All that we are is the result of what we have thought. The mind is everything. What we think we become.—Gautama Buddha
Some years ago, one of the authors (GT) was privileged to witness a South American shaman working with a number of people who were suffering from various afflictions, ranging from physical pain to what many Westerners would regard as psychotic episodes. The performance was electrifying.
Healthcare systems evolving out of non-Western cultures are often dismissed as ‘traditional’ or ‘folk’ medicine. The implication here is that they somehow fall short of a superior system developed by a Western, educated, industrialized, rich, and democratic scientific elite (see pages xii, 3, and 268).
However, many of these approaches are of interest in the continuing development of Medical NLP. Our observation has been that some of the methods used are at least as effective as their Western counterparts—albeit most often within the culture in which they are practiced.
This allows supporters of the statistically driven randomized control test approach to file the phenomenon away as a simple example of the placebo effect. A powerful belief in a specific treatment, they say, can yield a positive clinical outcome, even with a protocol that has been shown ‘scientifically’ not to work.
This, we believe to be true. And, it emerges from two recent studies, so do more primary care physicians than might be expected. A national study conducted in the US showed that more than half (56%) of a random sample of family physicians knowingly prescribe placebos in the form of antibiotics and other substances, both active and inert,270 while a stunning 97% of their counterparts in the United Kingdom admitted to using placebos at some point or other in their practices.271 The important point is simply…they know it (or rather, ‘something’) works.
In other cultures, belief—or the ‘meaning’ of the treatment—is often regarded as an integral part of treatment, a phenomenon now supported by developments in PET scanning. While many areas of the brain are activated by the application of a placebo, some, including the anterior cingulate cortex, dorsolateral prefrontal cortex and basal ganglia, are related to interpretation of threat and the initiation of a physical response, such as the production of opioid, or pain relieving, chemicals.
Traditional practitioners, known variously as shamans, curanderos, root doctors, native healers, medicine men (or women), kahunas, or sangomas, seem fully aware of this hardwired response, and a considerable part of treatment appears to involve achieving ‘buy-in’ (otherwise known as compliance, or concordance) and a thorough ‘explanation’ of how the disorder has arisen, and how it will be resolved.
In the case of the shaman referred to above, and as is common with many similar ‘schools’ of traditional medicine, most diseases are attributed to the victim having been cursed, usually by a disenfranchised employee or resentful family member.
The translator explained that conditions for diagnosis and treatment had to be precise: the shaman wore garb and face- and body-decoration dictated in every detail by centuries of tradition; chants to prepare both patient and practitioner were equally precise.
The patient presently consulting the shaman had been unable to move his shoulder more than a few centimeters in any direction without palpable agony. All other treatments thus far had proved ineffective against the pain.
A cursory examination by a Western eye would have diagnosed some form of bursitis, probably subacromial—an extremely painful inflammation and swelling of the fluid-filled sacs that act as cushioning between the rotator cuff and the part of the shoulder blade known as the acromion. Victims of bursitis often find the simplest movement, such as combing the hair, little short of agonizing.
According to the translator, however, the patient had been cursed by a jealous brother-in-law, who had secured the services of another, less scrupulous, shaman in order to deliver, quite literally, a body-blow to the victim. The means of the psychic attack, it emerged, was an invisible knife that had become lodged alongside the shoulder blade. Details of the weapon were quite specific—double-edged, steel-bladed, about eight inches long, and of modern, rather than traditional, design. The shaman and the patient seemed in perfect accord about the means, motive, and opportunity for the attack.
After some preparatory chanting, the shaman began pushing and pulling at the patient’s shoulder blade, twisting and dragging as if to remove a physical blade embedded in the joint. Suddenly, he bent and clamped his lips on the patient’s flesh, then fell back with a triumphant grunt. He fell to his knees, spat theatrically and even managed to throw up a thin, green trickle of bile.
It was necessary, the translator explained patiently, for the shaman to vomit up the offending blade, or he would inherit the patient’s unhappy condition.
Then, with no real sign of surprise, the patient rubbed his shoulder, shifted his position cautiously, then swung his arm in increasingly energetic circles, clearly absolutely free of any discomfort.
In Medical NLP terminology, the double-bladed knife would be described as a ‘glyph’.
Glyph work is an important tool of Medical NLP. It is simple, effective, and, often, quite remarkable in its effectiveness. If we steer the patient away from linear description and value-judgments (Inferences) towards a purely felt sense (non-evaluative self-observation), the symptom may be experienced as a three-dimensional ‘form’, which in Medical NLP we call a glyph (see previous chapter).
The patient may not believe he has been cursed by a family member (although we have encountered just this complaint on more than one occasion), but a pain may nevertheless be experienced as, and described as a physical ‘thing’—‘like a wire, burning very hot, white, like phosphorous’, to quote one example given us. Anxiety may be ‘like a dark, cold hole’ in the stomach. Pain is often experienced as red or black. Sometimes it appears as a symbol or even a figure.
Case history: A young doctor who read the first edition of this book asked the question, ‘What’s it like?’ of a patient suffering from fibromyalgia.
The patient instantly replied, ‘It’s an angel.’
‘I have to say I was excited and delighted,’ the doctor recalls. ‘An angel seemed to me to be a really appropriate representation of what fibromyalgia often “does” for people.’
‘The solution seemed pretty obvious to me, so I said to her, “Well, angels have wings—so why not ask your angel to fly away?”’
To his surprise, the woman vehemently rejected the suggestion. She went away and, after that, dealt with other doctors in the practice (although it was reported back that she was ‘doing well’).
The doctor recounted the story at one of our seminars, and asked, ‘What happened there? Why did she respond the way she did?’
This is an extremely useful example of two issues relevant to glyph work and Medical NLP:
1. The glyph is exclusive to the individual. It has form, substance, and meaning that relates to her subjective experience only.
And, possibly even more important to remember…
2. There is a difference between helping the patient and curing the disease. The former respects the patient’s internal experience; the latter attempts to superimpose an externally applied solution to ‘fix’ the problem.
The first half of the doctor’s intervention succeeded in eliciting a form to the patient’s pain. The figure of an angel suggested protection, so it’s a fair assumption that when he tried to urge it to fly away, the patient dug in her heels.
Here’s the lesson. Never try to take away a glyph, symptom, or behavioral response without establishing and recognizing its significance, and then ensuring its ‘positive intention’ is met.
A more appropriate question might have been, ‘How can your angel be with you in a way that’s different, and brings you the help you need?’
Almost always, patients asked this kind of question have no trouble in coming up with creative solutions. The glyph corresponds to the Object level of Korzybski’s Structural Differential. Richard Bandler’s observation that ‘experience’ had characteristics (coded in sub-modalities) was, in the opinion of the authors, little short of revolutionary.
Until then (and even now), cognitive therapists attempted to effect change only at the language level, unaware that the Event occurring within the subject’s nervous system is perceived with form and substance in the form of a metaphoric shape, before it can be translated into words.
Neurological function at the Object and Event levels appears to be more fluid than that at the level of Inference (largely because the way we speak or think about our experience helps to maintain its structure). The glyph is marked by the following characteristics:
Case history: A psychiatrist colleague, who also practices as a family doctor, was consulted by a Filipina woman in some distress.
She told him her son had been arrested back in the Philippines on a trumped-up charge, and she was desperately worried that he would not receive the help he needed. At the same time, she complained of a severe pain in her throat, caused, she said, by a fishbone she had swallowed a few days before.
The doctor examined her but could find no sign of any fishbone. Since she continued to complain, he referred her to an Ear, Nose, and Throat specialist. The specialist was also unable to find any fishbone, and, agreed with the psychiatrist that the woman was probably suffering from globus hystericus, brought on by her anxiety about the fate of her son.
When she was given a diagnosis, she was even more distraught, complaining that doctors in England were incompetent and bemoaning the fact that she would have to return to the Philippines to consult someone who understood her condition.
Some weeks later, she arrived at the psychiatrist’s consulting rooms without an appointment. Curious to hear what had happened during her trip back to the Philippines, the psychiatrist invited her in.
She told him that she had managed to find a lawyer to represent her son who was released from custody. At the same time, she consulted a local healer who confirmed that she had, indeed, swallowed a fishbone which was now lodged in her throat. After some maneuvering, and using only his fingers, the healer triumphantly flourished the offending fishbone.
Seeing the psychiatrist’s expression of incredulity, the woman removed a Kleenex from her purse, unwrapped it and presented the fishbone that had been ‘removed’ from her throat. It was, the psychiatrist reported, a skeleton of a small fish, about 5 cm long and perfect from head to tail. Something in the woman’s expression told him that she would not tolerate any contradiction, so he decided the best option was to smile, and congratulate her on the satisfactory end to her problems.
Remember: we always proceed as if the glyph is ‘real’. Most patients are aware that it is a metaphoric representation of their problem, but, in some cultures, it will be regarded and treated as if it had a physical existence of its own.
Either way, it is lodged in the patient’s awareness, and it is our contention that resistance to ‘what is’ causes as much, if not more, psychic and physical pain than the condition itself. These feelings are always localized. ‘Bad’ feelings have distinct boundary conditions and are contracted in nature. ‘Good’ feelings, such as excitement, joy, love, and orgasm, on the other hand, are expansive and unbounded, sometimes transcending the confines of the body.
It is sometimes possible to resolve a problem by working with the glyph alone, especially where no particularly traumatizing event is perceived as, or is actually, responsible for the response.
One of the conditions for resolution involves moving out of resistance to the experience. Resistance is painful. Resistance (at this stage) is the only response the patient has at her disposal. Apart from the physical tension required to resist an unwanted internal experience, the kind of Inferences made by the patient and others reviewing her problem have the potential for ‘locking’ the experience in place, or even making it worse.
It is a prerequisite that the patient acquire the skill for (temporarily) tolerating the symptom, and then learn how effectively to dissociate so that the structure and process can be changed. It cannot be changed if she is actively resisting, or trying unsuccessfully to dissociate from, it.
The glyph may be approached in a number of ways. The following protocol is one of Medical NLP’s most effective interventions.
Glyphs may also be ‘swished’. That is, its sub-modalities changed very rapidly to those of a more resourceful state.
In Chapter 6, we referred to a family doctor who used the glyph, a ‘black ball’, identified by her patient as a ‘relaxation technique’ to accomplish significant relief from anxiety and depression. By doing this, the doctor effectively created a ‘meta technique’ operating at a higher order than the problem itself.
So successful have some readers found the technique that we wish to identify Dr. Arti Maini as its creator, and to describe the underlying process here.
Dr. Maini’s patient had a rich pathography, which would have taken considerable time to address, item by item. Undoubtedly, it would have been difficult, if not impossible, to alleviate the patient’s emotional distress by discussing and advising him on tackling the external problems that were besetting him. However, he had little trouble in identifying his glyph as black and spherical, ‘like a ball’.
Dr. Maini also chose to steer the patient away from the current knee-jerk response of medicating problems that may be simply the vicissitudes of everyday life.
Instead, by allowing the glyph to surface, the complexity of the patient’s experience collapsed into a manageable ‘thing’. Her approach, framing as a ‘relaxation technique’ and handing over manipulation of the glyph, effectively restored control over the patient’s experience.
The glyph parallels the theories of physicist David Bohm regarding the ‘implicate’ and ‘explicate’ aspects of ‘reality’. In Bohm’s enfolded ‘implicate’ order, space, time, and sequential details no longer dominate, but all aspects are enfolded into a comprehensive ‘whole’.272
‘This order,’ Bohm wrote, ‘is not to be understood solely in terms of a regular arrangement of objects (e.g. in rows) or as a regular arrangement of events (e.g. in a series). Rather, a total order is contained in some implicit sense, in each region of space and time.’
The astute reader (we hope) will detect several associations with the glyph and the psychophysical complexity out of which it emerges, as well as text (the sequential details of the patient’s and the practitioner’s understanding of events) and context, the field in which the patient (and the practitioner) function.
Philosophizing aside, here is a simple protocol to help you create meta techniques of your own:
Or, and we’d argue that this might be the preferable approach…
What needed to happen for the glyph to continue to exist within her body differently?
1. Take a few moments to relax, preferably with your eyes closed.
2. Scan your body, from the inside of the top of your head, right down to the tips of your fingers and toes. Notice any anomalies—discomfort, tightness, sensations that differ in some way from the surrounding internal landscape.
3. Ask yourself, ‘What is this like?’ and pay special attention to the physical attributes of the experience: size, color, location, movement, etc.
4. Now, either:
a. observe the glyph, with detached interest. Allow it to transform in its own way,
or,
b. Experiment by changing the characteristics—pushing it out of your body, blunting sharp edges, deepening or softening colors or textures, etc.
5. Notice how this transforms the experience, over both the short and long term.
6. Create an explicit technique or meditation out of your experience, and test it on an ongoing basis.
7. Do the same with at least six of your patients or clients and track their experiences.
270. Kermen R, Hickner J, Brody H, Hasham (2010) Family Physicians Believe the Placebo Effect Is Therapeutic But Often Use Real Drugs as Placebos, Family Medicine 42(9): 636-642.
271. Howick J, Bishop FL, Heneghan C, Wolstenholme J, Stevens S, et al (2013) Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners. PLoS One 8(3): e58247.
272. Bohm, David (1980) Wholeness and the Implicate Order. London: Routledge.