Instinct: a natural or innate impulse...
 natural intuitive power...urged or animated by some inner force.
          Emotion: an affective state of consciousness.
     Random House College Dictionary

Marie has come to my office holding her left cheek as if it were a small, wounded bird. It is Fall 1992 and I last saw her like this in early 1984.

"After you treated me I was fine until January 1991 when all my facial pain returned."

Marie went on to explain that two weeks before the return of her pain, her husband had committed suicide, employing a shotgun in the den of their home as she slept in another room. It was the dead of winter in Arkansas and an ice storm prevented her leaving the scene or help arriving for over three hours. "That," she says emphatically, "was stressful."

A remarkable article by Peter Levine details the instinctive physiologic reactions of prey animals to attack and inevitable capture. The well-known flight or fight response that ultimately mobilized the muscles for maximum power and speed is perfectly reversed once the animal realizes it is trapped. Prior to the killing blow of the predator, a mammal will grow limp, displaying a paralytic freezing evidenced by lower body temperature and profoundly diminished muscle tone. The trapped animal is not "feigning death" but rather reacting instinctively in a way that often inhibits predatory aggression. Animals do this naturally; humans must be taught that a bear in the wild may only sniff you if you lie perfectly still.

Marie suffered the pain in her face for three months. Then she heard of a surgeon who specialized in the management of trigeminal neuralgia and traveled a thousand miles for an examination. Sure enough, surgery revealed that her trigeminal nerve had been creased by a vein, apparently congenitally, and meticulous surgery restored her anatomy and Marie was without pain for six weeks. Then her pain returned.

Man's Presumptuous Brain by ATW Simeons, M.D., traces the evolution of instinctive response to threat and clearly differentiates these from human emotion:

"An instinct is a very old impulse which is generated in the diencephalon by a combination of hormonal and sensory stimuli. In this process the cortex is involved only to the extent that it censors the raw incoming messages from the senses. An emotion is the conscious or subconscious elaboration of a diencephalic instinct by the cortical processes of memory, association and reasoning. Emotions are thus generated in the cortex out of crude instinct."

Simeons goes on to describe the cortex as a censor of instinctive movement or expression. Beyond that, once the cortex transforms instinct into emotion, it will commonly censor any expression of the emotion itself. He feels that since our society is built on cortical control (as opposed to our basic instincts), psychosomatic illnesses will commonly occur. Only by identifying this conflict and accepting the complex working of our inner and outer lives might we avoid the insidious onset of chronic illness.

Marie's surgeon wanted to explore her nerve again. She was hesitant. "Maybe I just have a sinus problem. I'm going to the ENT clinic for another opinion." A massive infection was discovered; she was relieved of her pain with antibiotics and the surgeon dismissed her from his care.

Peter Levine has coined the term "fixated immobility reactions" to describe the array of clinical findings common among various traumatic anxiety symptoms and syndromes. These findings are neuromuscular, autonomic, and perceptual, and predictably will accompany our instinctive response to intolerable or threatening situations. It appears that the entire scope of physiologic reactions to a simultaneous increase in parasympathetic and sympathetic tone become evident as Levine's technique of "somatic experiencing" enhances his client's awareness. Previously repressed sensations and bodily feelings are then used to transport the client through the event(s) as they are remembered in active imagination. During this process movement is encouraged. Levine states, "The central axis in the resolution of post traumatic and various anxiety responses was in completing previously thwarted motor acts...While catharsis (emotive response) may sometimes occur, it is the emergence of defensive activation that is the critical catalyst for therapeutic response.

After three months of pain relief with antibiotics, Marie underwent laser surgery for her sinus malformation. Her facial pain returned full force and the ENT clinic could not help her.

Simeons discusses the tendency for fearful flight (as opposed to rage) to predominate in humans. He points out that instinctive flight from threat is directly correlated to an animal's ability to bodily defend itself or counterattack. Humans have evolved in such a fashion as to nearly eliminate our ability to defend ourselves, and the desire to flee with its attendant increase in sympathetic tone dominates the messages from our diencephalon. Cortical elaboration of these messages may result in a wide variety of emotions. These may be modified through cultural and sociological pathways so complex and embedded as to censure any overt expression of what we feel. We may suppress the feeling itself. The urge to flee lies buried beneath all of this.

It was suggested to Marie that she return once again to the dentist who has seen her in 1984. He adjusted her occlusion and she began to sleep normally and the pain receded. After three months the pain returned and the dentist sent her to me.

Levine has identified the need for movement to accompany effective care for anxiety reactions and the physical pain that is commonly concurrent. He refers to these movements as a "genetically endowed defensive capability." Appropriately expressed, these movements augment the emotion that may or may not accompany them. It has been Levine's experience (and mine) that a predominately emotive response to gentle handling tends not to be as productive as we would hope. It appears that care that reinforces dramatic expression of emotion rather than instinctive movement tends to recycle particular events without resolving the underlying conflict between the diencephalon and the cortex.

Marie is cold. She tells me she's been cold for many months. She realizes that her facial pain and her husband's death are no coincidence. Both of us know that during the two week interim between being trapped in a place she desperately wished to leave and the onset of her pain she did not change anatomically, and that treatment designed to alter her in that way has its limitations. It is time to move instinctively, and it's time to warm up.

I have nothing against the authentic expression of emotion. But I understand that by the time people are experiencing pain related to trauma and/or anxiety that the emotion they express during bodywork may be an elaboration of instinctive fear. What they need is movement that represents their effective defensive resources that were suppressed during the initiating event. Levine calls this "active-adaptive behavior." I call it spontaneous movement and find that it will emerge in response to "simple contact."

I ask Marie to move as she instinctively wishes, and she grows warm. Aside from an immediate decrease in her pain, she begins to sense a deep depression and drops the facade of characteristic cheerfulness she has maintained. She has work to do.

If I chose to do a body-based psychotherapy, I might seek more emotion and catharsis. But I chose somatics, a philosophy of care that emphasizes instinctive activity and the innate power of the human body to do the right thing with a minimum of cortical interference. When discomfort and dysfunction crosses that ill- defined border from acute to chronic, we need to look beyond joint mechanics and fascial restriction. If we take the time to examine the conflict each of us faces as both instinctive and emotive beings, we can begin to see more clearly what treatment should include. And we can keep the profession of physical therapy where it belongs.

Hanna T. What is somatics? Somatics, 1986;5(4)
Levine P. The body as healer: a revisioning of trauma and anxiety. Somatics. 1990;8(1)
Simeons ATW. Man's Presumptuous Brain. New York, NY: Dutton;1961