When we think about health, there is an intuitive idea that collectively we all carry which is that when we feel well, this is what it means to be healthy. From the medical, allopathic model, you can examine health from different variables, for example when you are taking someone’s blood pressure or cholesterol levels, if they conform to what is deemed normal levels, then that is seen as healthy.
Of course, as psychotherapists, we should always first and foremost ensure a client has good medical care as priority, otherwise we marginalise the medical model, siding only with the psychological meaning in the symptom. Secondly, when we feel well, this in a consensus reality sense does reflect health. Yet on other levels, its good to not label experiences or individuals as healthy or unhealthy, knowing health is not always so clear cut.
An allopathic doctor looks at an illness from a diagnosis and ultimately curative angle – they are diagnosing for a cure. A doctor’s responsibility is to ensure that the body is being looked after, that good health is maintained and that all potentialities are investigated.
For example, let’s examine the allopathic approach to a patient’s presenting symptom of fatigue and tiredness. Many people complain of unusual tiredness and fatigue. When a symptom like this is presented to an allopathic doctor, the doctor knows there can be a diverse range of explanations behind it. It could be reflective of both minor and more serious illnesses, such as diabetes, cancer, low iron, thyroid issues, stress or depression. All the possible other explanations need to be explored before any diagnosis can be given. Fatigue and tiredness symptoms are usually investigated through a process of exclusion, where causes are excluded rather than a particular diagnosis explored.
With this in mind, a doctor needs to take a full history, which includes the patient’s ideas, concerns and expectations, any accompanying diagnosis’ and close family history. Are there sleeping problems or signs of depression? How long and how severe is the fatigue? Lifestyle habits, adequate rest, drinking, smoking and working habits would also be explored. Next, all the systems in the body need checking through blood tests for deficiencies in key nutrients, thyroid issues, iron, vitamin B 12, glucose, anaemia and kidney-liver function. A thorough physical examination would also need to be done, checking glands, listening to the breathing, heart and lung, checking for high blood pressure or an enlarged liver. If all the tests return normal, ‘healthy’ levels congruent with what might be expected and there’s no history to be considered, and the symptoms are still consistent weekly, then the patient would then be asked to revisit periodically for monitoring.
If symptoms persist for over six months, then these symptoms could be suggestive of Chronic Fatigue Syndrome (CFS). With CFS, fatigue and tiredness must have been present for at least six months and it must take at least twenty-four hours to get over mild exertion. Other accompanying, often vague symptoms that might occur simultaneously are muscle pain, sore lymph glands, sore throat, headaches and Fibromyalgia, which causes pains and tenderness in many areas of the body. The next step would be to refer the patient to a rheumatologist as they are generally responsible for managing CSF diagnosis – this is due to the joint and muscle symptom aspect of CFS. They might also get referred on for help with their lifestyle habits and the management of the symptoms on a long term basis. Incidentally, as a therapist, muscle testing is a great way to add more clarity or another level of understanding onto the physical issue.
From the perspective of my work, preventing and alleviating symptoms are just as important as unfolding the meaning of the symptom. I share allopathic medicine’s view that diagnosis is important, as once we have a diagnosis, we have a pattern and many symptoms follow predictable, repeatable patterns of behaviour. Illnesses also needs to be approached and worked on at all levels of manifestation, and I view the physical diagnosis and labelling as a crucial part of the process of symptom exploration. Yet I also seek to redefine what we label as healthy and widen our perspective about health, but this is not in polarisation to allopathic medicine, but working alongside it. I also recognises that there is a fine line between health and illness, and as with all chronic symptoms and disabilities, we need to be careful to not marginalise further those that are already marginalised through their symptoms.
To this end, I view the body as an information system that transforms our everyday identity by bringing our wholeness into awareness. We are complex, self-regulating systems, rather than separate, isolated individuals. Bringing awareness into a system means we bring transformation which can transform symptoms too. Like many chronic states, there are polarised parts in the system. With chronic fatigue syndrome, taking this as an example, there are also lots of other symptoms other than tiredness and fatigue – all of which might be symptomatic of not moving (due to tiredness) or inhibition of movement, i.e. muscle pains or headaches.
Before any exploration on a psychological level, it’s important to explore any medical explanations. It’s important to first establish this, firstly for ethical reasons and for the client’s own wellbeing, as well as offering possible further illumination on issues. I am not a doctor and I am not here to diagnose so advising a visit to the doctor is one of the first steps.
Next, knowing what you are focusing on, and understanding the symptom’s context is a crucial step, diagnosis also help give context. Finding out whether symptoms have been short or long term, the history and background as well as the content is important. What is the individual’s subjective experience of their symptom in connection to the story as they are telling it? Their experience of the symptom and who the client is in relation to the symptom can elucidate valuable information and is reflective of my interest in the whole person and whole experience at all levels.
With a symptom like fatigue, tiredness or exhaustion, it’s important to get interested in how the client talks about their fatigue, the language they use, their identification or non-identification with it. How do they experience fatigue, where are they when they feel it, how do they know they are experiencing it, how do they feel about being fatigued. What else is happening in their life right now, what other experiences have they been happening, really supporting them to talk around the symptom.
Exploring the symptom in this way allows the dreaming world to bring through the relevant information that I need to catch and unfold. The process itself is happening everywhere, it is not localised to one part of the body or just to the body itself as a dreaming process. In this way, I am interested in where they themselves are perceiving from as this is part of the symptom and wholeness of the system. This whole process brings awareness to the symptom experience which supports people to stay present with it, rather than just talking about it.
At this stage we are listening and looking for signals or the gestalt, a set of signals. We are asking ourselves what is the client marginalising or overriding in herself. We are noticing what we get pulled towards, what’s unexpected in us or in the signals, how we are reacting internally, bringing our attention to this as they tell their story, especially since dreaming up is common with strong edges or chronic long term symptoms. We are looking for the structure of the identity in the moment (as through a session this structure shifts) from the way the client speaks, what they feel at ease with, their posture, the way they are speaking their story and looking for occupied and unoccupied channels through their language, what’s more primary and more secondary in the moment.
We are asking what belief systems are organising the identity. Long term fatigue and tiredness suggests possible strong edges around certain primary ways of behaving. Edge beliefs around symptoms might need amplification and edge figure representation. There might be individual edge beliefs like “I can’t stop or slow down as I have to do or organise” or “everyone needs me to be moving and doing” or “I must work otherwise… will happen”. There may also be edges to being in the body, connecting with feelings or proprioception. Fatigue and tiredness inhibit movement and make us move slower, this often in turn allows us to be present more with our awareness. Tiredness can also be an edge to something that we are not able to fully live. For example, perhaps we cannot muster up discipline or the taskmaster within, so we experience tiredness, a distorted version of the discipline which requires a slower approach using awareness and methodical slowness. On another level perhaps the tiredness accompanies isolation from others, asking us to go within and be separate or connect with the sense of our own inner self. These are some of many multiple possibilities.
Our ability to slow down or even stop is a cultural edge for many clients. We need to think in terms of system and cultural edges, as well as our own edges as therapists, what is valued and what is marginalised? With tiredness or fatigue, there might be edge beliefs around, for example, being a waste of space in society, or useless, sponging off the state. Paying attention to if there’s a disturbance in the world channel (how the world around flirts with it’s synchronicities and what we get drawn towards through all channels of our experience) around this might also be useful to explore.
With a chronic edge such as chronic fatigue syndrome, there’s usually no clear alternative pattern or behaviour, so there’s a confinement by the belief system. Finding new patterns is one way to support the work over the edge. It’s important to remember that we are working with the whole identity, in which case it might mean that the primary identity needs to be disturbed for all the parts in the system to be supported, this is often the aim of strong physical symptoms.
When working with a symptom directly, working with its energy, we have the perspective that the symptom holds the seed to the solution and the body shows us the direction to take. The symptom is the creative drive which contains a new pattern. At this point, if we want to know more about the symptom’s creative drive, then we need to cook it, apply heat. For this we use amplification. With an experience like chronic fatigue, we are looking for what’s trying to emerge, welcoming that and amplifying and looking for feedback. We are looking for where the energy or process naturally flows and a flow of signals which creates the different parts of the identity. We are trying to guess the identity from the signals and look for the body’s answer. Then we might muscle test to get more information and a deeper sense or accurate answers. When perceiving, through looking for signals in the different channels of the client’s experience, we might need to slow things down or amplify, name or catch the signals as well feel it ourselves, feeding back to our client what we notice. We are asking where we are in the system; are we also as the therapist, a part of the different identities?
Like many states, chronic fatigue has many aspects and parts to it, there might be a secondary part that’s fatiguing and slowing and another more primary part that’s pushing out and saying “you must function, get better and start being useful”. The direction to take the work depends on the signals and feedback. One way of working is proprioceptively, finding the experience in the body, amplifying, working with localising or globalising, feeling it more, following it with the body and unfolding until connecting with the essence of the symptom maker. So for example with tiredness, become more tired, see what needs to happen for the body to really follow that signal. When amplified, a channel switch or addition sometimes helps to support deepening. At the point of acute experience, see if there is a dreamfigure, an animal or an archetypal or mythic figure, which supports the client to shapeshift and experience it more fully. Or represent the primary process and see what the figure wants to say to it.
If we go all the way into the fatigue, not being against it, it might transform into a deep sentient, spiritual experience. There might be a symptom that creates tiredness too, for example a headache, in which case the focus needs to be on the symptom maker that creates the headache, not the tiredness itself, i.e. the sharp pain in the head, this is important to isolate early on.
Another way of working with a chronic long term symptom such as CFS would be to find the symptom in the dream, or the dream in the symptom. Working with a dream, we might look for a numinous moment or identify the spectrum of primary to secondary and from this place look at how the body itself holds the energies of the dream. Where are the dream signals getting repeated in the body symptoms? In the same way as I see patterns in dreams as also reflected in the body, our reoccurring childhood dreams or life myths can reflect the function of our symptoms, or elucidate more understanding on what is trying to emerge. The childhood dream or an early memory often works to organise our entire life. This is particularly useful to explore with long term, chronic symptoms like CFS. We might ask the client to tell us their childhood dream or the numinous experience they remember in their childhood.
Whether the approach you take to working with your physical symptoms is allopathic or therapy, both are needed for different reasons, both bring something to the other, and can coexist. I offer a wholeness to the allopathic approach and the allopathic approach brings the structure and focus on diagnosis issues and stresses the importance of looking at the parts of the illness before placing it in the context of the wholeness of the individual. If you have CFS, and are looking for answers, then get in touch to see if we can work together.