Psychosomatics 43:253-254, June 2002
© 2002 The Academy of Psychosomatic Medicine
Minding the Body: Clinical Uses of Somatic Awareness
By Donald Bakal, New York, Guilford Press 1999, 228 pages $35.00, ISBN 1–57230–9
Deborah R. Sepinwall, Ph.D.
Key Words: Somatic Awareness • Immune Deficiency Syndromes
Dilip Ramchandani, M.D.
BOOK REVIEW EDITOR
Over the past decades, numerous investigations have been launched to elucidate the complex relationship between psychological states and promotion or prevention of illness. In his book Minding the Body, Donald Bakal, a Canadian health psychologist, further illuminates the interplay between psychological and physiological variables within the person by introducing an experiential component of psychobiological health that he calls somatic awareness.
According to Bakal, somatic awareness constitutes an innate wisdom that people have about their somatic selves. It is conceived of as an active process that begins with volitional attention to the information coming from our bodies for the purpose of improving physical health. Bakal believes that getting in touch with bodily experience has the advantage of providing individuals with experiential access to healing mechanisms within themselves. While somatic awareness may take many forms, such as visualization, effortless breathing, meditative awareness, or biofeedback training, the ultimate goal is self-regulation through bodily self-knowledge.
Bakal argues against the exclusive use of traditional means to manage symptoms. For example, he cites numerous widely used and, in his view, unsuccessful coping strategies employed by pain patients that are characterized by avoidance of the underlying pain (such as diverting attention, ignoring pain, praying, increasing activity, and engaging in positive self-talk). Bakal believes that such avoidance interferes with individuals' ability to experience their natural healing processes and to know, in effect, if their conscious strategies are initiating the desired bodily changes within themselves.
Bakal makes a similar case for the potentially detrimental reliance on medications, like analgesics, to manage pain. While he states that there is no reason for which medications cannot be used in conjunction with somatic awareness to achieve symptom management, patients may very quickly come to rely solely on medication and ignore or distrust the healing resources within themselves.
Bakal argues that while faith in medicine, religion, physicians, or any other "transitional object" is important, if it is greater than faith in oneself, then the individual is deprived of the opportunity to both acquire a better understanding of his or her own psychobiological processes and to use this information for rehabilitation purposes. According to Bakal, in all cases, there needs to be a greater utilization of bodily information as a legitimate dimension of health promotion.
Bakal's discussion of somatic awareness is refreshing for several reasons. First, it places trust in the power of the person to both have access to internal bodily sensations and to make healing choices based on this information. Listening, responding to, and learning from one's body, rather than relying solely on external treatment, may increase one's sense of bodily self-control and personal empowerment as well as cultivate self-nurturance and self-soothing. Second, an enhanced awareness of internal bodily sensations may help one recognize subtle symptoms and mobilize efforts to prevent their exacerbation. Finally, sensory monitoring may diffuse negative and emotional (such as fearful) interpretations of bodily information, thereby resulting in perceptions that are relatively neutral and manageable.
The problem with Bakal's theory is that, in large part, it has yet to be proven. While it is very possible that the mind's awareness of the body's sensations has great potential in the treatment of numerous symptoms, diseases, and illness conditions, there is limited evidence in the book to support this. Bakal himself acknowledges the paucity of solid clinical proof demonstrating the therapeutic effects of bodily awareness. Consequently, Bakal raises many more questions than he can answer at this time. Nonetheless, he provides a legitimate context and foundation for these questions based on what is known about the influence of psychological variables on disease. For example, he writes, "Now that it is understood that at both the anatomical and the functional levels, there are connections between the brain, the autonomic nervous system, and the immune system, the question is whether the human mind has the capability to capture the adaptive nature of the immune system through conscious experience" (p 139).
Unfortunately, empirically addressing questions such as this one may prove difficult. This may be especially true in the case of illnesses like hypertension, heart disease, cancer, and diseases of the immune system since they do not possess identifiable sensory correlates of underlying pathophysiology. Therefore, the opportunity for somatic awareness, as well as measurement of its effects and mechanisms of action, becomes more challenging. Bakal suggests that, with these conditions, somatic awareness needs to be conceptualized in terms of bodily sensations that are indirectly or secondarily related to underlying disease processes or, even more broadly, in terms of general well-being. However, it is precisely this generality that would prove problematic in scientific studies of this concept.
Finally, Bakal's arguments may provoke other questions from the reader that are not addressed in the book. For example, for whom might somatic awareness be contraindicated, based on personal history, cultural background, or other factors? Should somatic awareness be approached differently for the patient whose anxiety may (at least temporarily) increase as a result of becoming more somatically focused? What additional techniques may be incorporated into somatic awareness training to address potentially aversive reactions that it may initially create in a sensitive patient? These questions may also deserve attention.
In Minding the Body, Bakal offers his vision for the ways in which somatic awareness may help patients better understand and regulate their internal states. While his discussion is primarily theoretical in nature, and while it may not lend itself easily to research pursuit, it is promising enough to justify such efforts. He also raises numerous important questions and inspires others that may also be worthy of investigation. This introduction to somatic awareness may serve as a cornerstone for the next stage in the evolution of holistic health care.
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