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Paralysis of Feeling
If synthetic faces can turn on feelings, paralyzed faces can turn off feelings. Psychologist Ben Twerski, co-author of a chapter in a book on paralysis, discussed how facial muscle paralysis patients suffered more depression than other paralysis patients. In a conversation, we speculated, that perhaps, their facial muscles weren't stimulating and exercising the conditioned feeling responses, the patterns that are turned on in the brain and which the brain activates when people make happy faces.
In one study, military veterans with spinal cord injuries reported decreased experience of emotion after their injury. The more extensive the spinal cord damage and resultant greater loss of body sensation, the greater was their loss of their ability to feel emotion. Patients described their feelings as cold, as mental rather than feeling and emotional.
"But I can't make a fake smile," so many people respond when asked to turn on a fake or synthetic smile. I tell them to do it anyway! The goal of emotional self regulation is to teach individuals to learn to find their own buttons for activating the patterns of good feelings built into their nervous system. The other side of the coin is the need to identify how they inhibit good feelings. I explain to patients, that when we create a synthetic smile, we usually experience feelings that flicker between the real; "feeling-good" and; "I'm just faking this and I feel silly or stupid" feelings. The reason we can actually switch to feeling genuinely good just by creating a synthetic smile is response pattern activation. The activation of facial muscle patterns usually genuinely associated with good feelings actually facilitates the turning on of the real thing--a feeling-good, conditioned response.
New patients often resist instructions to smile. They resist, saying: "I can't smile," "I don't want to smile," "It feels silly," or "strange" or "It doesn't feel real so I don't want to do it."
I
ask one to smile and he says he can't. I pause, allowing the silence to
grow pregnant, then nod my head with a whimsical smile and ask, "C,mon.
You can't smile?" I knit my brow, perplexed. "Do you have a
neurological deficit?
No? Then you don't want to smile?"
My patients appear annoyed, as though they were about to say, "Leave me alone. I don't want to smile." But they do want to smile. My little pre-schooler acts the same way when he's miffed. I joke with him and he flickers between laughing, smirking and frowning. The patients are stuck in old patterns of inhibition that prevent them from opening up to good feelings when they want to.
It's
so common for people to be uncomfortable expressing their feelings.
John Perry describes how anorgasmic women are comfortable having
orgasms masturbating with their legs closed, but become anxious when
they spread their legs.
He teaches them to masturbate with their legs spread so they become comfortable with the position.
Here's
how I work with smile resisting patients: I suggest, "You do want to
smile, don't you? Let me show you how."
At that point, I demonstrate an
exagerated smile. Or I'll tell a joke or threaten tickling (if it's a
group.) So far, this effort has never failed. Every patient smiles and
usually laughs spontaneously. Part of the reason my little trick works
is because there are two nerve pathways which control the smile and
other facial expressions. The upper nerve pathway is connected to the
gray matter motor cortex of our brain. When we decide we want to smile
and think "smile," then the motor cortex activates our smile via the
upper nerve pathway. Stroke patients with damage to their motor cortex
lose the ability to voluntarily turn on a smile, though some smile
rehabilitation physical therapy can help.
But even after a stroke, patients with the lower smile pathway still intact will reflexively smile in response to something funny or ticklish, because the lower pathway is connected to the lower part of the brain, where emotions are mediated and where the stress and emotion mediating sympathetic nervous system is controlled. I get my patients to smile and laugh by bypassing their voluntarily or subconsciously disconnected upper smile pathway. I've tickled their lower smile pathway into activation by turning on synthetic smiles that activate the PE physiological response pattern, allowing them to feel the real thing.
The smile response pattern activation proves to my patient he can smile. When he sees my exagerated,smile, an image of a smile is formed in his brain. This smile image helps to animate or rouse his own smile-conditioned response pattern homunculus and to facilitate the lower pathway smile response pattern. The image functions like a template or behavioral "mold," shaping and helping the release of his feeling-good response, even though the patient had been stuck, inhibiting it a moment earlier.
Some patients are feeling so bad, they say they don't want to or can't smile. Then, smile biofeedback can be useful. Patients use zygomaticus EMG feedback to tell them what strategies help to boost their smile muscle strength and boost the EMG amplitude.
They learn to voluntarily create a genuine smile that helps them let go of their positive experience inhibiting behaviors. The concrete, muscle strength oriented feedback helps them to strengthen their smile reflex without initially expecting wonderful feelings. Over and over again, we've found in our research that people, when asked to smile as strong as they can, work and strain to make a smile. Sometimes, in their beginning efforts to intensify their smiles, they screw their faces into distorted smiles, very artificial in appearance (just as other physical therapy patients suffer from unwanted co-contraction of antagonist muscles). We crack some jokes, kid around. Making any feeling good sound, like laughter, humming, cheering, seems to strengthen the smile activity. When we coax them into laughing, the smile comes effortlessly with the help of the lower motor neuron pathway, and is 20% to 100% stronger than the strained effort. This approach actually teaches feeling relaxation-- the ability to stay relaxed and comfortable while feeling deep emotions.
Kicking in the lower motor-neuron pathway is a very important step for the so many people suffering from alexithymia and other emotional dysregulation disorders. Learning to at first tolerate, then remain comfortable while experiencing strong feelings is often a sign of improvement for patients in many different forms of psychotherapy. The anxiety of feeling emotion is a common one that can be coped with very effectively. The feeling biofeedback and facial muscle exercises allow people to take small, safe steps. The patient's begin to take risks. The smile becomes more symmetrical, more natural and more robust. The goal of smile aided relaxation is to go beyond feeling nothing, to feeling deeply, to be able to comfortably enjoy strong, deep feelings. You can learn to turn on the full range of your emotions with comfort and joy.
