological standpoint the kind of clarity of perception that was described earlier in this chapter as not-thinking. Although there is not yet a definitive answer from the scientific stand- point, he explains:

Meditation creates a series of complex psycho-physiological changes. To begin with a loose generalization, one might say that Zen meditation does involve a kind of not thinking, clearly. And it then proceeds to carry this clear awareness into everyday living

.. . Zen training is an agency of character change. It’s a program designed to point the whole personality in the direction of increasing selflessness and enhanced awareness.43

Thus, this ancient combination of Zen practices, which include zazen, mindfulness, and not-thinking (not being trapped by concepts), focused on cultivating awareness and dampening the ego in order to cultivate wisdom and compassion, gently nudges the brain toward the allocentric pathways and not the egocentric pathways.44

Another important aspect is the relationship between nuclei of the dorsal thalamus (a part of the limbic brain) and the neocortex. In addi- tion to the influence of the amygdala, these nuclei also send “impulses from the limbic system .. . to influence the emotional responses of the cortex.”45 These ripples between the thalamus and the neocortex could serve to reinforce egocentric pathways.46 Austin theorizes that kensho and satori have the potential to “decrease the functions of .. . the dorsal thalamus. These deactivations could cause a significant decrease in the maladaptive influences of the Self.”47

So how does this relate back to stress and Zen’s potential to reduce and alleviate the stress response? Basically, just as stress rewires the brain as mentioned earlier, so can zazen and mindfulness practices undo the harm that stress can cause in the body. In particular, current neurobiological research, hypotheses, and theories about how Zen

 

practice affects the brain imply that Zen practice provides a way to calm and bypass the tyranny of the limbic brain over the neocortex because it provides a way to encourage selflessness as a form of per- ception. Since the limbic brain is actively involved in the stress response and especially in hyperarousal and stress reactivity, the poten- tial of Zen to provide relief is then clear. And finally, since Kabat-Zin’s mindfulness-based stress reduction programs focus on changes in per- ception as the foundation of relief from stress and Zen is an ancient practice for changing perception and cultivating clarity, the potential for Zen to aid in that change in perception is present. Ultimately, the letting go and returning to the present moment of zazen turns out to be a form of control and a way to change one’s internal circum- stances enough so that one is no longer controlled by external circum- stances. This entire chapter has been an explanation of how the ancient concept of upeksha or equilibrium could be practiced and how and why it leads to happiness that is not dependent on external circumstances.

PRACTICAL SUGGESTIONS

What are some practical applications of Zen practice to help alleviate stress in daily life? In this last section, we will focus on two practices designed to encourage gently returning to the present moment until you can see clearly what is in front of you. Zazen, as described previ- ously, is the foundation of all of these practices. Other practices that have not been fully described in this chapter include cultivating “Right View.” one of the practices of the Eightfold Noble Path in Buddhism, creating and using a personal koan, and breath practice in everyday situations.

Thich Nhat Hanh suggests using the question “Am I sure?” when confronted with something that we think threatens us. Such a practice could be used when faced with a stressor. “Right View” is all about real- izing that our perceptions are not reality and in fact can never be reality. In his explanation of “Right View,” Thich Nhat Hanh points out that the Buddha said, “Where there is perception, there is deception.”48 According to Hanh, “most of our perceptions are erroneous” and erro- neous perceptions lead to suffering.49 This is similar to Kabat-Zin’s emphasis on how the stress response often arises in reaction to “per- ceived” threats, rather than actual threats. Thus, practicing asking “Am I sure?” or “What is this?” potentially buys you time and allows you to tolerate your reaction until perhaps it can become a response.

 

Therefore, if possible, keep asking the question until clarity arises. The ancient application of “Right View” through questions such as “Am I sure?” or “What is this?” encourages us to question our own percep- tions and regain our sanity.

Cultivating a personal koan is also a way to reappropriate the ancient Zen practice of using an unanswerable question to knock the Zen stu- dent out of concepts and into direct experience. When you are faced by a situation that you cannot resolve or that puzzles you, you could develop a question that might help you come up with an answer indi- rectly and spontaneously. For example, if you cannot tell the difference between a threat and a mild irritant at work, developing a question about that might help. Cohen Roshi describes this process of develop- ing a personal koan in detail in her book Turning Suffering Inside Out.

Creating your own personal koan then would involve reflecting on the seemingly intractable situation and finding a question that could neutrally give you information about the situation. For example, if friends complain that you never listen to them, you might use the question “How do I listen?” as a personal koan and see what happens. From the perspective of Zen practice, asking yourself the question at arbitrary times of day and potentially before speaking with a friend without expecting an answer is perhaps the most important part of the practice. Forcing change is not part of Zen practice. The question eventually drops the issue into your subconscious and eventually an answer that you did not develop intellectually might arise. Questions tailored to stressful situations could also be devised.

These are only a few of the practical applications of Zen. Many more exist and can be cultivated. These ancient practices have trans- formed suffering into peace, joy, and liberation for many over the cen- turies. Kabat-Zin modified Zen mindfulness practices for a general audience and his programs on mindfulness-based stress reduction have been transforming the suffering caused by stress now for decades. Now, with the advent of nascent neurobiological research on how meditation in general and Zen in particular change the brain, we can finally see that to transform our suffering is to transform our percep- tion, which in turn transforms our body.

NOTES

1. Boorstein,   Sylvia   (Fall   1999).   “The   Gesture   of    Fearlessness and the Armor of Loving-Kindness,” http://ecbuddhism.blogspot.com/

 

2009/04/fear-fearlessness-what-buddhists-teach.html (accessed October 30, 2009).

2. Epel, Elissa, Daubenmier, Jennifer, Moskowitz, Judith Tedlie, Folkman, Susan, & Blackburn, Elizabeth. (2009). “Can meditation slow the rate of cellular aging? Cognitive stress, mindfulness, and telomeres,” Longevity, Regeneration, and Optimal Health, 1172, 34–53.

3. This article will be using primarily the works of James Austin, MD, in particular, Zen and the Brain, Zen-Brain Reflections, and Selfless Insight.

4. Austin, Zen-Brain Reflections, 138–140.

5. Herbert, Bob. (2009, August 21). “Voices of Anxiety.” The New York Times; Zeleny, Jeff. (2008, December 24). “Obama’s Zen State, Well It’s Hawaiian.” The New York Times.

6. Aitken, Original Dwelling Place, 47.

7. Ibid.

8. Ibid., 48–49.

9. Hanh, Teachings on Love, 8.

10. A basic difference between Rinzai Zen and Soto Zen is that Rinzai Zen focuses on sudden enlightenment whereas Soto Zen focuses on gradual enlightenment.

11. Kabat-Zin, Full Catastrophe Living, 235–238. 12. Ibid., 241.

13. Ibid.

14. Ibid., 251.

15. Jon Kabat Zin’s Full Catastrophe Living is one example of books on the subject. However, James Austin’s books Zen and the Brain, Zen-Brain Reflec- tions, and Selfless Insight are more recent texts on scientific investigation of the effects of Zen on the body and in particular on the brain.

16. Soeng, The Diamond Sutra, 63–64.

17. Cook, “Karma,” in How to Raise an Ox, 43.

18. Kwang, Dae (Fall 1999). “Mind Placebo,” http://www.kwanumzen.org/ pzc/newsletter/v11n04-1999-apr.html (accessed October 30, 2009).

19. Austin, Zen-Brain Reflections, 472. Samadhi means “an extraordinary alternate state of one-pointed absorption” or sometimes it also means merely a state.

20. http://www.berkeleyzencenter.org/Texts/jewelmirror.shtml (accessed October 30, 2009).

21. Kabat-Zin, Full Catastrophe Living, 269–273.

22. Eihei Dogen, Moon in a Dewdrop, 69.

23. Eihei Dogen, “Spring and Fall,” in How to Raise an Ox, 111.

24. Ibid.

25. Cook, 43.

26. Austin, Zen-Brain Reflections, 113–114.

27. Austin, Selfless Insight, 109.

28. Austin, Zen-Brain Reflections, xxv.

 

29. Austin, Zen-Brain Reflections, 59. 30. Ibid., 104.

31. Ibid., 141.

32. Austin, Selfless Insight, 92.

33. Austin, Zen-Brain Reflections, 86, 90.

34. Ibid., 93.

35. Ibid.

36. James Austin, Selfless Insight, 201. 37. Ibid., 271.

38. Ibid., 272.

39. Ibid., 93–94.

40. Ibid., 179–180.

41. Ibid., 187–188.

42. Ibid., 142–143.

43. Austin, Zen-Brain Reflections, xxv, xxxvi.

44. Austin, Selfless Insight, 188.

45. Ibid., 90.

46.   Ibid.,  92. 47. Ibid., 93–94.

48. Hanh, The Heart of the Buddha’s Teaching, 53.

49. Ibid.

REFERENCES

Aitken, R. (1996). Original dwelling place: Zen Buddhist essays. Washington, DC: Counterpoint.

Austin, J. (2009). Selfless insight: Zen and the meditative transformations of consciousness. Boston: MIT Press.

Austin, J. (1999). Zen and the brain: Toward an understanding of meditation and consciousness. Boston: MIT Press.

Austin, J. (2006). Zen-brain reflections: Reviewing recent developments in medita- tion and states of consciousness. Boston: MIT Press.

Cohen, D. (2004a). The one who is not busy: Connecting with work in a deeply satisfying way. Layton, UT: Gibbs Smith.

Cohen, D. (2004b). Turning suffering inside out: A Zen approach to living with physical and emotional pain. Boston: Shambhala.

Cook, F. (2002). How to raise an ox: Zen practice as taught in master Dogen’s shobogenzo. Boston: Wisdom.

Dogen, E. (1995). Moon in a dewdrop: Writings of Zen master Dogen.

K. Tanahashi (Ed.); R. Aitken, E. Brown, K. Tanahashi, et al. (Trans.). New York: North Point Press.

Epel, E., Daubenmier, J., Moskowitz, J. T., Folkman, S., & Blackburn, E. (2009). Can meditation slow the rate of cellular aging? Cognitive stress,

 

mindfulness, and telomeres. Longevity, Regeneration, and Optimal Health, 1172, 34–53.

Hanh, T. N. (1999). The heart of the Buddha’s teaching. New York: Broadway Books.

Hanh, T. N. (1998). Teachings on love. Berkeley, CA: Parallax Press.

Kabat-Zin, J. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Dell.

Soeng, M. (2000). The diamond sutra: Transforming the way we perceive the world. Somerville, MA: Wisdom.

Suzuki, S. (2005). Zen mind, beginner’s mind. Trudy Dixon (Ed.). Boston: Weatherhill.

 

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PART THREE

CONTEMPLATIVE PRACTICES IN ACTION: APPLICATION

PREFACE TO PART THREE

Part Three, Contemplative Practices in Action: Application, examines vari- ous applications of spiritual and contemplative practices. Delbecq’s chapter shows that learning meditation—a well-researched and founda- tional contemplative practice—can have a powerful impact on business leaders. Next, Wachholtz and Pearce remind us that spiritual traditions contain rousing practices as well as quieting practices, and these arousing practices may be useful for treating chronic pain. Finally, Manuel and Stortz examine the spirituality, health, and solidarity-promotional value of three oft-forgotten practices from Christian tradition: lamentation, intercession, and pilgrimage.

 

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CHAPTER 11

Contemplative Practices in Action 12] “Shaking the Blues Away”: Energizing Spiritual Practices for the Treatment of Chronic Pain

 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.

REFERENCES

1. Melzack, R. (1999). From the gate to the neuromatrix. Pain, 6(S1), S121–S126.

 

2. Wachholtz, A. B., Pearce, M. J., & Koenig, H. G. (2007). Exploring the relationship between spirituality, coping, and pain. Journal of Behavioral Medicine, 30(4), 311–318.

3. Andersson, R. H. (2008). The Lakota Ghost Dance of 1890. Lincoln: Uni- versity of Nebraska Press.

4. Poloma, M. M, & Pendleton, B. F. (1989). Religious experiences, evan- gelism, and institutional grown within the assemblies of God. Journal for the Scientific Study of Religion, 28(4), 415–431.

5. Owen, C. (2008). Whirling dervish dance: Where the dance comes from and what it means, http://worlddance.suite101.com/article.cfm/whirling

_dervish_dance#ixzz0Cs8L5eLp (accessed April 16, 2009).

6. Ralte,  L.  (2006).  Dance  theology  in  Mizo  tradition,  http://www

.mizobooks.com/dance_theology.htm, (accessed April 29, 2009).

7. Poloma, M. M. (1997). The “Toronto blessing”: Charisma, institution- alization, and revival. Journal for the Scientific Study of Religion, 2(36), 257–271.

8. Poloma, M. M,  &  Hoelter,  L. F.  (1998).  The  “Toronto”  blessing: A holistic model of healing. Journal for the Scientific Study of Religion, 37(2), 257–272.

9. Bromley, D. G. (2007). On spiritual edgework: The logic of extreme ritual performances. Journal for the Scientific Study of Religion, 46(3), 287–303.

10. Kane, S. M. (1982). Holiness ritual fire handling: Ethnographic and psychophysiological considerations. Ethos, 10(4), 369–384.

11. Colman, A. D. (1997). Pain and surgery: The Shamanic experience. In

D. Sandner & S. H. Wong (Eds.), The sacred heritage. New York: Routledge; : 125–137.

12. Price, C. A., & Snow, M. S. (1998). Ceremonial dissociation in American Protestant worship. Journal of Psychology and Christianity, 17(3), 257–265.

13. Borg, J., Andree, B., Soderstrom, H., & Farde, L. (2003). The serotonin system and spiritual experiences. American Journal of Psychiatry, 160(11), 1965–1969.

14. Prince, R. (1982). The endorphins: A review for psychological anthro- pologists. Ethos, 10(4), 303–316.

15. Shumaker, J. F. (1995). The corruption of reality: A unified theory of religion, hypnosis, and psychopathology. Amherst, NY: Prometheus Books.

16. Neher, A. (1961). Auditory driving observed with scalp electrodes in normal subjects. EEG and Clinical Neurophysiology, 13, 449–451.

17. Krumhansl, C. L. (1997). An exploratory study of  musical  emotions and psychophysiology. Canadian Journal of Experimental Psychology, 51(4), 336–352.

18. Perlman, S. G, Connell, K. J, Clark, A., et al. (1990). Dance-based aerobic exercise for rheumatoid arthritis. Arthritis & Rheumatism. ;3(1), 29–35.

 

19. Rickard, N. S. (2004). Intense emotional responses to music: A test of the physiological arousal hypothesis. Psychology of Music, 32(4), 371–388.

20. Miller, M. M., & Strongman K. T. (2002). The emotional effects of music on  religious  experience: A  study of the  Pentecostal-Charismatic style of music and worship. Psychology of Music, A30(1), 8–27.

 

CHAPTER 13