| Phenomenology, Applied Psychophysiology, and Behavioral Medicine|
Donald Moss, Ph.D.
Prior to commencing training in applied psychophysiology and biofeedback, this author had the benefit of studying phenomenological psychology and philosophy for ten years, pursuing applications in psychology, psychiatry, and education (Moss, 1978, 1981, 1984, 1989a, 1989b, 1992; Bollnow, 1966/1987; Straus, 1930/1982). Phenomenology and applied psychophysiology may seem to present antagonistic viewpoints with no common ground. However, in the first half of the twentieth century phenomenology offered to many European researchers in psychiatry, medicine, and biology the same kind of breakthrough that self-regulation theory later provided for American researchers.
In European medicine and psychiatry, phenomenology provided a conceptual breakthrough which allowed researchers to get beyond the narrow reductionistic thinking of the time. Phenomenology also provided an alternative methodological approach--still scientific yet less restrictive--to a variety of problems, such as, the human experience of time and space (Straus, 1966, 1963/1969; Minkowksi, 1933/1970); the neurophysiology and psychology of body image (Plugge, 1970; Straus, 1967); the disturbed reality perceptions and language of mentally ill persons (Binswanger, 1942; von Gebsattel, 1954); and the fragmented and disorganized thoughts and actions of brain-damaged individuals (Merleau-Ponty, 1945/1962). The Heidelberg internist von Weizsacker (1947a, 1947b) applied phenomenology to illuminate problems in psychosomatic and internal medicine, and the Dutch physiologist Buytendijk (1965/1974) used this perspective to develop a phenomenological physiology of human motion and posture in the human environment.
Phenomenology shares with applied psychophysiology an emphasis on the unity of mind and body, a dissatisfaction with one-dimensional physicalistic medicine, and an intolerance for mentalistic models which explain behavior by hypothesized psychic mechanisms. Phenomenology placed its emphasis on a philosophy of body-mind, or of the "body-subject," with an accent on how close the expressive, human body is to personhood. Biofeedback in turn has placed the emphasis on helping the human individual to enhance awareness and control over the living body.
The present chapter will orient the reader to some of the most relevant lessons of phenomenology for the fields of applied psychophysiology and behavioral medicine: first, through an historical review of phenomenology; second, through an examination of the phenomenological approach and methodology; third, through a discussion of the clinical implications of phenomenology; and fourth, through a review of parallels between the phenomenology of consciousness and the neurofeedback movement.
Brief Review of Phenomenological Philosophy, Psychiatry, and Psychology
Phenomenology, as a movement, began with the work of the Austrian psychologist Franz Brentano who wrote a book titled Psychology from the Empirical Standpoint (1874). Prior to Brentano psychologists such as Wundt and Ebbinghaus attempted to explain the qualities of human thinking and action via "associationism," by referring to the smallest elements of experience, such as minute sensations and feelings, which come together in association with one another to form higher mental complexes (Kockelmans, 1967, pp. 53-64). Brentano rejected this idea of breaking psychological phenomena down into their most minute elements. He adopted an empirical descriptive approach to psychology, to define and characterize the subject matter of psychology (Kockelman, 1967, pp. 66-67). He identified "intentionality" as the decisive characteristic of psychic phenomenonon, which distinguished them from physical objects. Psychic acts are intentional because they are oriented or directed toward some specific situation or object beyond themselves, and can be meaningfully understood only by that context. Later phenomenological researchers expanded this idea of intentionality to emphasize the organism-environment relationship (Straus, 1969) and the unity of the human being with the world (Heidegger, 1927/1962; Merleau-Ponty, 1945/1962).
The next significant figure in the development of phenomenology was Edmund Husserl whose painstaking investigations of the field of consciousness returned over and over to a fine-grained description of the immediacy of human experiencing. Husserl developed the phenomenological method as a way of objectively studying many phenomena that common sense calls subjective: consciousness, the structure of time, and the emergence of meaning (Husserl, 1900-1901/1970, 1925/1977). Husserl especially called for the development of a phenomenological psychology which would set aside the "naturalistic" modes of thinking used by medicine, biology, and physiology, and remain with a specifically psychological perspective (Husserl, 1925/1977, P. 3; Kockelmans, 1967). He criticized those psychological theories of his time which sought to explain a human experience by reference to chemistry, physiology, or neurology, without exploring the immediate purely psychological sense and organization of the experience (Giorgi, 1970).
Husserl also developed the concept of the "life world" -- the immediate realm of everyday experiencing which we trust and take for granted before and after our work days as scientists (1935-1937/1970). For Husserl, the many scientific realities--the physical, atomic, and sub-atomic universe studied by the physicist; the vital realm of living processes studied by the biologist; or the realm of neuro-chemical processes studied by the neuro-scientist -- are all secondary or derivative realities, which receive their full meaning by reference back to this immediate realm of waking and sleeping, living and dying, loving and working. He does not devalue the scientific perspective but points out that our scientific understanding of phenomena often proceeds by metaphor, images, and linguistic constructions borrowed from everyday life. The ultimate significance of scientific concepts is also dependent on their impact on this life world. Joe Kamiya (1993), one of the founders of biofeedback, has observed the same paradox: He emphasizes the contradiction in the behavioral scientist who awakens in the morning, narrates his dreams to his wife, discusses his feelings and opinions over breakfast, then commutes to a laboratory where he excludes private experiences or introspection as invalid or illusionary.
Phenomenological psychology understands the science of human behavior as organized around various levels of analysis: Each successive level of scientific analysis reflects a more microscopic or macroscopic view of the same reality. The truth does not reside in any one level of analysis, yet the everyday "life-world" of immediate human experiencing is the level which gives meaning to the findings of all levels (Moss, 1981). A pathologist uses anatomical knowledge to identify a lymphoma; this bare "fact" takes on meaning as the human being faces the risk of death. A lack of availability of serotonin in the synaptic cleft is a fact for biochemistry; its relevance is found in the immediate sadness or despondency of the human being in everyday life. The willful determination of that serotonin-lacking individual to live fully and push toward greater athletic vigour in everyday life may in turn impact back on the serotonin level in the unseen synaptic cleft. The phenomenologist reminds us that the everyday "life world" is the ultimate frame of reference for all scientific findings. At the end of the working day the scientist leaves the laboratory and returns to the macroscopic world of nature, landscapes, and beloved persons.
Later researchers within psychiatry, psychology, and the biological sciences applied the concepts and approach of phenomenology to their specific fields with rich results. Of special relevance for applied psychophysiology are the French phenomenological philosopher Maurice Merleau-Ponty, the German psychiatrist and neurologist Erwin Straus, and the Swiss psychiatrist Medard Boss.
Merleau-Ponty shifted the focus of phenomenological research from the field of consciousness and the structure of internal mental acts, to the structure of behavior, viewed as intentionally directed toward a situation. Merleau-Ponty defined the "mental" as the organization or structure of behavior. In his principle works, The Structure of Behavior (1942/1963) and the Phenomenology of Perception (1945/1962), Merleau-Ponty took the evidence of the Gestalt psychologists, especially Kurt Goldstein's investigations of neurologically damaged individuals, to explore the organization of normal human movement and the embodied organism's relationship to the environment.
For Merleau-Ponty, phenomenology was never merely introspection; one knows the human being through his behavioral involvement in situation and world. "It is through my relation to 'things' that I know myself; inner perception follows afterward..." (1945/1962, p. 383). For the phenomenologist no human behavior and no neuro-physiological process can ultimately be understood apart from its situational context; identify the correct context and even the most bizarre or pathological behavior is meaningful.
Merleau-Ponty developed Husserl's idea of an active constitution of meaning further, with an empirical emphasis. Husserl pointed out that the human mind actively works on the environment, shaping it and endowing it with meaning, while being shaped in turn by culture, language, and situation. Merleau-Ponty emphasized that as a bodily organism the human being is "condemned to meaning," driven to actively interrogate its environment, questioning and shaping meaning at a pre-verbal perceptual level. Further, organism and environment organize and "co-constitute" one another. The lived body, according to Merleau-Ponty, inhabits the world as the heart inhabits the organism; the body "breathes life" into the world, sustains it, and "with it forms a system" (1945/1962, p. 203). The textures of the earth as we experience it mirror the organization of the human sensorium.
Similarly motion and perception stand in a reciprocal relation, each shaping the other (Merleau-Ponty, 1945/1962, p. 101-103). McConnville (1978, p. 110) showed that "the perceptually meaningful structures of the spatial world are not something passively registered on the retina, but something actively solicited by a body which moves through space and engages the world."
For example, the normally hungry human body organizes around itself a world in which the pathways to obtaining nourishment have a particular perceptual prominence, and in turn the repeated encounter with varieties of tempting foods can transform a satiated individual into a state of subjective, felt hunger. The eating disordered individual with an obsessive preoccupation perceives food cues where others notice nothing, and at the same time creates a behavioral environment with cupboards full of junk food. In turn this environment serves as a cue or trigger for out of control binge behavior (Moss, 1989a, 1992).
In summary, Merleau-Ponty utilized the philosophical concepts of intentionality and constitution, along with the psychological data of the Gestaltists, to express the principles that American psychology conceptualizes as self-regulation and systemic dysregulation. What emerged was an image of an active organism contributing to the structure of its environment, anticipating the neuropsychological view of Pribram (1960):
The shift is from the notion that an organism is a relatively passive protoplasmic mass whose responses are controlled by the arrangement of environmental stimuli to a conception of an organism that has considerable control over what will constitute stimulation. (1960, p. 4)
Erwin Straus drew on many examples from the annals of neurological and psychiatric pathology, such as the phantom limb, to understand normal human embodiment and the relationship of the embodied human being to the sensory world (Straus, 1935/1963). He highlighted the essential experience of the body as my own and the disruption of this experience in illness, when disease appears as a foreign power attacking and overpowering one (Straus, 1967, 1963/1969). For Straus, the possessive experience of one's own body marks the transition from physiology to psychological experiencing. The elevated EMG level and presence of trigger points in a particular muscle group is a physiological datum; for the human individual, however, the essential problem is that "my head hurts, I cannot relax, and I'm becoming worried about what's wrong with me." The personal pronouns mark the threshold of psychology and the person (Moss, 1981b,1982).
Medard Boss, a Swiss psychiatrist, entered a long apprenticeship with the German existential and phenomenological philosopher, Martin Heidegger, and organized regular seminars with Heidegger and Swiss physicians seeking to apply the phenomenological perspective to rethink the foundations of both medicine and psychology (Boss, 1971/1979). Boss defined health as the total "haleness and wholeness" of the human being, which is characterized by an openness and flexible responsiveness to the world. In turn he defined unhealthiness in human existence as "nothing but the privation, blocking, impairment or constriction of this original openness and freedom" (Boss, 1988). He investigated psychosomatic illness as a means of jamming or blocking one's openness to the world and to specific threatening situations (Boss, 1971/1979; Moss, 1978). His theory resembles that of Wilhelm Reich, who emphasized that muscular tensions serve as an armour against a full range of emotional experiencing. From this perspective, the reduction of a chronically elevated muscular tension may be a path toward recovery for a person with chronic pain, but only if the individual at the same time accepts the renewed openness to a variety of experiences. When EMG guided muscular retraining is successful, the individual does more than modify a physiological fact; the rehabilitated individual also rehabilitates his or her access to a new world of mobility, action, and possibilities.
The Phenomenological Approach: A Methodological Pathway for Theory and Research Phenomenological psychology is more an approach to knowledge than it is a specific set of skills, facts or concepts. Phenomenology begins methodologically with a dedication to return to the data of immediate experience. Husserl counseled a careful cultivation of a "phenomenological reduction," meaning that one begins by suspending all common sense and scientific assumptions (Ashworth, 1996). In the moment of experiencing, Husserl insisted, "we are here all beginners." To perceive freshly, one must give up the passionate need to draw conclusions--the attitude that one has understood the answers before posing questions. Further, Maurice Merleau-Ponty advises that one must seek to recover a sense of wonder in the face of the world. The phenomenological reduction "slackens the intentional threads which attach us to the world and thus brings them to our notice...." (Merleau-Ponty, 1945/1962, p. xiii). This strategy reveals the same world once again as "strange and paradoxical" (1945/1962, p. xiii).
The phenomenologist achieves a sense of philosophical wonder by his/her attention to experience but also accomplishes scientific ends. A return to immediate experience often serves as a corrective against overly hasty scientific conclusions, by disclosing the assumptions which bias scientific inquiry. Husserl showed that even in everyday life our immediate perceptions of the world are shaped through a "garb of ideas" (Ideenkleid) which clothes the world (Husserl, 1935-1937/1970). The philosopher of science Paul Feyerabend asserted that: "Observational reports, experimental reports, 'factual' statements, either contain theoretical assumptions or assert them by the manner in which they are used" (1978, p. 31). In other words, the particular ideas one takes for granted, about science, physiology, and behavior, shape the observations and conclusions one arrives at in research.
In 1930, the German psychiatrist and neurologist Erwin Straus used this "phenomenological reduction" to critique the unrecognized assumptions of Pavlov's reflex theory and Freud's psychoanalytic drive theory. Straus accepted many of the observations of Pavlov's research and Freud's case studies, but showed how scientific assumptions biased their conclusions and conceptual models. In doing so, Straus arrived at an innovative cognitive theory of post-traumatic experiencing four decades before the cognitive psychology of Beck and Lazarus (Moss, 1992). According to this theory, the individual world of experience is an articulated structure supported by the pillars of general meanings assimilated by an individual. The traumatic event and its impact on an individual's experiencing can be understood from the specific prior organization of this individual's experience-world, and from the sweeping transformations the traumatic event brings about in this structure of general meanings.
Erwin Straus contributed another valuable methodological perspective for research. Straus formulated and repeatedly interrogated data with what he called the "anthropological question": How must normal human experiencing and behavior be organized, if such pathological phenomena as this are to be possible (Straus, 1930/1982)? He expressed this idea already in his dissertation in neurology: "Only the man who carries in himself a virtual image of the intact whole is able to correctly perceive a torso" (1926, p. 123).
Straus' anthropological perspective can be applied to the phenomena of applied psychophysiology: If we are to recognize the significance of abnormal wave forms in muscular physiology, we might better grasp how such wave forms occur in normal muscle physiology, and their significance for intact locomotion within the human world. This means that we must become more familiar with physiological norms based on well-functioning persons, but it also means more. If we are to grasp the significance of a reduced Electrodermal Response or a decreased peripheral temperature, we may need to understand the transformation in the individual's experience of self and world at that moment. The altered physiology of the stress response is a derivative of the threatened organism's cognitive, emotional and behavioral response to an emergency situation, and physical relaxation through biofeedback is a strategy which assists the person in modifying that entire relationship with the threatening situation.
On the American scene, Amedeo Giorgi (1970, 1979) applied the European phenomenological perspective to propose that psychology be re-conceptualized as a "human science." He emphasized that in the European and especially the German sciences there has long existed an accepted distinction between the natural sciences (Naturwissenschaften) and the "sciences of the human mind or spirit" (Geisteswissenschaften). The American science of psychology has largely emphasized the methodologies and assumptions of the natural sciences--especially explanation, quantitative measurement, and experimentation. Giorgi proposed a new emphasis within a "human science psychology" on understanding, qualitative research, and description. In other words, he proposed a new field of psychology which would spend more time investigating what shame or anxiety are, how these unique experiences unfold for the person and the meaning they take on in the individual's experiencing, and place less emphasis on seeking to causally explain such phenomena by means of neural mechanisms, correlations with certain life events, or early predisposing factors. Giorgi proposed a psychology which would spend less time measuring or predicting an emotional experience, and more time understanding such phenomena (1970). He asserted that this human science approach is not unscientific, but rather seeks a methodology and assumptions which are more appropriate to the subject matter of human behavior and experience.
Giorgi (1979) cited the German scholar Wilhelm Dilthey (1894) as proposing a similar view of psychology as a descriptively oriented human science seeking qualitative understanding. Dilthey's famous motto was: "Nature we explain, the life of the soul we understand." Erwin Straus (1930/1982) criticized the typical behavior of many psychological researchers who proceed partway through a psychological exploration of some phenomenon, then suddenly disappear below the surface, like a "diving duck on a lake," and reappear with some submarine explanation about a neurophysiological mechanism, without ever completing the psychological investigation.
Giorgi's response to such a critique was that description is a valued goal within psychological research and should aim at a qualitative understanding of the meaningful structures of human behavior and experience. Giorgi recognized the validity of natural scientifically oriented efforts at explaining behavior by identifying underlying neural or biological mechanisms. However, he insisted that such investigations should not serve as a substitute for understanding a psychological phenomenon on its own level. For example, the locus coeruleus, a subcortical structure in the lower brain stem, might very well play a significant role in sustaining the intense emotional arousal among victims of post-traumatic stress disorder, but psychology must also study the human experience of terror as it is perceived by each person.
B. F. Skinner voiced a similar critique against accepting any reference to the "conceptual nervous system" as a cheap substitute for a behavioral analysis. Skinner's understanding of behavior was different from the phenomenological concept, but Skinner recognized that levels of analysis or investigation should not be confused. Skinner also agreed with phenomenology in regarding "behavior in context" as a fundamental datum and in favoring relational descriptions over a search for underlying mechanisms (Cf., Chiesa, 1992).
Further, Merleau-Ponty showed in several of his re-analyses of the findings of Gestalt psychology, that causative effects at the mechanistic or physiological level are often changed by events at the human level of meaning and experience (Merleau-Ponty, 1942/1963). Merleau-Ponty utilized the example of El Greco, the Spanish painter, who was astigmatic and painted stunning canvases with a mystic quality, showing elongated human beings and elongated architectural structures. Merleau-Ponty asserts that a simple physiological explanation, that El Greco's astigmatism caused him to paint elongated, mystic pictures, is inadequate and over-simplified. Rather, El Greco's mechanistic visual disorder served his artistic vision: "... his liberty consisted only in justifying this accident of nature by infusing it with a metaphysical meaning" (1942/1963, p. 203).
We could also cite the more contemporary findings of psychoneuroimmunology, which remind us that bio-chemical or neuro-physiological mechanisms alone rarely give a full account of a human disease process. Rather, we must have recourse to the behavior, perception, cognitions, and affective experiencing of the person with the disease. To paraphrase the Greek physician, Hippocrates, it is not so important to know what kind of disease the person has, as to know what kind of person has the disease (Davies, 1996). Impaired immune function can causally render an individual vulnerable to cancer, yet the will to live, a sense of humor, cultivation of relaxation and meditative practices, personal journalling, and a variety of similar emotionally and spiritually therapeutic exercises can in turn alter those same immune functions in measurable ways (Borysenko, 1987; Cousins, 1979; Simonton, Mathews-Simonton, & Creighton, 1980; Siegel, 1986; Pennebaker, Kiecolt-Glaser, & Glaser, 1988; and Pennebaker, 1995). The human world of experience, creative acts, and meaning is the ultimate framework within which all physiological processes within a human being are ultimately organized. This is the final environment toward which human bio-chemical and neuro-physiologic processes are directed.
Finally, American phenomenologically oriented researchers in psychology, philosophy, and the health sciences have developed a number of creative methodologies to place a greater emphasis on empirical and systematic gathering and analysis of data. Giorgi (1970, 1979, 1985) has been a major influence on these qualitative methodologies. The review of these methodologies goes beyond the scope of this chapter. The reader is referred to Aanstoos (1984), Giorgi (1985), Karlsson (1993), and Leder (1992), as well as to the Journal of Phenomenological Psychology, many issues of which contain empirical, phenomenological studies, with references to current methodological developments.
The Phenomenological Approach and Clinical Care
Thomas Moore, in his recent work, Care of the Soul, expressed the clinical equivalent to the phenomenological attitude:
... observance means first of all listening and looking carefully
at what is revealed in the suffering. An intent to heal can get
in the way of the healing. By doing less more is accomplished.
The core of the phenomenological challenge to the behavioral medicine clinician is the invitation to enter into the world and story of the patient. The individual seeking help is isolated within personal suffering and troubles, and the essential guiding principle of the phenomenological approach is to stand with the patient and bridge that isolation. If the clinician is to succeed in entering the patient's concerns, then he or she must not only conceptualize but also co-experience the patient's unique situation (Moss, 1989b, p. 196).
From the phenomenological perspective, health and disease are not simple physiological facts, rather each involves qualitative differences in the individual's relationship to the physical environment, in personal temporality and spatiality, in relationships to the family and social world, and in the struggle for identity (Moss, 1992, p. 179). As the Dutch phenomenological psychiatrist Van den Berg showed, the sick individual -- whether mentally or physically ill -- lives a different existence and inhabits a perceptually and experientially different world (1966, 1972). Illness and suffering turn a person back upon him- or herself. The world seems less inviting, loses its appeal, while at the same time one senses that life goes on for others without one. Understanding the patient's objective medical condition, as measured through a complete blood count, an MRI, and other measures, without empathy for the "world of the sickbed," leaves the behavioral medicine clinician only half prepared.
Recent phenomenological investigations have explored the personal experiencing of individuals faced with a variety of conditions and situations: autism (Zaner, 1981), bereavement in general and the death of a child (Smith, 1975; Brice, 1991), obesity (Moss, 1984, 1992), back pain (Murphy, 1978), schizophrenia (Davidson, 1992), multiple sclerosis (Toombs, 1992), AIDS (Murphy, 1992), and adjustment to retirement (Hornstein and Wapner, 1984). Such phenomenological descriptive investigations are valuable in opening up the alien world of the suffering person, who otherwise remains isolated with his or her malady.
The clinician's task, prior to implementing any specific technical intervention, and throughout the course of any treatment, is to join with the patient in his or her specific, altered mode of being in the world. The clinician need not become psychotic with the psychotic, or experience a loss of continuity with the neurologically impaired person, yet must lend imagination and intuition to perceiving those disjointed and overwhelming realities with the suffering individual.
Aaron Beck has developed a diversity of cognitive therapeutic interventions for depression and anxiety. However, he counsels us to begin phenomenologically, by listening to the client's perception of reality. All confrontation and technical intervention follow this initial moment of experiencing with the patient (Beck, 1979).
Phenomenology, Consciousness, and the Neurofeedback Movement
The resurgence of research in EEG feedback brings applied psychophysiology back into the realm of diverse states of consciousness. Neurofeedback involves the task of learning new modes of attending or being present. Phenomenology began as a philosophy of consciousness, and has a rich tradition of research into what it means to be conscious, to be present, or to attend differently. This section will review the phenomenology of consciousness briefly, highlighting four concepts relevant for the neurophysiology of consciousness and the clinical application of EEG feedback.
First, for phenomenology consciousness is not inside the head, and is for the most part not an internal experience. Rather, consciousness consists of an attunement and an orienting process toward objects and situations in the world. The individual is conscious of something, and this something is in the majority of instances something beyond the physical bounds of one's own body. Actual internal experiencing, the focusing on pain, physical sensations, or on some internal fear or worry, is often a morbid phenomenon, characteristic of a troubled person or a diseased or injured body.
The variety of states of consciousness involve variations in how one is present to the current situation. Research on the EEG shows that the dominant frequency of electrical activity in the cortex covaries with changes in one's attunement or manner of being aware of the present environment. When the dominant electrical activity on the EEG is in the 13 to 35 Herz range (Beta waves), we find a wakeful individual, actively scanning his environment, focusing on specific objects or problems, and consciously thinking or deliberating about his current task. As we shift toward slower wave activity, in the 8 to 12 Herz range (Alpha activity), we find the person conscious, but more receptive and less task or goal directed. As the cortical activity slows further, in the 4 to 7 Herz range (Theta), we find the person in a kind of reverie, with wandering attention, loosely connected (hypnogogic) imagery, and drowsiness.
This initial phenomenological characterization of the states of consciousness accompanying various cortical frequency ranges is oversimplistic, because we are speaking as though fairly wide frequency bands were the only relevant variable in describing cortical activity. Neuropsychologically the situation is much more complex. One can perceive qualitative differences in the wave form of various theta range electrical waves; these and other differences within the same frequency band may have experiential correlates and functional consequences. Tansey (1985; 1993) reports that narrow 1 Herz frequency bands differ qualitatively in their significance for neuropsychological functioning. Sheer (1988), Sams (1995), and others believe that activity in several neural structures centered around 40 Herz is optimal for focused learning and memory tasks. Further, the right-left symmetry, the topographical distribution of electrical activity, and the subcortical orgins of a specific pattern of excitation, and the absolute and relative power of brain activity all have significance which requires much more investigation (Sterman, in press; Abarbanel, 1995). In the future the phenomenology of the experiential correlates of these diverse EEG states may come to rival the intricacies of Hindu and Buddhist descriptions of human consciousness (Rama, 1981; Pannikar, 1977).
Neurofeedback training involves training the individual in alternative ways of being present to situations. The fundamental promise of neurofeedback is that it appears to present a simple tool useful in training subjects to shift one's state of consciousness, or mode of being present, through the use of immediate EEG feedback about one's currently dominant brain state. This promise of neurofeedback is gaining credibility in applications such as the treatment of attention deficit disorder and addictive disorders. The promise remains to be proven with a host of other applications. Whether training the EEG is the most effective pathway to change for a specific problem or disorder, remains an empirical and not a phenomenological question. To date for instance, it appears to be more clinically-effective to treat panic disorder by cognitive-behavioral therapy, but new protocols may qualify this conclusion.
For the individual with attention deficit and hyperactivity disorder neurofeedback means learning a more focused and organized mode of presence toward a specific academic problem or work situation. This is an alteration in a state of consciousness. Neurophysiologically this involves giving feedback to prompt and to guide the individual toward the suppression of slow wave, less organized cortical rhythms (theta range activity), and the enhancement of faster wave, more organized rhythms (beta range activity).
For the anxious individual the training process is approximately reverse; the individual EEG baseline profiles vary a great deal in anxiety, but frequently involve excesses of upper range beta wave activity, and a scarcity of alpha range slower wave activity. The training process involves learning a less vigilant, less tightly focused mode of presence, and in an experiential sense a more trusting, open, and receptive approach to situations.
Older descriptions from the phenomenology of meditative and mystical consciousness come to mind, as parallel to this neurotherapy for anxiety. The German mystic Johannes Tauler, living in the 14th century, advised the spiritual novice to seek Gelassenheit, a mental and spiritual attitude of "letting go-ness" (Moss, 1980). Tauler counseled the Christian seeking a mystical oneness with God to give up effortful focusing on tasks and ends, to cease measuring himself or herself by performance or achievement. Tauler encouraged the beginner to learn inner stillness and to overcome inward restlessness and disorder. Then one could perform all of one's actions from this serene center (Moss, 1980).
The German philosopher Heidegger discussed a similar philosophical and spiritual process of opening oneself, for which he used the same German term, Gelassenheit or letting-be-ness. He advocated the individual living in today's disordered amd rootless technological world to cultivate this philosophical style of thinking, which creates a a "clearing in being," allowing what exists to shine forth in its own manner. Heidegger emphasizes that this change in one's approach transforms not only one's inner self, but also one's relatedness to the world as experienced (Heidegger, 1954; von Eckartsberg & Valle, 1981).
When neurofeedback guides the anxious individual to enhance alpha-theta range slow cortical activity, we may be assisting the individual practically toward a similar spiritual and emotional transformation. Eugene Peniston's protocol for neurofeedback with alcoholic and addictive individuals combines visualization exercizes with neurofeedback, and explicitly draws on a similar kind of self-transformation (Peniston & Kukolski, 1989).
Second, when one's state of consciousness alters, the physiognomy or face of the world is transformed. This principle has implications for a variety of changes in consciousness. To wake up and become conscious, for example, means in an everyday sense that one is aware once again of having a surrounding world. Ethologists have observed that an animal's virtual behavioral environment is organized around the animal's instinctual needs and drives -- of hunger or thirst, for example. The human individual's state of consciousness -- which includes moodedness, cognitive expectancies, and motivational sets -- similarly affects the manner in which this surrounding world will be organized and experienced in this moment.
This principle can be illustrated by examples from psychopathology. The paranoid individual vigilantly and suspiciously scans the surrounding environment, seeking threat and danger, especially signs that the hostile ones are out there intending to do one harm. Such a person sees a car pass, that might have gone by yesterday, and wonders what or who is behind it, and what danger this might portend. Such an individual does not experience the danger as within his or her own head. Rather, the paranoia-world as it is immediately experienced presents a face full of potential threats and hazards.
In turn the normal consciousness of an individual feeling secure in his or her familiar neighborhood or home, is marked by an emphasis on the presence of familiar and comforting objects, sounds, and atmospheres. The German poet Goethe comments on the individual awakening in the night to find that "Earth -- this night too thou art abiding" (Faust, Part II).
Third, the technical interventions of neurofeedback, because they involve a potential modification in states of consciousness, touch on the deepest existential dimensions of the human person. It is these existential dimensions which phenomenological psychologists and philosophers have explored for much of this century. The rich cameos to be found in phenomenological investigation may spark understanding of changes reported by patients in neurofeedback.
We will touch briefly on the example of the phenomenology of memories and fantasies of childhood. Access to and understanding of childhood experiencing is crucial for psychotherapy and many applications of neurofeedback. Elizabeth Loftus (1994) has recently focused on the dubious validity of repressed memories recovered in psychotherapy. This is a critical question, in both clinical practice and legal proceedings. The phenomenological approach, however, deepens the question beyond the simple problem of factual accuracy. In his book The poetics of reverie, Gaston Bachelard (1960/1969) carried out a phenomenological reflection on the images of childhood available in poetry, to explore adult reveries of childhood. Bachelard observes that when one turns in daydreaming to one's own childhood, one discovers not one but several child faces coming to meet one, each seemingly a distinct person:
We were several ... in our primitive life. Only through the
accounts of others have we come to know of our unity. On the
thread of our history as told by others, year by year, we end up
resembling ourselves. We gather all our beings around the unity of
our name. (Bachelard, 1960/1969, p. 99)
Donnenberg (1973, p. 84) cited the German novelist Arno Schmidt, who similarly observed that, even beyond childhood, life is not originally experienced as a unity:
The events of our life spring forth. On the string of meaninglessness, of
omnipresent leisure, the pearl chain of tiny unities of inner and outer
experiences is threaded. From midnight to midnight is not one day at all,
but rather 1440 minutes (and of these, on the other hand, at the most 50
are of any significance!) ...
My Life?! is no continuum! ... [rather]: a tray of glistening snapshots.
Bachelard proposes that access to childhood through reverie and reminiscence lends unity and depth to adult identity. He observes that imagination and memory are so interwoven as we look back at childhood, that we may more accurately say that we are remembering our fantasies, and fantasizing our memories: "The imagination ceaselessly revives and illustrates the memory" (1960/1969, p. 20). In adult life childhood remains a dimension ever present; the childhood within us yields a "consciousness of roots" and according to Bachelard comforts the entire tree of one's being (1960/1969, p. 20).
In an earlier book The poetics of space (1958/1964), Bachelard explored the memories and fantasies of childhood which emerge as one pictures one's original childhood home. The house for Bachelard is an archetype of the self and world of the child:
For our house is our corner of the world. As has often been said, it is
our first universe, a real cosmos in every sense of the word. (p. 4)
Of course, thanks to the house, a great many of our memories are
housed, and if the house is a bit elaborate, if it has a cellar and a
garrett, nooks and corridors, our memories have refuges that are all
the more clearly delineated. (p. 8)
Memories of childhood adhere to the significant places of childhood, the grandmother's kitchen with the fragrance of fresh bread, the father's workshop with its forbidding shelves of tools, or the living room where the family Christmas tree stood and where one still hears echoes of the carols sung by the family.
The childhood which the adult recovers is not merely an array of facts, but a clustered series of those other distinct childhoods which the child has dreamed, the childhoods he or she wished for, as well as those which should have been. In this regard Bachelard (1960/1969, p. 112) cites the poet Alexandre Arnoux:
Of childhood I have so many
That I would get lost counting them.
Bachelard also describes childhood as remaining virtually incomplete. When some phrase or event turns an adult back in revery, the remembering surpasses the bare facts and rounds out the story (1960/1969, p. 106). Bachelard views this reminiscence and fictional completion of one's childhood as endowing childhood with layers of meaning it did not originally possess. Bachelard sees this recovery and completion of childhood as part of the "integration of the self" described by Jung.
Many patients who undergo physical and sexual abuse or other traumatic experiences in early life have little or no access to reveries of childhood, or to the identity integration process described by Bachelard. Rather they are pursued by the terror lurking in their memories, or haunted by an absence of memory. The most extreme instance of this is the individual with a post-traumatic dissociative disorder. Dissociative individuals are caught up living in an extreme form of response stereotypy. The child, unable to face the full brutality and betrayal of the original abuse, dissociates mentally. His or her awareness simply "goes away," or the event is experienced numbly and without feeling, or another self crystalizes in the moment of the abuse and "takes over." This original protective response, however, increases the likelihood of continued reliance on dissociative strategies throughout life. The process of dissociation prevents the individual each time from experiencing the same memory or the same type of emotional experience, which is never de-sensitized or mastered. Each near-encounter evokes the same self-protective sequence of behavioral and cognitive escaping, without real learning.
A patient reported to me that each time our therapeutic discussion approached the time of her second grade year, she experienced entering a tunnel with dim light, and had a sense of dimly seeing the same events at her grandmother's house. As she tried to see more clearly she felt a shattering, like of breaking glass and felt herself fragmented along with the image. These shattering moments released extreme pain, disconnected from any specific memory, and overwhelming despair. She lost any desire to live, despaired of ever escaping her painful emotions, and became more avoidant of discussing her childhood.
Many therapists doing verbal, psychodynamic psychotherapy with dissociative patients in past years have encountered many such moments, in which the patient is re-traumatized over and over in a therapy without outcome.
The neurophysiology of traumatic anxiety is relevant here (van der Kolk, 1987; Kolb, 1987), highlighting a variety of brain mechanisms and processes which are activated in extreme post-traumatic and dissociative experiencing. These neurophysiological mechanisms reinforce the hopeless vicious circle experienced by post-traumatic patients. The locus coeruleus in the lower brainstem may be chronically aroused, activating noradrenergic pathways to the limbic system, the cerebral cortex, the cerebelum, and the hippocampus. With repeated traumatization, these mechanisms escape inhibitory control, and produces chronic emotional arousal. Zajonc ( 1984) proposes that there are direct neuropsychological pathways linking the retina and other aspects of the sensorium to these affective excitatory mechanisms, without cognitive mediation. Experientially the individual becomes hypervigilant and oversensitive to a variety of triggers in everyday life, and remains unable to regain control of his or her emotions. For example, without warning and without thought, a certain kind of light reflecting in her windshield excites terror in a woman driving her auto, who then can neither calm or control her panic.
Consequently purely cognitive therapies often fail to interrupt the sequence from a momentary sensation or image to overwhelming physiologic arousal and emotional terror. The practical lesson is clear: Additional techniques such as neurofeedback, EMDR, and hypnotic strategies are necessary to modify the patient's response. Such strategies raise the hope of interrupting this vicious cycle,
which is both an experiential and neurophysiological impediment to recovery.
Carol Manchester (1994) has advocated the use of a modified Peniston neurofeedback protocol for individuals with post-traumatic dissociative identity disorders, such as multiple personality disorder. The cultivation of a slower wave alpha-theta brain state appears to facilitate both a faster and more controlled recovery and healing of dissociated realms of traumatic memories and childhood experiences. She proposes that teaching the patient to re-integrate traumatic memories while in this state of low neurophysiological arousal arousal minimizes the risk of re-traumatization. For the clinician this novel approach is exciting, because individuals with dissociative syndromes are treatment challenges. From the phenomenological point of view it appears that both Manchester and Peniston are using neurofeedback to train the patient to enter a receptive state of mind more conducive to reverie and personality integration.
Fourth, phenomenological psychology insists that brain functions, consciousness, and overt behavior stand in a circular, interactive relationship. The current bias within biological psychology and psychiatry tends to view the biochemistry of neural function as causing variations in consciousness and behavior. However, current neuroscience research shows a much more compex and reciprocal relationship between brain and behavior.
For example, recent research using PET imaging on the neural function of individuals with severe obsessive compulsive disorder shows abnormally high glucose metabolism in the caudate nucleus as well as in the the fronto-orbital cortex and cingulate gyrus (Baxter, 1990). Pharmacological treatment with a selective seritonin reuptake inhibitor (SSRI) such as Fluoxetine tends to normalize the glucose metabolism in these neural centers. The decrease in OCD symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), correlates with the percent decrease in metabolic activity in the caudate nucleus. However, behavioral therapy including repeated
exposure to anxiety-triggering situations also normalizes the glucose metabolism in the same neural areas (Baxter, Schwartz, Bergman, Szuba, et al, 1992). Behavior changes here produce neurophysiological changes.
Further, an earlier study by Isaac Marks and colleagues suggested that the therepeutic effects were significantly lower when patients with OCD took a seritonin stimulating medication (in this case Clomipramine), but were instructed to avoid anxiety-provoking situations (Marks, Lelliott, Basoglu, Noshirvani, Monteiro, Cohen, & Kasvikis, 1988). The behavioral exposure appeared to facilitate the pharmacologically triggered changes.
The close linkages among neuro-chemistry, neural function, physiology, cognition, and behavior are circular. Intervention at any level may effect or potentiate significant change at all other levels. This "bio-neuro-physio-cognitive-behavioral model" represents an extension of Elmer Green's "psychophysiological principle, which states that: "...every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state is accompanied by an appropriate change in the physiological state" (Green, Green, & Walters, 1970). The challenge to behavioral medicine is to identify and verify specific interventions which make use of this principle with health impacting, clinically effective and cost-effective results.
Conclusion: A Creative Partnership for Phenomenology and Applied Pychophysiology
The technique of biofeedback was named only 25 years ago, at the first conference in Santa Monica in 1969 of the Biofeedback Research Society, now known as the Association for Applied Psychophysiology and Biofeedback. Present in the creation of biofeedback were researchers whose primary interest were in the study of private internal experiencing (Kamiya, 1976), the psychology of consciousness (Ornstein, 1972), altered states of consciousness and meditation (Tart, 1975), Eastern religion, and the expansion of human potential and human awareness (Kamiya, 1993; Green & Green, 1977). A recent letter appearing in the Biofeedback newsmagazine, and signed by several leading figures in the Association for Applied Psychophysiology and Biofeedback called for a re-affirmation of the original values of the organization and a return to the original emphasis on "consciousness, self-awareness, spirit, and self-regulation" (Kall, 1993).
Phenomenology evolved into a school of psychiatry and psychology studying the human being involved in an active and self-actualizing dialogue with the physical and cultural environment. This philosophical image of the human being converges with the psycho-physiological theory of a self-regulating biopsychosocial human organism in a systemic relationship with its environment. The intent of this chapter is to encourage a new partnership, in which the phenomenological approach and the rich findings of phenomenological investigations may contribute to the theoretical and empirical progress of applied psychophysiology and mind-body medicine.
Because of the historical emphasis of this chapter, translated works are listed whenever possible with their original date of publication, followed by their English publication date (for example, Boss, 1971/1979).
Aanstoos, C. (Ed.). (1984). Exploring the lived world: Readings in phenomenological psychology. West Georgia College Studies in the Social Sciences, 23, 1-150.
Abarnel, A. (1995). Gates, states, rhythms, and resonances: The scientific basis of neurofeedback training. Journal of Neurotherapy, 1 (2), 15-38.
Ashworth, P. (1996). Presuppose nothing! The suspension of assumptions in phenomenological psychological methodology. Journal of Phenomenological Psychology, 27 (1), 1-25.
Bachelard, G. (1960/1969). The poetics of reverie (trans. by D. Russell). Boston: Beacon Press.
Bachelard, G. (1958/1964). The poetics of space (trans. by M. Jolas). NY: Orion Press.
Baxter, L. R. (1990). Brain imaging as a tool in establishing a theory of brain pathology in obsessive compulsive disorder. Journal of Clinical Psychiatry, 51 (Suppl.), 22-25.
Baxter, L. R.; Schwartz, J. M.; Bergman, K. S.; Szuba, M. P.; Guze, B. H.; Mazziotta, J. C. et al. (1992). Caudate glucose metabolic rate change with both drug and behavior therapy for OCD. Archives of General Psychiatry, 49, 681-689.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Binswanger, L. (1942). Grundformen und Erkenntnis menschlichen Daseins. (Basic forms and knowledge of human existence). Zurich: Niehans Verlag.
Bollnow, O. F. (1966/1987). Crisis and new beginning: Contributions to a pedagogical anthropology. (D. Moss, Trans.). Pittsburgh: Duquesne University Press.
Borysenko, J. (1987). Minding the body, mending the mind. Reading, MA: Addison-Wesley Publishing.
Boss, M. (1971/1979). Existential foundations of medicine and psychology. N.Y.: Jason Aronson.
Boss, M. (1988). Recent considerations in Daseinsanalysis. In E. Craig (Ed.), Psychotherapy for freedom: The daseinsanalytic way in psychology and psychoanalysis. (Special edition). The Humanistic Psychologist, 16 (1), 58-74.
Brentano (1874). Psychologie vom empirischen Standpunkt. (Psychology from the empirical standpoint). Leipzig: Duncker Und Humboldt.
Brice, C. W. (1991). What forever means: An empirical-phenomenological investigation of maternal mourning. Journal of Phenomenological Psychology, 22 (1), 16-38.
Buytendijk, F. J. J. (1965/1974). Prolegama to an anthropological physiology. Pittsburgh: Duquesne University Press.
Chiesa, M. (1992). Radical behaviorism and scientific frameworks: From mechanistic to relational accounts. American Psychologist, 47 (11), 1287-1299.
Cousins, N. (1979). Anatomy of an illness as perceived by a patient. NY: Norton.
Davidson, L. (1992). Developing an empirical-phenomenological approach to schizophrenia research. Journal of Phenomenological Psychology, 23 (1), 3-15.
Davies, T. (1996, August). Mental health in the 21st century: The challenge for primary care. In I. Wickramasekera (Chair), Mind-body medicine. Symposium at the annual convention of the American Psychological Association, Toronto.
Dilthey, W. (1894) Ideen uber eine beschreibende und zergliedernde Psychologie (Ideas concerning a descriptive and analytic psychology). Reprinted in W. Dilthey (1924), Gesammelten Schriften, IV. Leipzig and Berlin.
Donnenberg, J. (1973). Bevorzugte Gattungen I: Kurzgeschichte, Reportage, Protokoll. In W. Weiss, J. Donnenberg, A. Haslinger, & K. Rossbacher, Gegenwartsliteratur (pp. 78-93). Stuttgart/Berlin/Koln/Mainz: Verlag W. Kohlhammer.
Feyerabend, P. (1978). Against method. London: Verso Press.
Giorgi, A. (1970). Psychology as a human science. NY: Harper and Row.
Giorgi, A. (1979). Phenomenology and psychological theory. In A. Giorgi, R. Knowles, and D. L. Smith (Eds.), Duquesne studies in phenomenological psychology, vol. III. Pittsburgh: Duquesne University Press.
Giorgi, A. (Ed.). (1985). Phenomenology and psychological research. Pittsburgh: Duquesne University Press.
Green, E., & Green, A. (1977). Beyond biofeedback. San Francisco: Delacorte Press.
Green, E. E.; Green, A. M.; & Walters, E. D. (1970). Voluntary control of internal states: Psychological and physiological. Journal of Transpersonal Psychology, 2, 1-26.
Heidegger, M. (1927/1962). Being and time. N.Y. Harper & Row.
Heidegger, M. (1954). Der Feldweg. Pfullingen: Gunther Neske Verlag.
Hornstein, G. A., & Wapner, S. (1984). The experience of the retiree's social network during the transition to retirement. In Aanstoos, C. (Ed.), Exploring the lived world: Readings in phenomenological psychology. West Georgia College Studies in the Social Sciences, 23, 119-136.
Husserl, E. (1900-1901/1970). Logical investigations (2 vols.). (J. Findlay, Trans.) New Jersey: Humanities Press.
Husserl, E. (1935-1937/1970). The crisis of European sciences and transcendental phenomenology. (D. Carr, Trans.). Evanston: Northwestern University Press.
Husserl, E. (1925/1977). Phenomenological psychology. (J. Scanlon, Trans). The Hague: Martinus Nijhof.
Kall, B. (1993). Biofeedback needs a change of heart; A hopeful beginning of a dialogue. Biofeedback, 21 (2), 7.
Kamiya, J. (1976). Autoregulation of the EEG Alpha rhythm: A program for the study of consciousness. In Biofeedback and self-control: An Aldine annual on the regulation of bodily proce