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The goal of conventional medicine is, of course, to cure disease. But because it has a clear target to focus on, it sometimes overlooks the bigger picture; the patient’s experience of disease.  Goleman in Emotional Intelligence[1] suggests that both physicians and patients often ignore how they are reacting emotionally to their medical problems and medical interventions. They think that the mind can influence the body in only the most inconsequential way. But in psycho-emotional illnesses such as depression, maintaining the link between the mind and the body is even more important. For practitioners of Chinese Medicine, where emotions and health are interlinked, this dichotomy is seen all too often. The following case of a patient illustrates the effects of this separation and its consequences.

Case Study

A patient complained of a chronic musculoskeletal pain in her back and feet. She is a dancer and two years ago injured her feet. At the time, the hospital Consultant injected her with cortisone. It didn’t work. She was eager to receive acupuncture. A tiny hair-thin needle was tapped quickly into her foot and immediately she was in floods of tears. Between sobs she explained it reminded her of her time at the hospital. The floodgates now open, she let out further revelations about how angry she was with the surgeon, how painful the procedure had been, and her sadness at its lack of effectiveness. She explained that she now “has a thing about her feet and can’t bear for anyone to touch them”. This outburst took the patient by surprise, and she started to consider the emotions she was still holding (previously not realizing their significance). This became a breakthrough and she allowed needles on subsequent sessions to be inserted into her feet, and her treatment progressed well.

This incident shows how the patient’s emotional reaction to the initial incident at the hospital, and that neither the patient nor Consultant had dealt with her response, has led to long-term problems. This raises a number of questions: has her negative view of the encounter affected her ability to seek further conventional medical intervention? (Yes she says); has her emotions prolonged her recuperation, or in other ways affected her recovery? (this we cannot know but it is probable). Often physicians are sceptical that emotions matter clinically: yet would this patient’s recovery path be different if her emotional response to her treatment at the time had been addressed? Chinese Medicine, contrary to most Western Medicine, acknowledges that people’s emotional states can play a significant role in their vulnerability to disease in the first place, and secondly, affect the progress or course of their recovery.

Emotions and Depression

Emotion is a mental and physiological state associated with a wide variety of thoughts, feelings and behaviours. Often it is short-lasting and sometimes intense. Commentators distinguish emotions from moods. Depression is a disorder of moods. They are longer-lasting, internal affective states, less specific than emotions, and often linked to personality traits (such as pessimism, neuroticism), medical conditions, the side-effects of medication or illicit substance abuse. Unravelling the emotions wrapping a person’s depression is not for the Chinese Medicine practitioner, but seeing the cause and effect related to the patient’s illness is very much their remit. Some patients speak directly of anxiety, sadness and depression, while others somatise their emotions and speak of body pain, weight changes, swellings and so on; some exhibit behavioural clues and gestures pointing towards mental and emotional illness. The classical texts of Chinese Medicine date back over 2,000 years, yet from these early times they recognized that soma and psyche are interdependent, and it is better to treat when the illness does not exist.[2] Our psychic persona permeates our everyday life experiences and so Chinese Medicine reflects this in its treatment philosophy which is based on holistic precepts of health and wellbeing. Consequently, a practitioner of Chinese Medicine will give advice on diet, eating habits, lifestyle, and exercise to address both aspects, which will be in addition to using acupuncture and Chinese herbs.

Causes of Depression

The causes of depressive disorders in conventional medicine are based on biological theories (mainly neurotransmitter activity) and psychosocial theories (personality disorders, learned cognitive patterns such as pessimism, negative distortions, post-traumatic stress, etc). The multi-factorial causal explanations for depression – which varies in symptom type, severity and duration – present a complex picture that the average, hard-pressed GP may respond to by prescribing anti-depressants rather than attempt to uncover any possible underlying causes. The efficacy of this approach, while pragmatic, may be sometimes questionable. Flaws (2001) asserts that “many patients receiving treatment are not successfully treated; their symptoms do not improve.”[3] Furthermore, relapse and recurrence following successful treatment of major depressive disorder is common and often carries massive social cost.[4] The risk of repeated episodes can be as high as 80% for some types of depression.[5]

A Different View

It is particularly this aspect of relapse and reoccurrence of depression and lack of success in its treatment that merits further discussion in relation to Chinese Medicine. Much of the theory on which Chinese Medicine, as mentioned earlier, is based dates back to ancient medical texts written over 2,000 years ago. The most famous texts are the Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine), a large part of which was written during the period of the Han Dynasty (206 BC-220AD). The Neijing has two parts: The Suwen (Simple Questions) and the Lingshu (Spiritual Axis). Chapter Two of The Suwen says, “waiting to treat until after the illness has already developed or after disorder has developed is comparable to digging a well when one is thirsty.”[2] The expert practitioner of Chinese Medicine is able to treat before the illness expresses itself.


Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine)

The ancient Chinese medical philosophy advocates working on internal practices for cultivating life based on Confucianism and Daoist texts. The different ideas and schools of thought of these classics crossover with Buddhist traditions of calm and serenity. They offer to Westerners an alternative to modern life that is different to the relentless march of consumerism, where in pursuit of happiness, people work longer hours to attain material goods at the expense of time spent with family and friends or doing creative activities. Yet, research shows that above a certain minimum, basic (food and shelter) gains to material wealth add less to our subjective wellbeing than the quality and quantity of our relationships with others.[6]

Chapter Eight of the Lingshu of the Neijing muses on the interplay of Spirit with the emotions, mind and body, and how these create and maintain health or reveal pathologies when the emotions and Spirit are not tended.8 In Chinese Medicine, psyche and soma are accorded equal status and treatment. There is no hierarchy or prejudice of somatic symptoms over the psychological. The body is seen as the material basis for the mind which then expresses the functions of the body.[3] The relationship is not linear, but bi-directional.

There are many different terms used in Chinese to signify the psyche or mind, but in medical literature words that include Spirit (or Shen) is commonly used. In a similar way the prefix ‘psycho’ is used in western medical terms. It refers to our physiological vitality as well as consciousness, and the function of thinking and feeling.[3] This ‘spirit of mind’ is said to reside in the Heart and its outward manifestation are our emotions. Thus the concept of Spirit or Shen in Chinese Medicine is not ‘spiritual’ in any conventional religious sense. Psychological diseases are seen as pathological abnormalities of the Shen, which reside in the Heart.[3]


Chinese pinyin character of the heart

The Chinese view of the Heart is more than just a pump to move blood, hence the capital letters to denote this difference. The Chinese pinyin character of the Heart not only reflects the physical shape of the Heart, but also that it is a bowl or receptacle that communicates and governs the body, bringing animation to life and from which the radiance of the Spirits or Shen shine out.[7] The Heart is the reason why we have to go and see wonderful scenery, be well rested, have good food and drink, in order that life is more refined.[7] However, the key to this radiating Shen is that it comes from a space or void that is the receptacle of the Heart. To achieve this space the Heart must be calm, tranquil and peaceful so the communication of Shen is not blocked or obstructed.[7] The flow of energy or Qi, as it is described in Chinese Medicine, ensures that the joy of living is felt. If we pursue our Western lifestyle of being constantly ‘on the go’, striving for more possessions, more knowledge, constantly stimulating our senses, we are filling up our Heart receptacle, which is then blocking the free communication, and movement of our Shen and making us vulnerable to disease and psychological disorders.[2] The Heart oversees the functioning of the body so that happiness or unhappiness, illness or health, longevity or premature death all depend on the Heart.[8]

The Suwen Chapter Eight tells us that the Heart fills without us knowing it, and although the Heart takes on the burden of all things it must remain void, albeit this seems like a contradiction. The ancient texts warn that we must empty our Heart “its movement of filling and encumbering itself is natural, since it is given to it ‘to take on the charge of beings,”[8] yet although the Heart is never without movement, it is quiet. The Heart is being drawn outwards constantly, externally to react with others, and objects that it is either attracted to or repulsed by. This externalization of being, if there is no control of conduct and emotions, results in a lack of capacity to return to an internal world or to within. The Art of the Heart is calm and quietude.[8]

Consequently, Chinese physicians will prescribe meditation for psycho-emotional states, such as depression.[3] Relaxation creates a sense of stillness and calm in the Heart and frees our flow of energy, lifting depressed and stagnant states, which is often underlying the illness. By freeing ourselves from excessive desires, and distracting thoughts, and the demands of our ego, we maintain a tranquil Shen or Spirit. The emphasis on relaxation may seem trivial advice for long-term psycho-emotional problems, and for some agitated patients, remaining still long enough will be difficult. In these instances, applied physical therapies may help create the space to later develop the skill of body and mind relaxation or meditation.[3]

Sometimes when we think less, our lives become clear. The engagement of the psyche and soma in Chinese Medicine, and the expert practitioner who strives to understand the wisdom of the Chinese classical texts and treat the cause as well as the symptoms of depression (called the root and branch), can bring about profound changes in patients. Critics argue that theories developed over 2,000 years ago cannot possibly apply to modern living. Yet human life has not changed in essence over that time. We still die and suffer from the same diseases we have always done. So it is this context that makes the classical medical texts of Chinese Medicine still relevant today, and able to offer a complementary and emphatic approach to the treatment of depression.

References

1.    Goleman D. Emotional Intelligence: Why It Can Matter More Than IQ. p165. Bloomsbury Publishing. London. ISBN 0747528306. 1996.
2.    Rossi E. Shen: Psycho-Emotional Aspects of Chinese Medicine. p3, 13. Churchill Livingstone/Elsevier. Edinburgh. ISBN 9780443101816. 2007.
3.    Flaws B and Lake J. Chinese Medical Psychiatry. pp 15, 324-325. Blue Poppy Press. Boulder. ISBN 1-891845-17-9. 2001.
4.    Mintz J et al. Treatment of Depression and the Functional Capacity to Work. Archives of General Psychiatry. (49): 761-768. 1992.
5.    Teasdale JD et al. Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology. 68(4): 615-623. 2000.
6.    Duncan G. What Do We Mean By ‘Happiness’? The Relevance of Subjective Wellbeing to Social Policy. Social Policy Journal of New Zealand. 25: 16-31. 2005.
7.    Claude Larre SJ, Rochat de la Vallee E. The Secret Treatise of the Spiritual Orchid: Nei Jing Suwen. Chapter Eight. pp37, 45, 46. Monkey Press. 2003.
8.    Claude Larre SJ, Rochat de la Vallée E and Stang S. Rooted in Spirit: The Heart of Chinese Medicine. p45, 48. Station Hill Press. Barrytown. New York. ISBN 0-88268-114-11995.