May 15, 2013
By MICHAEL POLLAN, "New York Times".
I can tell you the exact date that I began to think of myself in the first-person plural — as a superorganism, that is, rather than a plain old individual human being. It happened on March 7. That’s when I opened my e-mail to find a huge, processor-choking file of charts and raw data from a laboratory located at the BioFrontiers Institute at the University of Colorado, Boulder. As part of a new citizen-science initiative called the American Gut project, the lab sequenced my microbiome — that is, the genes not of “me,” exactly, but of the several hundred microbial species with whom I share this body. These bacteria, which number around 100 trillion, are living (and dying) right now on the surface of my skin, on my tongue and deep in the coils of my intestines, where the largest contingent of them will be found, a pound or two of microbes together forming a vast, largely uncharted interior wilderness that scientists are just beginning to map.
I clicked open a file called Taxa Tables, and a colorful bar chart popped up on my screen. Each bar represented a sample taken (with a swab) from my skin, mouth and feces. For purposes of comparison, these were juxtaposed with bars representing the microbiomes of about 100 “average” Americans previously sequenced.
Here were the names of the hundreds of bacterial species that call me home. In sheer numbers, these microbes and their genes dwarf us. It turns out that we are only 10 percent human: for every human cell that is intrinsic to our body, there are about 10 resident microbes — including commensals (generally harmless freeloaders) and mutualists (favor traders) and, in only a tiny number of cases, pathogens. To the extent that we are bearers of genetic information, more than 99 percent of it is microbial. And it appears increasingly likely that this “second genome,” as it is sometimes called, exerts an influence on our health as great and possibly even greater than the genes we inherit from our parents. But while your inherited genes are more or less fixed, it may be possible to reshape, even cultivate, your second genome.
Justin Sonnenburg, a microbiologist at Stanford, suggests that we would do well to begin regarding the human body as “an elaborate vessel optimized for the growth and spread of our microbial inhabitants.” This humbling new way of thinking about the self has large implications for human and microbial health, which turn out to be inextricably linked. Disorders in our internal ecosystem — a loss of diversity, say, or a proliferation of the “wrong” kind of microbes — may predispose us to obesity and a whole range of chronic diseases, as well as some infections. “Fecal transplants,” which involve installing a healthy person’s microbiota into a sick person’s gut, have been shown to effectively treat an antibiotic-resistant intestinal pathogen named C. difficile, which kills 14,000 Americans each year. (Researchers use the word “microbiota” to refer to all the microbes in a community and “microbiome” to refer to their collective genes.) We’ve known for a few years that obese mice transplanted with the intestinal community of lean mice lose weight and vice versa. (We don’t know why.) A similar experiment was performed recently on humans by researchers in the Netherlands: when the contents of a lean donor’s microbiota were transferred to the guts of male patients with metabolic syndrome, the researchers found striking improvements in the recipients’ sensitivity to insulin, an important marker for metabolic health. Somehow, the gut microbes were influencing the patients’ metabolisms.
Our resident microbes also appear to play a critical role in training and modulating our immune system, helping it to accurately distinguish between friend and foe and not go nuts on, well, nuts and all sorts of other potential allergens. Some researchers believe that the alarming increase in autoimmune diseases in the West may owe to a disruption in the ancient relationship between our bodies and their “old friends” — the microbial symbionts with whom we coevolved.
These claims sound extravagant, and in fact many microbiome researchers are careful not to make the mistake that scientists working on the human genome did a decade or so ago, when they promised they were on the trail of cures to many diseases. We’re still waiting. Yet whether any cures emerge from the exploration of the second genome, the implications of what has already been learned — for our sense of self, for our definition of health and for our attitude toward bacteria in general — are difficult to overstate. Human health should now “be thought of as a collective property of the human-associated microbiota,” as one group of researchers recently concluded in a landmark review article on microbial ecology — that is, as a function of the community, not the individual.
Such a paradigm shift comes not a moment too soon, because as a civilization, we’ve just spent the better part of a century doing our unwitting best to wreck the human-associated microbiota with a multifronted war on bacteria and a diet notably detrimental to its well-being. Researchers now speak of an impoverished “Westernized microbiome” and ask whether the time has come to embark on a project of “restoration ecology” — not in the rain forest or on the prairie but right here at home, in the human gut.
In March I traveled to Boulder to see the Illumina HiSeq 2000 sequencing machine that had shed its powerful light on my own microbiome and to meet the scientists and computer programmers who were making sense of my data. The lab is headed by Rob Knight, a rangy, crew-cut 36-year-old biologist who first came to the United States from his native New Zealand to study invasive species, a serious problem in his home country. Knight earned his Ph.D. in ecology and evolutionary biology from Princeton when he was 24 and then drifted from the study of visible species and communities to invisible ones. Along the way he discovered he had a knack for computational biology. Knight is regarded as a brilliant analyst of sequencing data, skilled at finding patterns in the flood of information produced by the machines that “batch sequence” all the DNA in a sample and then tease out the unique genetic signatures of each microbe. This talent explains why so many of the scientists exploring the microbiome today send their samples to be sequenced and analyzed by his lab; it is also why you will find Knight’s name on most of the important papers in the field.
Over the course of two days in Boulder, I enjoyed several meals with Knight and his colleagues, postdocs and graduate students, though I must say I was a little taken aback by the table talk. I don’t think I’ve ever heard so much discussion of human feces at dinner, but then one thing these scientists are up to is a radical revaluation of the contents of the human colon. I learned about Knight’s 16-month-old daughter, who has had most of the diapers to which she has contributed sampled and sequenced. Knight said at dinner that he sampled himself every day; his wife, Amanda Birmingham, who joined us one night, told me that she was happy to be down to once a week. “Of course I keep a couple of swabs in my bag at all times,” she said, rolling her eyes, “because you never know.”
A result of the family’s extensive self-study has been a series of papers examining family microbial dynamics. The data helped demonstrate that the microbial communities of couples sharing a house are similar, suggesting the importance of the environment in shaping an individual’s microbiome. Knight also found that the presence of a family dog tended to blend everyone’s skin communities, probably via licking and petting. One paper, titled “Moving Pictures of the Human Microbiome,” tracked the day-to-day shifts in the microbial composition of each body site. Knight produced animations showing how each community — gut, skin and mouth — hosted a fundamentally different cast of microbial characters that varied within a fairly narrow range over time.
Knight’s daily sampling of his daughter’s diapers (along with those of a colleague’s child) also traced the remarkable process by which a baby’s gut community, which in utero is sterile and more or less a blank slate, is colonized. This process begins shortly after birth, when a distinctive infant community of microbes assembles in the gut. Then, with the introduction of solid food and then weaning, the types of microbes gradually shift until, by age 3, the baby’s gut comes to resemble an adult community much like that of its parents.
The study of babies and their specialized diet has yielded key insights into how the colonization of the gut unfolds and why it matters so much to our health. One of the earliest clues to the complexity of the microbiome came from an unexpected corner: the effort to solve a mystery about milk. For years, nutrition scientists were confounded by the presence in human breast milk of certain complex carbohydrates, called oligosaccharides, which the human infant lacks the enzymes necessary to digest. Evolutionary theory argues that every component of mother’s milk should have some value to the developing baby or natural selection would have long ago discarded it as a waste of the mother’s precious resources.
It turns out the oligosaccharides are there to nourish not the baby but one particular gut bacterium called Bifidobacterium infantis, which is uniquely well-suited to break down and make use of the specific oligosaccharides present in mother’s milk. When all goes well, the bifidobacteria proliferate and dominate, helping to keep the infant healthy by crowding out less savory microbial characters before they can become established and, perhaps most important, by nurturing the integrity of the epithelium — the lining of the intestines, which plays a critical role in protecting us from infection and inflammation.
“Mother’s milk, being the only mammalian food shaped by natural selection, is the Rosetta stone for all food,” says Bruce German, a food scientist at the University of California, Davis, who researches milk. “And what it’s telling us is that when natural selection creates a food, it is concerned not just with feeding the child but the child’s gut bugs too.”
Where do these all-important bifidobacteria come from and what does it mean if, like me, you were never breast-fed? Mother’s milk is not, as once was thought, sterile: it is both a “prebiotic” — a food for microbes — and a “probiotic,” a population of beneficial microbes introduced into the body. Some of them may find their way from the mother’s colon to her milk ducts and from there into the baby’s gut with its first feeding. Because designers of infant formula did not, at least until recently, take account of these findings, including neither prebiotic oligosaccharides or probiotic bacteria in their formula, the guts of bottle-fed babies are not optimally colonized.
Most of the microbes that make up a baby’s gut community are acquired during birth — a microbially rich and messy process that exposes the baby to a whole suite of maternal microbes. Babies born by Caesarean, however, a comparatively sterile procedure, do not acquire their mother’s vaginal and intestinal microbes at birth. Their initial gut communities more closely resemble that of their mother’s (and father’s) skin, which is less than ideal and may account for higher rates of allergy, asthma and autoimmune problems in C-section babies: not having been seeded with the optimal assortment of microbes at birth, their immune systems may fail to develop properly.
At dinner, Knight told me that he was sufficiently concerned about such an eventuality that, when his daughter was born by emergency C-section, he and his wife took matters into their own hands: using a sterile cotton swab, they inoculated the newborn infant’s skin with the mother’s vaginal secretions to insure a proper colonization. A formal trial of such a procedure is under way in Puerto Rico.
While I was in Boulder, I sat down with Catherine A. Lozupone, a microbiologist who had just left Knight’s lab to set up her own at the University of Colorado, Denver, and who spent some time looking at my microbiome and comparing it with others, including her own. Lozupone was the lead author on an important 2012 paper in Nature, “Diversity, Stability and Resilience of the Human Gut Microbiota,” which sought to approach the gut community as an ecologist might, trying to determine the “normal” state of the ecosystem and then examining the various factors that disturb it over time. How does diet affect it? Antibiotics? Pathogens? What about cultural traditions? So far, the best way to begin answering such questions may be by comparing the gut communities of various far-flung populations, and researchers have been busy collecting samples around the world and shipping them to sequencing centers for analysis. The American Gut project, which hopes to eventually sequence the communities of tens of thousands of Americans, represents the most ambitious such effort to date; it will help researchers uncover patterns of correlation between people’s lifestyle, diet, health status and the makeup of their microbial community.
It is still early days in this research, as Lozupone (and everyone else I interviewed) underscored; scientists can’t even yet say with confidence exactly what a “healthy” microbiome should look like. But some broad, intriguing patterns are emerging. More diversity is probably better than less, because a diverse ecosystem is generally more resilient — and diversity in the Western gut is significantly lower than in other, less-industrialized populations. The gut microbiota of people in the West looks very different from that of a variety of other geographically dispersed peoples. So, for example, the gut community of rural people in West Africa more closely resembles that of Amerindians in Venezuela than it does an American’s or a European’s.
These rural populations not only harbor a greater diversity of microbes but also a different cast of lead characters. American and European guts contain relatively high levels of bacteroides and firmicutes and low levels of the prevotella that dominate the guts of rural Africans and Amerindians. (It is not clear whether high or low levels of any of these is good or bad.) Why are the microbes different? It could be the diet, which in both rural populations features a considerable amount of whole grains (which prevotella appear to like), plant fiber and very little meat. (Many firmicutes like amino acids, so they proliferate when the diet contains lots of protein; bacteroides metabolize carbohydrates.) As for the lower biodiversity in the West, this could be a result of our profligate use of antibiotics (in health care as well as the food system), our diet of processed food (which has generally been cleansed of all bacteria, the good and the bad), environmental toxins and generally less “microbial pressure” — i.e., exposure to bacteria — in everyday life. All of this may help explain why, though these rural populations tend to have greater exposures to infectious diseases and lower life expectancies than those in the West, they also have lower rates of chronic disorders like allergies, asthma, Type 2 diabetes and cardiovascular disease.
“Rural people spend a lot more time outside and have much more contact with plants and with soil,” Lozupone says. Another researcher, who has gathered samples in Malawi, told me, “In some of these cultures, children are raised communally, passed from one set of hands to another, so they’re routinely exposed to a greater diversity of microbes.” The nuclear family may not be conducive to the health of the microbiome.
As it happens, Lozupone and I had something in common, microbially speaking: we share unusually high levels of prevotella for Americans. Our gut communities look more like those of rural Africans or Amerindians than like those of our neighbors. Lozupone suspects that the reasons for this might have to do with a plant-based diet; we each eat lots of whole grains and vegetables and relatively little meat. (Though neither of us is a vegetarian.) Like me, she was proud of her prevotella, regarding it as a sign of a healthy non-Western diet, at least until she began doing research on the microbiota of H.I.V. patients. It seems that they, too, have lots of prevotella. Further confusing the story, a recent study linking certain gut microbes common in meat eaters to high levels of a blood marker for heart disease suggested that prevotella was one such microbe. Early days, indeed.
Two other features of my microbiome attracted the attention of the researchers who examined it. First, the overall biodiversity of my gut community was significantly higher than that of the typical Westerner, which I decided to take as a compliment, though the extravagantly diverse community of microbes on my skin raised some eyebrows. “Where have your hands been, man?” Jeff Leach of the American Gut project asked after looking over my results. My skin harbors bacteria associated with plants, soil and a somewhat alarming variety of animal guts. I put this down to gardening, composting (I keep worms too) and also the fact that I was fermenting kimchi and making raw-milk cheese, “live-culture” foods teeming with microbes.
Compared to a rain forest or a prairie, the interior ecosystem is not well understood, but the core principles of ecology — which along with powerful new sequencing machines have opened this invisible frontier to science — are beginning to yield some preliminary answers and a great many more intriguing hypotheses. Your microbial community seems to stabilize by age 3, by which time most of the various niches in the gut ecosystem are occupied. That doesn’t mean it can’t change after that; it can, but not as readily. A change of diet or a course of antibiotics, for example, may bring shifts in the relative population of the various resident species, helping some kinds of bacteria to thrive and others to languish. Can new species be introduced? Yes, but probably only when a niche is opened after a significant disturbance, like an antibiotic storm. Just like any other mature ecosystem, the one in our gut tends to resist invasion by newcomers.
You acquire most of the initial microbes in your gut community from your parents, but others are picked up from the environment. “The world is covered in a fine patina of feces,” as the Stanford microbiologist Stanley Falkow tells students. The new sequencing tools have confirmed his hunch: Did you know that house dust can contain significant amounts of fecal particles? Or that, whenever a toilet is flushed, some of its contents are aerosolized? Knight’s lab has sequenced the bacteria on toothbrushes. This news came during breakfast, so I didn’t ask for details, but got them anyway: “You want to keep your toothbrush a minimum of six feet away from a toilet,” one of Knight’s colleagues told me.
Some scientists in the field borrow the term “ecosystem services” from ecology to catalog all the things that the microbial community does for us as its host or habitat, and the services rendered are remarkably varied and impressive. “Invasion resistance” is one. Our resident microbes work to keep pathogens from gaining a toehold by occupying potential niches or otherwise rendering the environment inhospitable to foreigners. The robustness of an individual’s gut community might explain why some people fall victim to food poisoning while others can blithely eat the same meal with no ill effects.
Our gut bacteria also play a role in the manufacture of substances like neurotransmitters (including serotonin); enzymes and vitamins (notably Bs and K) and other essential nutrients (including important amino acid and short-chain fatty acids); and a suite of other signaling molecules that talk to, and influence, the immune and the metabolic systems. Some of these compounds may play a role in regulating our stress levels and even temperament: when gut microbes from easygoing, adventurous mice are transplanted into the guts of anxious and timid mice, they become more adventurous. The expression “thinking with your gut” may contain a larger kernel of truth than we thought.
The gut microbes are looking after their own interests, chief among them getting enough to eat and regulating the passage of food through their environment. The bacteria themselves appear to help manage these functions by producing signaling chemicals that regulate our appetite, satiety and digestion. Much of what we’re learning about the microbiome’s role in human metabolism has come from studying “gnotobiotic mice” — mice raised in labs like Jeffrey I. Gordon’s at Washington University, in St. Louis, to be microbially sterile, or germ-free. Recently, Gordon’s lab transplanted the gut microbes of Malawian children with kwashiorkor — an acute form of malnutrition — into germ-free mice. The lab found those mice with kwashiorkor who were fed the children’s typical diet could not readily metabolize nutrients, indicating that it may take more than calories to remedy malnutrition. Repairing a patient’s disordered metabolism may require reshaping the community of species in his or her gut.
Keeping the immune system productively engaged with microbes — exposed to lots of them in our bodies, our diet and our environment — is another important ecosystem service and one that might turn out to be critical to our health. “We used to think the immune system had this fairly straightforward job,” Michael Fischbach, a biochemist at the University of California, San Francisco, says. “All bacteria were clearly ‘nonself’ so simply had to be recognized and dealt with. But the job of the immune system now appears to be far more nuanced and complex. It has to learn to consider our mutualists” — e.g., resident bacteria — “as self too. In the future we won’t even call it the immune system, but the microbial interaction system.” The absence of constructive engagement between microbes and immune system (particularly during certain windows of development) could be behind the increase in autoimmune conditions in the West.
So why haven’t we evolved our own systems to perform these most critical functions of life? Why have we outsourced all this work to a bunch of microbes? One theory is that, because microbes evolve so much faster than we do (in some cases a new generation every 20 minutes), they can respond to changes in the environment — to threats as well as opportunities — with much greater speed and agility than “we” can. Exquisitely reactive and adaptive, bacteria can swap genes and pieces of DNA among themselves. This versatility is especially handy when a new toxin or food source appears in the environment. The microbiota can swiftly come up with precisely the right gene needed to fight it — or eat it. In one recent study, researchers found that a common gut microbe in Japanese people has acquired a gene from a marine bacterium that allows the Japanese to digest seaweed, something the rest of us can’t do as well.
This plasticity serves to extend our comparatively rigid genome, giving us access to a tremendous bag of biochemical tricks we did not need to evolve ourselves. “The bacteria in your gut are continually reading the environment and responding,” says Joel Kimmons, a nutrition scientist and epidemiologist at the Centers for Disease Control and Prevention in Atlanta. “They’re a microbial mirror of the changing world. And because they can evolve so quickly, they help our bodies respond to changes in our environment.”
A handful of microbiologists have begun sounding the alarm about our civilization’s unwitting destruction of the human microbiome and its consequences. Important microbial species may have already gone extinct, before we have had a chance to learn who they are or what they do. What we think of as an interior wilderness may in fact be nothing of the kind, having long ago been reshaped by unconscious human actions. Taking the ecological metaphor further, the “Westernized microbiome” most of us now carry around is in fact an artifact of civilization, no more a wilderness today than, say, the New Jersey Meadowlands.
To obtain a clearer sense of what has been lost, María Gloria Dominguez-Bello, a Venezuelan-born microbiologist at New York University, has been traveling to remote corners of the Amazon to collect samples from hunter-gatherers who have had little previous contact with Westerners or Western medicine. “We want to see how the human microbiota looks before antibiotics, before processed food, before modern birth,” she told me. “These samples are really gold.”
Preliminary results indicate that a pristine microbiome — of people who have had little or no contact with Westerners — features much greater biodiversity, including a number of species never before sequenced, and, as mentioned, much higher levels of prevotella than is typically found in the Western gut. Dominguez-Bello says these vibrant, diverse and antibiotic-naïve microbiomes may play a role in Amerindians’ markedly lower rates of allergies, asthma, atopic disease and chronic conditions like Type 2 diabetes and cardiovascular disease.
One bacterium commonly found in the non-Western microbiome but nearly extinct in ours is a corkscrew-shaped inhabitant of the stomach by the name of Helicobacter pylori. Dominguez-Bello’s husband, Martin Blaser, a physician and microbiologist at N.Y.U., has been studying H. pylori since the mid-1980s and is convinced that it is an endangered species, the extinction of which we may someday rue. According to the “missing microbiota hypothesis,” we depend on microbes like H. pylori to regulate various metabolic and immune functions, and their disappearance is disordering those systems. The loss is cumulative: “Each generation is passing on fewer of these microbes,” Blaser told me, with the result that the Western microbiome is being progressively impoverished.
He calls H. pylori the “poster child” for the missing microbes and says medicine has actually been trying to exterminate it since 1983, when Australian scientists proposed that the microbe was responsible for peptic ulcers; it has since been implicated in stomach cancer as well. But H. pylori is a most complicated character, the entire spectrum of microbial good and evil rolled into one bug. Scientists learned that H. pylori also plays a role in regulating acid in the stomach. Presumably it does this to render its preferred habitat inhospitable to competitors, but the effect on its host can be salutary. People without H. pylori may not get peptic ulcers, but they frequently do suffer from acid reflux. Untreated, this can lead to Barrett’s esophagus and, eventually, a certain type of esophageal cancer, rates of which have soared in the West as H. pylori has gone missing.
When after a recent bout of acid reflux, my doctor ordered an endoscopy, I discovered that, like most Americans today, my stomach has no H. pylori. My gastroenterologist was pleased, but after talking to Blaser, the news seemed more equivocal, because H. pylori also does us a lot of good. The microbe engages with the immune system, quieting the inflammatory response in ways that serve its own interests — to be left in peace — as well as our own. This calming effect on the immune system may explain why populations that still harbor H. pylori are less prone to allergy and asthma. Blaser’s lab has also found evidence that H. pylori plays an important role in human metabolism by regulating levels of the appetite hormone ghrelin. “When the stomach is empty, it produces a lot of ghrelin, the chemical signal to the brain to eat,” Blaser says. “Then, when it has had enough, the stomach shuts down ghrelin production, and the host feels satiated.” He says the disappearance of H. pylori may be contributing to obesity by muting these signals.
But what about the diseases H. pylori is blamed for? Blaser says these tend to occur only late in life, and he makes the rather breathtaking suggestion that this microbe’s evolutionary role might be to help shuffle us off life’s stage once our childbearing years have passed. So important does Blaser regard this strange, paradoxical symbiont that he has proposed not one but two unconventional therapeutic interventions: inoculate children with H. pylori to give them the benefit of its services early in life, and then exterminate it with antibiotics at age 40, when it is liable to begin causing trouble.
These days Blaser is most concerned about the damage that antibiotics, even in tiny doses, are doing to the microbiome — and particularly to our immune system and weight. “Farmers have been performing a great experiment for more than 60 years,” Blaser says, “by giving subtherapeutic doses of antibiotics to their animals to make them gain weight.” Scientists aren’t sure exactly why this practice works, but the drugs may favor bacteria that are more efficient at harvesting energy from the diet. “Are we doing the same thing to our kids?” he asks. Children in the West receive, on average, between 10 and 20 courses of antibiotics before they turn 18. And those prescribed drugs aren’t the only antimicrobials finding their way to the microbiota; scientists have found antibiotic residues in meat, milk and surface water as well. Blaser is also concerned about the use of antimicrobial compounds in our diet and everyday lives — everything from chlorine washes for lettuce to hand sanitizers. “We’re using these chemicals precisely because they’re antimicrobial,” Blaser says. “And of course they do us some good. But we need to ask, what are they doing to our microbiota?” No one is questioning the value of antibiotics to civilization — they have helped us to conquer a great many infectious diseases and increased our life expectancy. But, as in any war, the war on bacteria appears to have had some unintended consequences.
One of the more striking results from the sequencing of my microbiome was the impact of a single course of antibiotics on my gut community. My dentist had put me on a course of Amoxicillin as a precaution before oral surgery. (Without prophylactic antibiotics, of course, surgery would be considerably more dangerous.) Within a week, my impressively non-Western “alpha diversity” — a measure of the microbial diversity in my gut — had plummeted and come to look very much like the American average. My (possibly) healthy levels of prevotella had also disappeared, to be replaced by a spike in bacteroides (much more common in the West) and an alarming bloom of proteobacteria, a phylum that includes a great many weedy and pathogenic characters, including E. coli and salmonella. What had appeared to be a pretty healthy, diversified gut was now raising expressions of concern among the microbiologists who looked at my data.
“Your E. coli bloom is creepy,” Ruth Ley, a Cornell University microbiologist who studies the microbiome’s role in obesity, told me. “If we put that sample in germ-free mice, I bet they’d get inflamed.” Great. Just when I was beginning to think of myself as a promising donor for a fecal transplant, now I had a gut that would make mice sick. I was relieved to learn that my gut community would eventually bounce back to something resembling its former state. Yet one recent study found that when subjects were given a second course of antibiotics, the recovery of their interior ecosystem was less complete than after the first.
Few of the scientists I interviewed had much doubt that the Western diet was altering our gut microbiome in troubling ways. Some, like Blaser, are concerned about the antimicrobials we’re ingesting with our meals; others with the sterility of processed food. Most agreed that the lack of fiber in the Western diet was deleterious to the microbiome, and still others voiced concerns about the additives in processed foods, few of which have ever been studied for their specific effects on the microbiota. According to a recent article in Nature by the Stanford microbiologist Justin Sonnenburg, “Consumption of hyperhygienic, mass-produced, highly processed and calorie-dense foods is testing how rapidly the microbiota of individuals in industrialized countries can adapt.” As our microbiome evolves to cope with the Western diet, Sonnenburg says he worries that various genes are becoming harder to find as the microbiome’s inherent biodiversity declines along with our everyday exposure to bacteria.
Catherine Lozupone in Boulder and Andrew Gewirtz, an immunologist at Georgia State University, directed my attention to the emulsifiers commonly used in many processed foods — ingredients with names like lecithin, Datem, CMC and polysorbate 80. Gewirtz’s lab has done studies in mice indicating that some of these detergentlike compounds may damage the mucosa — the protective lining of the gut wall — potentially leading to leakage and inflammation.
A growing number of medical researchers are coming around to the idea that the common denominator of many, if not most, of the chronic diseases from which we suffer today may be inflammation — a heightened and persistent immune response by the body to a real or perceived threat. Various markers for inflammation are common in people with metabolic syndrome, the complex of abnormalities that predisposes people to illnesses like cardiovascular disease, obesity, Type 2 diabetes and perhaps cancer. While health organizations differ on the exact definition of metabolic syndrome, a 2009 report from the Centers for Disease Control and Prevention found that 34 percent of American adults are afflicted with the condition. But is inflammation yet another symptom of metabolic syndrome, or is it perhaps the cause of it? And if it is the cause, what is its origin?
One theory is that the problem begins in the gut, with a disorder of the microbiota, specifically of the all-important epithelium that lines our digestive tract. This internal skin — the surface area of which is large enough to cover a tennis court — mediates our relationship to the world outside our bodies; more than 50 tons of food pass through it in a lifetime. The microbiota play a critical role in maintaining the health of the epithelium: some bacteria, like the bifidobacteria and Lactobacillus plantarum (common in fermented vegetables), seem to directly enhance its function. These and other gut bacteria also contribute to its welfare by feeding it. Unlike most tissues, which take their nourishment from the bloodstream, epithelial cells in the colon obtain much of theirs from the short-chain fatty acids that gut bacteria produce as a byproduct of their fermentation of plant fiber in the large intestine.
But if the epithelial barrier isn’t properly nourished, it can become more permeable, allowing it to be breached. Bacteria, endotoxins — which are the toxic byproducts of certain bacteria — and proteins can slip into the blood stream, thereby causing the body’s immune system to mount a response. This resulting low-grade inflammation, which affects the entire body, may lead over time to metabolic syndrome and a number of the chronic diseases that have been linked to it.
Evidence in support of this theory is beginning to accumulate, some of the most intriguing coming from the lab of Patrice Cani at the Université Catholique de Louvain in Brussels. When Cani fed a high-fat, “junk food” diet to mice, the community of microbes in their guts changed much as it does in humans on a fast-food diet. But Cani also found the junk-food diet made the animals’ gut barriers notably more permeable, allowing endotoxins to leak into the bloodstream. This produced a low-grade inflammation that eventually led to metabolic syndrome. Cani concludes that, at least in mice, “gut bacteria can initiate the inflammatory processes associated with obesity and insulin resistance” by increasing gut permeability.
These and other experiments suggest that inflammation in the gut may be the cause of metabolic syndrome, not its result, and that changes in the microbial community and lining of the gut wall may produce this inflammation. If Cani is correct — and there is now some evidence indicating that the same mechanism is at work in humans — then medical science may be on the trail of a Grand Unified Theory of Chronic Disease, at the very heart of which we will find the gut microbiome.
My first reaction to learning all this was to want to do something about it immediately, something to nurture the health of my microbiome. But most of the scientists I interviewed were reluctant to make practical recommendations; it’s too soon, they told me, we don’t know enough yet. Some of this hesitance reflects an understandable abundance of caution. The microbiome researchers don’t want to make the mistake of overpromising, as the genome researchers did. They are also concerned about feeding a gigantic bloom of prebiotic and probiotic quackery and rightly so: probiotics are already being hyped as the new panacea, even though it isn’t at all clear what these supposedly beneficial bacteria do for us or how they do what they do. There is some research suggesting that some probiotics may be effective in a number of ways: modulating the immune system; reducing allergic response; shortening the length and severity of colds in children; relieving diarrhea and irritable bowel symptoms; and improving the function of the epithelium. The problem is that, because the probiotic marketplace is largely unregulated, it’s impossible to know what, if anything, you’re getting when you buy a “probiotic” product. One study tested 14 commercial probiotics and found that only one contained the exact species stated on the label.
But some of the scientists’ reluctance to make recommendations surely flows from the institutional bias of science and medicine: that the future of microbiome management should remain firmly in the hands of science and medicine. Down this path — which holds real promise — lie improved probiotics and prebiotics, fecal transplants (with better names) and related therapies. Jeffrey Gordon, one of those scientists who peers far over the horizon, looks forward to a time when disorders of the microbiome will be treated with “synbiotics” — suites of targeted, next-generation probiotic microbes administered along with the appropriate prebiotic nutrients to nourish them. The fecal transplant will give way to something far more targeted: a purified and cultured assemblage of a dozen or so microbial species that, along with new therapeutic foods, will be introduced to the gut community to repair “lesions” — important missing species or functions. Yet, assuming it all works as advertised, such an approach will also allow Big Pharma and Big Food to stake out and colonize the human microbiome for profit.
When I asked Gordon about do-it-yourself microbiome management, he said he looked forward to a day “when people can cultivate this wonderful garden that is so influential in our health and well-being” — but that day awaits a lot more science. So he declined to offer any gardening tips or dietary advice. “We have to manage expectations,” he said.
Alas, I am impatient. So I gave up asking scientists for recommendations and began asking them instead how, in light of what they’ve learned about the microbiome, they have changed their own diets and lifestyles. Most of them have made changes. They were slower to take, or give their children, antibiotics. (I should emphasize that in no way is this an argument for the rejection of antibiotics when they are medically called for.) Some spoke of relaxing the sanitary regime in their homes, encouraging their children to play outside in the dirt and with animals — deliberately increasing their exposure to the great patina. Many researchers told me they had eliminated or cut back on processed foods, either because of its lack of fiber or out of concern about additives. In general they seemed to place less faith in probiotics (which few of them used) than in prebiotics — foods likely to encourage the growth of “good bacteria” already present. Several, including Justin Sonnenburg, said they had added fermented foods to their diet: yogurt, kimchi, sauerkraut. These foods can contain large numbers of probiotic bacteria, like L. plantarum and bifidobacteria, and while most probiotic bacteria don’t appear to take up permanent residence in the gut, there is evidence that they might leave their mark on the community, sometimes by changing the gene expression of the permanent residents — in effect turning on or off metabolic pathways within the cell — and sometimes by stimulating or calming the immune response.
What about increasing our exposure to bacteria? “There’s a case for dirtying up your diet,” Sonnenburg told me. Yet advising people not to thoroughly wash their produce is probably unwise in a world of pesticide residues. “I view it as a cost-benefit analysis,” Sonnenburg wrote in an e-mail. “Increased exposure to environmental microbes likely decreases chance of many Western diseases, but increases pathogen exposure. Certainly the costs go up as scary antibiotic-resistant bacteria become more prevalent.” So wash your hands in situations when pathogens or toxic chemicals are likely present, but maybe not after petting your dog. “In terms of food, I think eating fermented foods is the answer — as opposed to not washing food, unless it is from your garden,” he said.
With his wife, Erica, also a microbiologist, Sonnenburg tends a colony of gnotobiotic mice at Stanford, examining (among other things) the effects of the Western diet on their microbiota. (Removing fiber drives down diversity, but the effect is reversible.) He’s an amateur baker, and when I visited his lab, we talked about the benefits of baking with whole grains.
“Fiber is not a single nutrient,” Sonnenburg said, which is why fiber supplements are no magic bullet. “There are hundreds of different polysaccharides” — complex carbohydrates, including fiber — “in plants, and different microbes like to chomp on different ones.” To boost fiber, the food industry added lots of a polysaccharide called inulin to hundreds of products, but that’s just one kind (often derived from the chicory-plant root) and so may only favor a limited number of microbes. I was hearing instead an argument for a variety of whole grains and a diverse diet of plants and vegetables as well as fruits. “The safest way to increase your microbial biodiversity is to eat a variety of polysaccharides,” he said.
His comment chimed with something a gastroenterologist at the University of Pittsburgh told me. “The big problem with the Western diet,” Stephen O’Keefe said, “is that it doesn’t feed the gut, only the upper G I. All the food has been processed to be readily absorbed, leaving nothing for the lower G I. But it turns out that one of the keys to health is fermentation in the large intestine.” And the key to feeding the fermentation in the large intestine is giving it lots of plants with their various types of fiber, including resistant starch (found in bananas, oats, beans); soluble fiber (in onions and other root vegetables, nuts); and insoluble fiber (in whole grains, especially bran, and avocados).
With our diet of swiftly absorbed sugars and fats, we’re eating for one and depriving the trillion of the food they like best: complex carbohydrates and fermentable plant fibers. The byproduct of fermentation is the short-chain fatty acids that nourish the gut barrier and help prevent inflammation. And there are studies suggesting that simply adding plants to a fast-food diet will mitigate its inflammatory effect.
The outlines of a diet for the new superorganism were coming clear, and it didn’t require the ministrations of the food scientists at Nestlé or General Mills to design it. Big Food and Big Pharma probably do have a role to play, as will Jeffrey Gordon’s next-generation synbiotics, in repairing the microbiota of people who can’t or don’t care to simply change their diets. This is going to be big business. Yet the components of a microbiota-friendly diet are already on the supermarket shelves and in farmers’ markets.
Viewed from this perspective, the foods in the markets appear in a new light, and I began to see how you might begin to shop and cook with the microbiome in mind, the better to feed the fermentation in our guts. The less a food is processed, the more of it that gets safely through the gastrointestinal tract and into the eager clutches of the microbiota. Al dente pasta, for example, feeds the bugs better than soft pasta does; steel-cut oats better than rolled; raw or lightly cooked vegetables offer the bugs more to chomp on than overcooked, etc. This is at once a very old and a very new way of thinking about food: it suggests that all calories are not created equal and that the structure of a food and how it is prepared may matter as much as its nutrient composition.
It is a striking idea that one of the keys to good health may turn out to involve managing our internal fermentation. Having recently learned to manage several external fermentations — of bread and kimchi and beer — I know a little about the vagaries of that process. You depend on the microbes, and you do your best to align their interests with yours, mainly by feeding them the kinds of things they like to eat — good “substrate.” But absolute control of the process is too much to hope for. It’s a lot more like gardening than governing.
The successful gardener has always known you don’t need to master the science of the soil, which is yet another hotbed of microbial fermentation, in order to nourish and nurture it. You just need to know what it likes to eat — basically, organic matter — and how, in a general way, to align your interests with the interests of the microbes and the plants. The gardener also discovers that, when pathogens or pests appear, chemical interventions “work,” that is, solve the immediate problem, but at a cost to the long-term health of the soil and the whole garden. The drive for absolute control leads to unanticipated forms of disorder.
This, it seems to me, is pretty much where we stand today with respect to our microbiomes — our teeming, quasi-wilderness. We don’t know a lot, but we probably know enough to begin taking better care of it. We have a pretty good idea of what it likes to eat, and what strong chemicals do to it. We know all we need to know, in other words, to begin, with modesty, to tend the unruly garden within.
Michael Pollan is the Knight professor of journalism at the University of California, Berkeley, and the author, most recently, of “Cooked: A Natural History of Transformation.”
INTEGRATIVE HOLISTIC MEDICINE AND PSYCHIATRY
6.14.2013
5.06.2013
HOLOTROPIC TREK–SPITI: AUGUST 2013 THE TRANSHIMALAYAN BACKCOUNTRY
Jimmy Eyerman MD group leader: jimeye108@gmail.com
Ki Gompa
Tabo Monastery, one of the Dalai Lama’s Favorite Gompas
Tabo Gompa, interior
ENTERING Kuzum Pass from Manali to Spiti
Yak Touring
Homestay Spiti has homestays in 6 villages: Langza, Komic, Demul, Lhalung, Dhankhar and Mikkim. Set along its highlands at an average altitude of 4000 meters (the notable exception being Mikkim in Pin valley), most of these villages fall within the Kibber Wildlife Sanctuary (except Mikkim that lies within the Pin valley National Park) and are home to rare and endangered species of wildlife and flora.
Trekking: a spiritual journey
The Bhuchens are a unique and rare sect of Tibetan Buddhist theatrical artists that preach religious, social and ecological morals to the locals through a set of diverse performances. Followers of Tholdan Gyalpo, who invented this art in the early 11th century A.D, they are now only found in the Spiti valley after disappearing from Tibet and Ladakh.
The Trans-Himalayan backcountry is one of the most stunning, graphic, and rugged regions on the globe. A well preserved Buddhist heritage, unique high altitude ecosystem, and an isolation that transcends the barriers of time leaves one spell bound by the magic of what is called ‘the Spiti experience’. Spiti trekking is a blend of geo- climatic and socio-cultural /spiritual heritage along with soft adventure.
Trekking Spiti, we will spend less time in getting to and away from the Spiti valley via Manali. In Spiti, we will experience meditative silence and Holotropic Breathwork at sacred sites, traditional homestays, stays at Gompa dharmasalas, trekking [and perhaps mountain biking] stunning and rugged back country trails, and local traditional Tibetan-Spitian culture. We may experience Yak safaris and short day hikes in Snow Leopard & Himalayan Wolf habitats. We will savor the local culture and cuisine in the homestays and gompas; we will spend quiet-time in the Gompas and at the stupas in meditation and contemplation. And after acclimatization, we will access non-ordinary states through Holotropic Breathwork. There will be time for meditative quiet-time [sadhana] at the sandhis [sunrise, noon, sunset and midnite]. Meals will be the local cuisine [if you have dietary restrictions you will need to ensure your own diet].
Group Leader: James Eyerman, MD – Jim was certified in Holotropic Breathwork [HB] in 1988. He has personally facilitated over 15 thousand individuals in HB. He has led Holotropic Trips to Peru and India and Nepal over the past 25 years. He conducts HB weekly in Mill Valley, CA on Sunday evenings.
For more information –
Contact: jimeye108@gmail.com
4.29.2013
A Clinical Report of Holotropic Breathwork in 11,000 Psychiatric Inpatients in a Community Hospital Setting by JAMES EYERMAN, MD
ABSTRACT Context: Holotropic Breathwork is a powerful, spiritually oriented approach to self- exploration and healing that integrates insights from modern consciousness research, anthropology, depth psychologies, transpersonal psychology, Eastern spiritual practices, and many mystical traditions.
Objective: Holotropic Breathwork offers many opportunities that may enhance treatment, including entering non-ordinary states of consciousness to seek healing and wisdom via a natural, non-addictive method, a direct experience of one’s Higher Power, and for physical and emotional catharsis associated with stress and prior trauma.
Design:The experiences of 482 consecutive patients were documented.
Patients and Setting: 11,000 psychiatric inpatients from a variety of psychiatric units dedicated to various diagnoses participated in Holotropic Breathwork over 12 years at community hospital.
Main Outcome Measure: Transpersonal (“mythopoetic”) experiences were reported by 82% of participants.
Results: This procedure was well received. No complaints of adverse reactions were recorded during the sessions nor afterwards on the clinical units.
Conclusions: Holotropic Breathwork offers a non-drug alternative for the induction of psychedelic therapeutic experiences.
INTRODUCTION
After a hiatus of several decades, research into psychedelic therapies has returned to psychiatry due, in large part, to the advocacy efforts of the Multidisciplinary Association for Psychedelic Studies (MAPS). Holotropic Breathwork was developed by Stanislav and Christina Grof during this interval as a non-drug alternative to psychedelic therapy. The Grofs designed Holotropic Breathwork to give cathartic, therapeutic, transpersonal1 experiences similar to the psychedelic experiences induced by LSD, DMT, mescaline, psilocybin, MDMA, ayahuasca, and other entheogens [Editor’s note: from the Greek,“manifesting the divine within”]. Group Holotropic Breathwork sessions were offered weekly in a community hospital to a psychiatric inpatient population over 12 years.
Spring 2013
Mandala drawings from Association for Holotropic Breathwork International members Martha Calhoun (top), Mojca Studen (bottom right), Maria Avila (bottom center), and anonymous (bottom right).
METHODS
Holotropic Breathwork, as developed on the basis of psychedelic studies by Stanislav and Christina Grof,2,3 has six elements:
(A) introductory presentation of a map of experiences in consciousness based on four themes of perinatal birth experience in four different realms: somatosensory, perinatal, biographical, and transpersonal;2 (B) enhanced breathing (hyperventilation); (C) evocative music; (D) body work focused on amplifying somatic blocks until they resolve spontaneously; (E) mandala drawing of the experience; and (F) supportive group sharing of experiences without analysis or interpretation. Holotropic Breathwork induces a non-specific amplification of a person’s psychic process facilitating the psyche’s natural capacity for healing and utilizes precautionary measures similar to the medical use of LSD.2
Holotropic Breathwork was offered to inpatients every Tuesday evening before dinner at the Stress Center of Hyland Behavioral Health, Saint Anthony’s Medical Center in Saint Louis, Missouri, from 1989 through 2001. 20 psychiatric inpatients attended weekly from a number of specialty units: sexual trauma, dual diagnosis, chemical dependency, anxiety, depression, adolescent, and acute intensive care (ICU) for psychoses. The best estimate of the total number of patients is 11,200 +⁄-200.
Hospital staff music therapists selected patients, after screening each one based on four exclusion criteria: severe cardiac disease, severe musculoskeletal disorders, pregnancy, and paranoid ideation.
The Holotropic Breathwork session was structured for a two-hour time slot. This allowed for a five-minute presentation of the experiential map, 90 minutes of music-Breathwork, 10 minutes for drawing, and 15 minutes of sharing without interpretation of the experiences.This followed the 1988 Holotropic Breathwork format from the first certification training in Breckenridge,Colorado.The 90-minute music-Breathwork session format was the standard of that time.This allowed inclusion of a two-hour music-Breathwork group into the psychiatric hospital activity schedule.
The patients received a five-minute orientation to the Grof’s map of Breathwork (psychedelic) experiences;many did not know what they were about to experience.They may have had preknowledge from other patients who had attended that the “music breathwork therapy” was a good group.These experiences are quite non-ordinary and unusual,2 and participants were encouraged not to share them with others who had not been in their session.
This was a spiritually naïve population. Some patients were in 12-step programs and had some psycho-spiritual background, but none had previously experienced anything similar to this. We routinely asked if anyone had done any Breathwork or had a meditation practice; not one person reported that they had.
The self-reports of 482 consecutive inpatients were recorded during the sharing periods.Their experiences were rated according to the four experiential realms which Grof developed during his LSD studies:2 (1) physical-sensory, (2) perinatal, (3) biographical, and (4) transpersonal. Often these were reported with different experiences mixed together. If they reported transpersonal experiences, that category was selected. If there were no transpersonal or perinatal themes but biographical stories were reported, they were listed as biographical. If they had perinatal plus biographical but not transpersonal experience,the
MAPS Bulletin Special Edition
experience was rated as perinatal. If only sensory experiences were reported, they were listed in that category. These ratings were determined by the music therapists.
RESULTS
82% of the 482 psychiatric inpatients reported having transpersonal (mythopoetic) experiences. 16% reported experiencing prior life experiences, including what was reported as perinatal experiences in two patients. 2% reported “no experiences.” There were no adverse reactions or unresolved negative outcomes.
Among the 11,000 inpatients, the experience was well tolerated.There were no reports of problems with the experience during sharing periods. Furthermore, there were no nursing staff reports of untoward sequelae or complaints after the sessions during this 12 year period.
Specific DSM diagnoses and symptoms profiles were not obtained from the medical record; hospital rehabilitation music therapy staff screened patients for the contraindications.
TWO EXPERIENTIAL CASE REPORTS (1)
A 14-year-old adolescent was admitted with severe major depression. He had attempted to kill himself twice by cutting his throat. The second time he came close to succeeding. He had a significant issue with shame and guilt. He’d gotten the sheriff ’s daughter pregnant in his community. No one in the town would talk to him; nor would she. He felt rejected and isolated. In the hospital he received fluoxetine; he breathed with four other clients in the first inpatient group in 1988. He reported that he re-experienced the night when he tried to kill himself.This time he experienced death, successfully completing the suicide in his process. He then he became the universe. His drawing had a bloody knife on the side with a mandala circle containing a bunch of stars. Since this was a new therapy, a guarded approach was taken to his quick remission of affective symptoms. He stayed another week and participated in the Holotropic Breathwork again. After that session, he reported that he “became the universe right away.” Then he became “pure consciousness,” in his own words.Then he “became pure consciousness and the universe together.” I considered this to be a significant experience for anyone, especially a 14 year old from a small town in the Missouri Ozarks. He was asked,“Do you know who Aristotle is?” “No.” “Who Buddha is?” “No.” “Ever heard of Shiva?” “No.” “Jesus?” “I’ve been to Sunday school twice!” So this adolescent boy was spiritually naïve, but he had profound metaphysical experiences.He did well for nine months living with his uncle in another city.When he returned to his parents’ hometown, he again became dysphoric, but he was not seriously depressed nor was he suicidal. (2)
A 31-year-old woman with suicidal major depression had a history of alcoholism and polysubstance abuse. She first experienced Holotropic Breathwork after she admitted herself due to the deterioration of her mood and to prevent an alcoholic relapse. She had been abused by her stepfather during the
ages of 12–14, and later became a runaway living on the street as a drug addict after her older brother, her main support in her family, died in combat. She had recovered in her early 20s but continued to cycle through severe major depressive episodes as an anniversary reaction to the loss of her brother.At admission, she was being treated as an outpatient with fluoxetine (60 mg) and trazodone (50 mg). Her medication was unchanged during her two week hospitalization except for an increase in trazodone to 75 mg due to insomnia.After her first Breathwork session she refused to draw or share. Her affect, however, appeared improved.The next week, after hearing the reports of others in the group sessions, she decided to share her experience: “This is too weird, but here is what happened: In the first session my dead father and dead brother showed up. They lifted me out of my body and took me to a wonderful place full of light and joy; I was so comforted. But then they dropped me back into my body. I just couldn’t talk about it, it was just too weird! In my second Breathwork session, my father and brother showed up again.This time they held my hands and stayed in the room. I could see them with my eyes open; I thought you could see them too.” Her Breathwork facilitator reassured her that he could not see them but that did not invalidate her experience. This woman did well for over three years after which she was lost to follow-up; by that time she had become a leader of a 12step program in her community.
DISCUSSION
The structure of Holotropic Breathwork allows the experiences to be private, in a safe and supportive environment, non-directive, and spontaneous. It is a non-intrusive therapy and offers significant benefits in terms of emotional catharsis and internal spiritual exploration, according to the participants.The lack of even one single reported adverse sequelae in more than 11,000 Holotropic Breathing in-patients over more than 12 years, indicates that Holotropic Breathwork could be considered a low-risk therapy to assist patients with an extremely broad range of psychological problems and existential life issues.
These reports support the proposition that therapy with non-ordinary states of consciousness is safe,when done in a supportive therapeutic environment. Specific therapeutic efficacy deserves further research. Holotropic Breathwork and other non-ordinary states appear to be a valuable therapeutic tool.
FURTHER DISCUSSION OF THE 2% WHO REPORTED “NO EXPERIENCE”
No other explanation may be proffered than an uneventful session. “No experience,” or consciousness without content, is a description of the yogic state of turiya (Sanskrit, fourth state). Turiya occurs in Holotropic Breathwork sessions with some frequency. Due to time restrictions for sharing in the groups of twenty patients, further questioning was not pursued regarding whether turiya criteria were met.These criteria include cessation of thought, and the suspension of breath while remaining awake, without sleepiness or fatigue afterwards.1 Turiya also is
Spring 2013
reported to occur as part of the mindfulness meditation experience and is described variously as “the space between thoughts” and “choiceless awareness.”6
The inpatients’ endorsement in 1989 of Holotropic Breathwork as their best therapy at Hyland Behavioral Health exit interviews swayed the hospital administration to assign extra music therapists to assist in the groups.The four extra music therapists allowed groups of 20 patients, with one facilitator for every four patients.The groups were oversubscribed and filled every week.
Hyland Behavioral Health Center was publicly supportive of this work. Their Training Institute sponsored Holotropic Breathwork workshops for the professional therapists in the Saint Louis area. Some of the hospital administrators eventually also participated in the breathwork sessions.
ADDITIONAL THERAPEUTIC EXPERIENCE WITH HOLOTROPIC BREATHWORK
Epworth Children’s Home, an adolescent residential program, also introduced Holotropic Breathwork after one of their adolescents returned from the hospital where he had a trans-formative transpersonal experience (conscious contact with his higher power) during the inpatient sessions.4 Epworth’s music therapist, Hallie Huber, trained with the author of this article. We then offered Holotropic Breathwork to interested residents as individual sessions. Huber noted that approximately half of the 52 children-in-residence participated. She also noted no untoward experiences among the adolescents.
Holotropic Breathwork is similar to meditation/contemplation practices, but much more intense. Some participants termed it a “crash course” in spirituality.That enhanced breathing and evocative music can give experiences similar to LSD, or other psychedelic therapies, is remarkable and largely unknown to professionals and the general public.2–5
The experiences of 482 consecutive Saint Anthony Medical Center psychiatric inpatients with Holotropic Breathwork were presented at the Washington University Department of Psychiatry Grand Rounds in 1991. They were also presented to the American Psychiatric/Italian Psychiatric Association in Sienna in 1997, as well as the weekly University of California, San Francisco Depression Seminars in 2007.
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REFERENCES
1. Transpersonal experiences have been defined as experiences in which the sense of identity or self extends beyond (trans) the individual or personal to encompass wider aspects of humankind,life,psyche or cosmos.Walsh,R.& Vaughan,F.On Transpersonal Definitions. Journal of Transpersonal Psychology, 25
(2) 125-182, 1993
2. Stanislav Grof MD., 1988. The Adventure of Self-Discovery: Dimensions of Consciousness and New Perspectives in Psychotherapy and Inner Exploration. SUNY Series in Transpersonal and Humanistic Psychology.
3. Grof, S., & Grof, C., 2010. Holotropic Breathwork:A new
ABOUT HOLOTROPIC BREATHWORK
Holotropic Breathwork (HB) provides a non-pharmacologic means of attaining non-ordinary states of consciousness (NOSC). HB is a powerful approach to self-exploration and self-healing that integrates insights from modern consciousness research, anthropology, various depth psychologies, transpersonal psychology, Eastern spiritual practices, and other mystical traditions of the world. HB combines rapid, deep breathing, evocative music, focused body work, artistic expression and group sharing in a safe, supportive environment.
Holotropic Breathwork was created by the Czech-American psychiatrist and LSD researcher Stanislav Grof, MD, and his wife Christina Grof in the 1970s after studying the use of NOSCs in various cultures and settings.
“Holotropic,” or “moving toward wholeness” is derived from “holo,” meaning “wholeness,” and “tropic,” meaning “moving toward.”
ONLINE RESOURCES
Association for Holotropic Breathwork International (ABHI)
grof-holotropic-breathwork.net
Grof Transpersonal Training
holotropic.com
approach to self-Dexploration and therapy. Excelsior Editions/State University of New York.
4. Brewerton,T.D.,Eyerman,J.D.,Cappetta,P.,Mithoefer, M.,2011.Long-Term Abstinence Following Holotropic Breath-work as Adjunctive Treatment of Substance Use Disorders and Related Psychiatric Comorbidity. Int J Ment Health Addiction 10;
(3) 453-459 Jun 2012.
Rhinewine, J. P., Williams, O. J., 2007. Holotropic Breathwork: the potential role of a prolonged, voluntary hyperventilation procedure as an adjunct to psychotherapy. The Journal of Alternative and Complementary Medicine, 13, 771–776.
Williams, M., Teasdale, J., Segal, Z., Kabat-Zinn, J., 2007. The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness
James Eyerman, MD was certified in Holotropic Breathwork and Transpersonal Psychology in 1988. He has been American Board Certified in Integrative Holistic Medicine,Adult Psychiatry,and Adolescent Psychiatry. He is an Associate Professor in Clinical Psychiatry at the University of California, San Francisco and an Adjunct Associate Professor in Clinical Psychiatry at Touro University.Holotropic Breath-work Sessions are offered weekly at his private office group room in Mill Valley. California. Learn more at jameseyerman.com. James can be reached at jimeye108@gmail.com.
You may download a pdf version of the journal here.
Objective: Holotropic Breathwork offers many opportunities that may enhance treatment, including entering non-ordinary states of consciousness to seek healing and wisdom via a natural, non-addictive method, a direct experience of one’s Higher Power, and for physical and emotional catharsis associated with stress and prior trauma.
Design:The experiences of 482 consecutive patients were documented.
Patients and Setting: 11,000 psychiatric inpatients from a variety of psychiatric units dedicated to various diagnoses participated in Holotropic Breathwork over 12 years at community hospital.
Main Outcome Measure: Transpersonal (“mythopoetic”) experiences were reported by 82% of participants.
Results: This procedure was well received. No complaints of adverse reactions were recorded during the sessions nor afterwards on the clinical units.
Conclusions: Holotropic Breathwork offers a non-drug alternative for the induction of psychedelic therapeutic experiences.
INTRODUCTION
After a hiatus of several decades, research into psychedelic therapies has returned to psychiatry due, in large part, to the advocacy efforts of the Multidisciplinary Association for Psychedelic Studies (MAPS). Holotropic Breathwork was developed by Stanislav and Christina Grof during this interval as a non-drug alternative to psychedelic therapy. The Grofs designed Holotropic Breathwork to give cathartic, therapeutic, transpersonal1 experiences similar to the psychedelic experiences induced by LSD, DMT, mescaline, psilocybin, MDMA, ayahuasca, and other entheogens [Editor’s note: from the Greek,“manifesting the divine within”]. Group Holotropic Breathwork sessions were offered weekly in a community hospital to a psychiatric inpatient population over 12 years.
Spring 2013
Mandala drawings from Association for Holotropic Breathwork International members Martha Calhoun (top), Mojca Studen (bottom right), Maria Avila (bottom center), and anonymous (bottom right).
METHODS
Holotropic Breathwork, as developed on the basis of psychedelic studies by Stanislav and Christina Grof,2,3 has six elements:
(A) introductory presentation of a map of experiences in consciousness based on four themes of perinatal birth experience in four different realms: somatosensory, perinatal, biographical, and transpersonal;2 (B) enhanced breathing (hyperventilation); (C) evocative music; (D) body work focused on amplifying somatic blocks until they resolve spontaneously; (E) mandala drawing of the experience; and (F) supportive group sharing of experiences without analysis or interpretation. Holotropic Breathwork induces a non-specific amplification of a person’s psychic process facilitating the psyche’s natural capacity for healing and utilizes precautionary measures similar to the medical use of LSD.2
Holotropic Breathwork was offered to inpatients every Tuesday evening before dinner at the Stress Center of Hyland Behavioral Health, Saint Anthony’s Medical Center in Saint Louis, Missouri, from 1989 through 2001. 20 psychiatric inpatients attended weekly from a number of specialty units: sexual trauma, dual diagnosis, chemical dependency, anxiety, depression, adolescent, and acute intensive care (ICU) for psychoses. The best estimate of the total number of patients is 11,200 +⁄-200.
Hospital staff music therapists selected patients, after screening each one based on four exclusion criteria: severe cardiac disease, severe musculoskeletal disorders, pregnancy, and paranoid ideation.
The Holotropic Breathwork session was structured for a two-hour time slot. This allowed for a five-minute presentation of the experiential map, 90 minutes of music-Breathwork, 10 minutes for drawing, and 15 minutes of sharing without interpretation of the experiences.This followed the 1988 Holotropic Breathwork format from the first certification training in Breckenridge,Colorado.The 90-minute music-Breathwork session format was the standard of that time.This allowed inclusion of a two-hour music-Breathwork group into the psychiatric hospital activity schedule.
The patients received a five-minute orientation to the Grof’s map of Breathwork (psychedelic) experiences;many did not know what they were about to experience.They may have had preknowledge from other patients who had attended that the “music breathwork therapy” was a good group.These experiences are quite non-ordinary and unusual,2 and participants were encouraged not to share them with others who had not been in their session.
This was a spiritually naïve population. Some patients were in 12-step programs and had some psycho-spiritual background, but none had previously experienced anything similar to this. We routinely asked if anyone had done any Breathwork or had a meditation practice; not one person reported that they had.
The self-reports of 482 consecutive inpatients were recorded during the sharing periods.Their experiences were rated according to the four experiential realms which Grof developed during his LSD studies:2 (1) physical-sensory, (2) perinatal, (3) biographical, and (4) transpersonal. Often these were reported with different experiences mixed together. If they reported transpersonal experiences, that category was selected. If there were no transpersonal or perinatal themes but biographical stories were reported, they were listed as biographical. If they had perinatal plus biographical but not transpersonal experience,the
MAPS Bulletin Special Edition
experience was rated as perinatal. If only sensory experiences were reported, they were listed in that category. These ratings were determined by the music therapists.
RESULTS
82% of the 482 psychiatric inpatients reported having transpersonal (mythopoetic) experiences. 16% reported experiencing prior life experiences, including what was reported as perinatal experiences in two patients. 2% reported “no experiences.” There were no adverse reactions or unresolved negative outcomes.
Among the 11,000 inpatients, the experience was well tolerated.There were no reports of problems with the experience during sharing periods. Furthermore, there were no nursing staff reports of untoward sequelae or complaints after the sessions during this 12 year period.
Specific DSM diagnoses and symptoms profiles were not obtained from the medical record; hospital rehabilitation music therapy staff screened patients for the contraindications.
TWO EXPERIENTIAL CASE REPORTS (1)
A 14-year-old adolescent was admitted with severe major depression. He had attempted to kill himself twice by cutting his throat. The second time he came close to succeeding. He had a significant issue with shame and guilt. He’d gotten the sheriff ’s daughter pregnant in his community. No one in the town would talk to him; nor would she. He felt rejected and isolated. In the hospital he received fluoxetine; he breathed with four other clients in the first inpatient group in 1988. He reported that he re-experienced the night when he tried to kill himself.This time he experienced death, successfully completing the suicide in his process. He then he became the universe. His drawing had a bloody knife on the side with a mandala circle containing a bunch of stars. Since this was a new therapy, a guarded approach was taken to his quick remission of affective symptoms. He stayed another week and participated in the Holotropic Breathwork again. After that session, he reported that he “became the universe right away.” Then he became “pure consciousness,” in his own words.Then he “became pure consciousness and the universe together.” I considered this to be a significant experience for anyone, especially a 14 year old from a small town in the Missouri Ozarks. He was asked,“Do you know who Aristotle is?” “No.” “Who Buddha is?” “No.” “Ever heard of Shiva?” “No.” “Jesus?” “I’ve been to Sunday school twice!” So this adolescent boy was spiritually naïve, but he had profound metaphysical experiences.He did well for nine months living with his uncle in another city.When he returned to his parents’ hometown, he again became dysphoric, but he was not seriously depressed nor was he suicidal. (2)
A 31-year-old woman with suicidal major depression had a history of alcoholism and polysubstance abuse. She first experienced Holotropic Breathwork after she admitted herself due to the deterioration of her mood and to prevent an alcoholic relapse. She had been abused by her stepfather during the
ages of 12–14, and later became a runaway living on the street as a drug addict after her older brother, her main support in her family, died in combat. She had recovered in her early 20s but continued to cycle through severe major depressive episodes as an anniversary reaction to the loss of her brother.At admission, she was being treated as an outpatient with fluoxetine (60 mg) and trazodone (50 mg). Her medication was unchanged during her two week hospitalization except for an increase in trazodone to 75 mg due to insomnia.After her first Breathwork session she refused to draw or share. Her affect, however, appeared improved.The next week, after hearing the reports of others in the group sessions, she decided to share her experience: “This is too weird, but here is what happened: In the first session my dead father and dead brother showed up. They lifted me out of my body and took me to a wonderful place full of light and joy; I was so comforted. But then they dropped me back into my body. I just couldn’t talk about it, it was just too weird! In my second Breathwork session, my father and brother showed up again.This time they held my hands and stayed in the room. I could see them with my eyes open; I thought you could see them too.” Her Breathwork facilitator reassured her that he could not see them but that did not invalidate her experience. This woman did well for over three years after which she was lost to follow-up; by that time she had become a leader of a 12step program in her community.
DISCUSSION
The structure of Holotropic Breathwork allows the experiences to be private, in a safe and supportive environment, non-directive, and spontaneous. It is a non-intrusive therapy and offers significant benefits in terms of emotional catharsis and internal spiritual exploration, according to the participants.The lack of even one single reported adverse sequelae in more than 11,000 Holotropic Breathing in-patients over more than 12 years, indicates that Holotropic Breathwork could be considered a low-risk therapy to assist patients with an extremely broad range of psychological problems and existential life issues.
These reports support the proposition that therapy with non-ordinary states of consciousness is safe,when done in a supportive therapeutic environment. Specific therapeutic efficacy deserves further research. Holotropic Breathwork and other non-ordinary states appear to be a valuable therapeutic tool.
FURTHER DISCUSSION OF THE 2% WHO REPORTED “NO EXPERIENCE”
No other explanation may be proffered than an uneventful session. “No experience,” or consciousness without content, is a description of the yogic state of turiya (Sanskrit, fourth state). Turiya occurs in Holotropic Breathwork sessions with some frequency. Due to time restrictions for sharing in the groups of twenty patients, further questioning was not pursued regarding whether turiya criteria were met.These criteria include cessation of thought, and the suspension of breath while remaining awake, without sleepiness or fatigue afterwards.1 Turiya also is
Spring 2013
reported to occur as part of the mindfulness meditation experience and is described variously as “the space between thoughts” and “choiceless awareness.”6
The inpatients’ endorsement in 1989 of Holotropic Breathwork as their best therapy at Hyland Behavioral Health exit interviews swayed the hospital administration to assign extra music therapists to assist in the groups.The four extra music therapists allowed groups of 20 patients, with one facilitator for every four patients.The groups were oversubscribed and filled every week.
Hyland Behavioral Health Center was publicly supportive of this work. Their Training Institute sponsored Holotropic Breathwork workshops for the professional therapists in the Saint Louis area. Some of the hospital administrators eventually also participated in the breathwork sessions.
ADDITIONAL THERAPEUTIC EXPERIENCE WITH HOLOTROPIC BREATHWORK
Epworth Children’s Home, an adolescent residential program, also introduced Holotropic Breathwork after one of their adolescents returned from the hospital where he had a trans-formative transpersonal experience (conscious contact with his higher power) during the inpatient sessions.4 Epworth’s music therapist, Hallie Huber, trained with the author of this article. We then offered Holotropic Breathwork to interested residents as individual sessions. Huber noted that approximately half of the 52 children-in-residence participated. She also noted no untoward experiences among the adolescents.
Holotropic Breathwork is similar to meditation/contemplation practices, but much more intense. Some participants termed it a “crash course” in spirituality.That enhanced breathing and evocative music can give experiences similar to LSD, or other psychedelic therapies, is remarkable and largely unknown to professionals and the general public.2–5
The experiences of 482 consecutive Saint Anthony Medical Center psychiatric inpatients with Holotropic Breathwork were presented at the Washington University Department of Psychiatry Grand Rounds in 1991. They were also presented to the American Psychiatric/Italian Psychiatric Association in Sienna in 1997, as well as the weekly University of California, San Francisco Depression Seminars in 2007.
REFERENCES
1. Transpersonal experiences have been defined as experiences in which the sense of identity or self extends beyond (trans) the individual or personal to encompass wider aspects of humankind,life,psyche or cosmos.Walsh,R.& Vaughan,F.On Transpersonal Definitions. Journal of Transpersonal Psychology, 25
(2) 125-182, 1993
2. Stanislav Grof MD., 1988. The Adventure of Self-Discovery: Dimensions of Consciousness and New Perspectives in Psychotherapy and Inner Exploration. SUNY Series in Transpersonal and Humanistic Psychology.
3. Grof, S., & Grof, C., 2010. Holotropic Breathwork:A new
ABOUT HOLOTROPIC BREATHWORK
Holotropic Breathwork (HB) provides a non-pharmacologic means of attaining non-ordinary states of consciousness (NOSC). HB is a powerful approach to self-exploration and self-healing that integrates insights from modern consciousness research, anthropology, various depth psychologies, transpersonal psychology, Eastern spiritual practices, and other mystical traditions of the world. HB combines rapid, deep breathing, evocative music, focused body work, artistic expression and group sharing in a safe, supportive environment.
Holotropic Breathwork was created by the Czech-American psychiatrist and LSD researcher Stanislav Grof, MD, and his wife Christina Grof in the 1970s after studying the use of NOSCs in various cultures and settings.
“Holotropic,” or “moving toward wholeness” is derived from “holo,” meaning “wholeness,” and “tropic,” meaning “moving toward.”
ONLINE RESOURCES
Association for Holotropic Breathwork International (ABHI)
grof-holotropic-breathwork.net
Grof Transpersonal Training
holotropic.com
approach to self-Dexploration and therapy. Excelsior Editions/State University of New York.
4. Brewerton,T.D.,Eyerman,J.D.,Cappetta,P.,Mithoefer, M.,2011.Long-Term Abstinence Following Holotropic Breath-work as Adjunctive Treatment of Substance Use Disorders and Related Psychiatric Comorbidity. Int J Ment Health Addiction 10;
(3) 453-459 Jun 2012.
Rhinewine, J. P., Williams, O. J., 2007. Holotropic Breathwork: the potential role of a prolonged, voluntary hyperventilation procedure as an adjunct to psychotherapy. The Journal of Alternative and Complementary Medicine, 13, 771–776.
Williams, M., Teasdale, J., Segal, Z., Kabat-Zinn, J., 2007. The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness
James Eyerman, MD was certified in Holotropic Breathwork and Transpersonal Psychology in 1988. He has been American Board Certified in Integrative Holistic Medicine,Adult Psychiatry,and Adolescent Psychiatry. He is an Associate Professor in Clinical Psychiatry at the University of California, San Francisco and an Adjunct Associate Professor in Clinical Psychiatry at Touro University.Holotropic Breath-work Sessions are offered weekly at his private office group room in Mill Valley. California. Learn more at jameseyerman.com. James can be reached at jimeye108@gmail.com.
You may download a pdf version of the journal here.
11.25.2012
Bill Maher Host of HBO's "Real Time with Bill Maher"
New Rule: Now that he's been reelected, President Obama must get back at all those right wing hacks who tried to paint him as an angry black man pushing a liberal agenda by becoming an angry black man who's pushing a liberal agenda.
Now, I have been mostly holding my tongue about the president this past season, because I didn't want to muddy the waters in a country where you only get two choices, but Mr. President, there are two ways to look at your 51 to 48 percent victory: One is, we love you. The other is, we like you three percent better than Mitt Romney. And by the way, let us never speak that name again... Mitt... let it be a dark and buried memory of a close call with a creature equal parts pure evil and excellent posture, like getting dry humped in a crowded subway by Roger Moore.
I like this president. In all those secret strategy meetings we had, with me and him and George Soros and The New Black Panthers, I found him to be very agreeable, Allah be praised. But it's now the job of progressives to hold his feet to the fire for causes important to us. If not now, when?
There's no third term, Mr. President, so you may as well throw caution to the wind, 'cause it's not like we're using it to produce energy. Yes, clean energy, that's just one of many issues, like civil liberties, the drug war, the drone war, the war war, gun control -- that have been on my mind these last four years, and let's just say I've been waiting to exhale. And by that I mean, I've been holding my nose.
But you're free now -- with no more elections to win, you are free to never again have to kiss the ass of coal miners and say the words "clean coal." There is no such thing as "clean coal." It's like saying "Internet Privacy" or "Tea Party Intellectual." Or "Fox News Journalist."
Another priority should be cutting the defense budget -- we're the home of the brave, let's prove it by getting by with one less submarine. Yes, we were involved in a struggle against a radical enemy bent on our destruction -- but the election is over, and we need to recognize that America has the same problem with the defense budget that Mrs. Petraeus has with her husband's penis: it's swollen, and we can't bring ourselves to touch it.
And as far as Afghanistan goes, I know you said we're leaving in 2014, but look at it this way: enemies are always on guard for a surprise attack, but they'd never suspect a surprise retreat. Really. We can leave right away. Because we've figured out something the Afghans haven't: air travel.
And as long as we're ending wars, how about the War on Drugs? Two states, Colorado and Washington, have actually legalized pot now, which gives you as president the rare opportunity to improve the world by doing... absolutely nothing. Just tell Eric Holder to stay the hell out of Boulder, and if the conservatives bitch about it, throw states' rights back in their face -- isn't that their big theme, send it back to the states, the will of the people? Well, this is the people who, in those two states on election day, got up off the couch and drove their 1987 Toyota Tercel with the "Visualize World Peace" sticker on the back to the polls, and voted to stop the drug war. And then drove home and got back on the couch.
And finally, instead of rewriting Social Security, how about rewriting the Patriot Act? How about another look at rendition, and warrantless searches and wire taps? And how about stop listening in on our phone calls and reading our e-mails. I'm not a teenager and you're not my mom, ok? And besides, there's a better way to confirm your suspicions that I'm smoking weed and hanging around the wrong people: just watch my show.
Real Time With Bill Maher returns with new shows on Friday, January 18th on HBO.
Follow Bill Maher on Twitter: www.twitter.com/billmaher
Now, I have been mostly holding my tongue about the president this past season, because I didn't want to muddy the waters in a country where you only get two choices, but Mr. President, there are two ways to look at your 51 to 48 percent victory: One is, we love you. The other is, we like you three percent better than Mitt Romney. And by the way, let us never speak that name again... Mitt... let it be a dark and buried memory of a close call with a creature equal parts pure evil and excellent posture, like getting dry humped in a crowded subway by Roger Moore.
I like this president. In all those secret strategy meetings we had, with me and him and George Soros and The New Black Panthers, I found him to be very agreeable, Allah be praised. But it's now the job of progressives to hold his feet to the fire for causes important to us. If not now, when?
There's no third term, Mr. President, so you may as well throw caution to the wind, 'cause it's not like we're using it to produce energy. Yes, clean energy, that's just one of many issues, like civil liberties, the drug war, the drone war, the war war, gun control -- that have been on my mind these last four years, and let's just say I've been waiting to exhale. And by that I mean, I've been holding my nose.
But you're free now -- with no more elections to win, you are free to never again have to kiss the ass of coal miners and say the words "clean coal." There is no such thing as "clean coal." It's like saying "Internet Privacy" or "Tea Party Intellectual." Or "Fox News Journalist."
Another priority should be cutting the defense budget -- we're the home of the brave, let's prove it by getting by with one less submarine. Yes, we were involved in a struggle against a radical enemy bent on our destruction -- but the election is over, and we need to recognize that America has the same problem with the defense budget that Mrs. Petraeus has with her husband's penis: it's swollen, and we can't bring ourselves to touch it.
And as far as Afghanistan goes, I know you said we're leaving in 2014, but look at it this way: enemies are always on guard for a surprise attack, but they'd never suspect a surprise retreat. Really. We can leave right away. Because we've figured out something the Afghans haven't: air travel.
And as long as we're ending wars, how about the War on Drugs? Two states, Colorado and Washington, have actually legalized pot now, which gives you as president the rare opportunity to improve the world by doing... absolutely nothing. Just tell Eric Holder to stay the hell out of Boulder, and if the conservatives bitch about it, throw states' rights back in their face -- isn't that their big theme, send it back to the states, the will of the people? Well, this is the people who, in those two states on election day, got up off the couch and drove their 1987 Toyota Tercel with the "Visualize World Peace" sticker on the back to the polls, and voted to stop the drug war. And then drove home and got back on the couch.
And finally, instead of rewriting Social Security, how about rewriting the Patriot Act? How about another look at rendition, and warrantless searches and wire taps? And how about stop listening in on our phone calls and reading our e-mails. I'm not a teenager and you're not my mom, ok? And besides, there's a better way to confirm your suspicions that I'm smoking weed and hanging around the wrong people: just watch my show.
Real Time With Bill Maher returns with new shows on Friday, January 18th on HBO.
Follow Bill Maher on Twitter: www.twitter.com/billmaher
5.01.2012
This may quiet and disquiet a few Homophobes?
Homophobic? Maybe You’re Gay
By RICHARD M. RYAN and WILLIAM S. RYAN
Published: NYT April 27, 2012
WHY are political and religious figures who campaign against gay
rights so often implicated in sexual encounters with same-sex
partners?
In recent years, Ted Haggard, an evangelical leader who preached that
homosexuality was a sin, resigned after a scandal involving a former
male prostitute; Larry Craig, a United States senator who opposed
including sexual orientation in hate-crime legislation, was arrested
on suspicion of lewd conduct in a men’s bathroom; and Glenn Murphy
Jr., a leader of the Young Republican National Convention and an
opponent of same-sex marriage, pleaded guilty to a lesser charge after
being accused of sexually assaulting another man.
One theory is that homosexual urges, when repressed out of shame or
fear, can be expressed as homophobia. Freud famously called this
process a “reaction formation” — the angry battle against the outward
symbol of feelings that are inwardly being stifled. Even Mr. Haggard
seemed to endorse this idea when, apologizing after his scandal for
his anti-gay rhetoric, he said, “I think I was partially so vehement
because of my own war.”
It’s a compelling theory — and now there is scientific reason to
believe it. In this month’s issue of the Journal of Personality and
Social Psychology, we and our fellow researchers provide empirical
evidence that homophobia can result, at least in part, from the
suppression of same-sex desire.
Our paper describes six studies conducted in the United States and
Germany involving 784 university students. Participants rated their
sexual orientation on a 10-point scale, ranging from gay to straight.
Then they took a computer-administered test designed to measure their
implicit sexual orientation. In the test, the participants were shown
images and words indicative of hetero- and homosexuality (pictures of
same-sex and straight couples, words like “homosexual” and “gay”) and
were asked to sort them into the appropriate category, gay or
straight, as quickly as possible. The computer measured their reaction
times.
The twist was that before each word and image appeared, the word “me”
or “other” was flashed on the screen for 35 milliseconds — long enough
for participants to subliminally process the word but short enough
that they could not consciously see it. The theory here, known as
semantic association, is that when “me” precedes words or images that
reflect your sexual orientation (for example, heterosexual images for
a straight person), you will sort these images into the correct
category faster than when “me” precedes words or images that are
incongruent with your sexual orientation (for example, homosexual
images for a straight person). This technique, adapted from similar
tests used to assess attitudes like subconscious racial bias, reliably
distinguishes between self-identified straight individuals and those
who self-identify as lesbian, gay or bisexual.
Using this methodology we identified a subgroup of participants who,
despite self-identifying as highly straight, indicated some level of
same-sex attraction (that is, they associated “me” with gay-related
words and pictures faster than they associated “me” with
straight-related words and pictures). Over 20 percent of
self-described highly straight individuals showed this discrepancy.
Notably, these “discrepant” individuals were also significantly more
likely than other participants to favor anti-gay policies; to be
willing to assign significantly harsher punishments to perpetrators of
petty crimes if they were presumed to be homosexual; and to express
greater implicit hostility toward gay subjects (also measured with the
help of subliminal priming). Thus our research suggests that some who
oppose homosexuality do tacitly harbor same-sex attraction.
What leads to this repression? We found that participants who reported
having supportive and accepting parents were more in touch with their
implicit sexual orientation and less susceptible to homophobia.
Individuals whose sexual identity was at odds with their implicit
sexual attraction were much more frequently raised by parents
perceived to be controlling, less accepting and more prejudiced
against homosexuals.
It’s important to stress the obvious: Not all those who campaign
against gay men and lesbians secretly feel same-sex attractions. But
at least some who oppose homosexuality are likely to be individuals
struggling against parts of themselves, having themselves been victims
of oppression and lack of acceptance. The costs are great, not only
for the targets of anti-gay efforts but also often for the
perpetrators. We would do well to remember that all involved deserve
our compassion.
Richard M. Ryan is a professor of psychology, psychiatry and education
at the University of Rochester. William S. Ryan is a doctoral student
in psychology at the University of California, Santa Barbara.
By RICHARD M. RYAN and WILLIAM S. RYAN
Published: NYT April 27, 2012
WHY are political and religious figures who campaign against gay
rights so often implicated in sexual encounters with same-sex
partners?
In recent years, Ted Haggard, an evangelical leader who preached that
homosexuality was a sin, resigned after a scandal involving a former
male prostitute; Larry Craig, a United States senator who opposed
including sexual orientation in hate-crime legislation, was arrested
on suspicion of lewd conduct in a men’s bathroom; and Glenn Murphy
Jr., a leader of the Young Republican National Convention and an
opponent of same-sex marriage, pleaded guilty to a lesser charge after
being accused of sexually assaulting another man.
One theory is that homosexual urges, when repressed out of shame or
fear, can be expressed as homophobia. Freud famously called this
process a “reaction formation” — the angry battle against the outward
symbol of feelings that are inwardly being stifled. Even Mr. Haggard
seemed to endorse this idea when, apologizing after his scandal for
his anti-gay rhetoric, he said, “I think I was partially so vehement
because of my own war.”
It’s a compelling theory — and now there is scientific reason to
believe it. In this month’s issue of the Journal of Personality and
Social Psychology, we and our fellow researchers provide empirical
evidence that homophobia can result, at least in part, from the
suppression of same-sex desire.
Our paper describes six studies conducted in the United States and
Germany involving 784 university students. Participants rated their
sexual orientation on a 10-point scale, ranging from gay to straight.
Then they took a computer-administered test designed to measure their
implicit sexual orientation. In the test, the participants were shown
images and words indicative of hetero- and homosexuality (pictures of
same-sex and straight couples, words like “homosexual” and “gay”) and
were asked to sort them into the appropriate category, gay or
straight, as quickly as possible. The computer measured their reaction
times.
The twist was that before each word and image appeared, the word “me”
or “other” was flashed on the screen for 35 milliseconds — long enough
for participants to subliminally process the word but short enough
that they could not consciously see it. The theory here, known as
semantic association, is that when “me” precedes words or images that
reflect your sexual orientation (for example, heterosexual images for
a straight person), you will sort these images into the correct
category faster than when “me” precedes words or images that are
incongruent with your sexual orientation (for example, homosexual
images for a straight person). This technique, adapted from similar
tests used to assess attitudes like subconscious racial bias, reliably
distinguishes between self-identified straight individuals and those
who self-identify as lesbian, gay or bisexual.
Using this methodology we identified a subgroup of participants who,
despite self-identifying as highly straight, indicated some level of
same-sex attraction (that is, they associated “me” with gay-related
words and pictures faster than they associated “me” with
straight-related words and pictures). Over 20 percent of
self-described highly straight individuals showed this discrepancy.
Notably, these “discrepant” individuals were also significantly more
likely than other participants to favor anti-gay policies; to be
willing to assign significantly harsher punishments to perpetrators of
petty crimes if they were presumed to be homosexual; and to express
greater implicit hostility toward gay subjects (also measured with the
help of subliminal priming). Thus our research suggests that some who
oppose homosexuality do tacitly harbor same-sex attraction.
What leads to this repression? We found that participants who reported
having supportive and accepting parents were more in touch with their
implicit sexual orientation and less susceptible to homophobia.
Individuals whose sexual identity was at odds with their implicit
sexual attraction were much more frequently raised by parents
perceived to be controlling, less accepting and more prejudiced
against homosexuals.
It’s important to stress the obvious: Not all those who campaign
against gay men and lesbians secretly feel same-sex attractions. But
at least some who oppose homosexuality are likely to be individuals
struggling against parts of themselves, having themselves been victims
of oppression and lack of acceptance. The costs are great, not only
for the targets of anti-gay efforts but also often for the
perpetrators. We would do well to remember that all involved deserve
our compassion.
Richard M. Ryan is a professor of psychology, psychiatry and education
at the University of Rochester. William S. Ryan is a doctoral student
in psychology at the University of California, Santa Barbara.
4.15.2012
Long-Term Abstinence Following Holotropic Breathwork as Adjunctive Treatment of Substance Use Disorders and Related Psychiatric Comorbidity
Int J Ment Health Addiction DOI 10.1007/s11469-011-9352-3
Timothy D. Brewerton & James E. Eyerman & Pamela Cappetta & Michael C. Mithoefer
# Springer Science+Business Media, LLC 2011
Abstract Addictions remain challenging conditions despite various promising traditional approaches. Although complete, long-term abstinence may be ideal, its attainment remains elusive. Many recovering addicts and clinicians stress the importance of spiritual issues in recovery, and 12-step programs such as AA are well-known approaches that embrace this philosophy. Holotropic Breathwork (HB) is another powerful, spiritually oriented approach to self-exploration and healing that integrates insights from modern consciousness research, anthropology, depth psychologies, transpersonal psychology, Eastern spiritual practices, and many mystical traditions. HB offers the addict many opportunities that may enhance addiction treatment, including entering non-ordinary states of consciousness to seek healing and wisdom via a natural, non-addictive method, a direct experience of one’s Higher Power, and for physical and emotional catharsis associated with stress and prior trauma. We report the successful use of HB in 4 cases in which complete abstinence was obtained and maintained for extended periods of time (2–19 years).
Keywords HolotropicBreathwork.Addiction.Substanceusedisorders.Psychotherapy. Spirituality. Comorbidity. Abstinence . Follow-up
Oral paper presentation at the Annual Meeting of the International Society of Addiction Medicine, November 2008, Cape Town, South Africa
T. D. Brewerton
Medical University of South Carolina, Charleston, SC, USA
J. E. Eyerman
University of California, San Francisco, CA, USA
P. Cappetta
Private Practice, Williamsburg, VA, USA
T. D. Brewerton : M. C. Mithoefer Private Practice, Mt. Pleasant, SC, USA
T. D. Brewerton (*)
216 Scott Street, Mt. Pleasant, SC 29464, USA e-mail: drtimothybrewerton@gmail.com
J. E. Eyerman
Private practice, Mill Valley, CA, USA
Int J Ment Health Addiction
Addictions to alcohol and various substances of abuse remain challenging conditions to treat, despite various promising traditional approaches. Although complete, long-term abstinence may be ideal, the attainment of this goal is often elusive. Many recovering addicts and clinical investigators alike have stressed the importance of spiritual or transpersonal issues in the recovery process, and 12-step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are well-known, successful approaches that incorporate this philosophy (Connors et al. 2001; Emrick et al. 1993; Moos and Moos 2004; Moos et al. 2004; Tonigan et al. 2003). Bill Wilson and other founders of AA and the 12-step philosophy emphasize the importance of a “spiritual awakening” or transformation in the process of recovery (AA Services 2002).
Holotropic Breathwork (HB) is another spiritually oriented approach that provides a non-pharmacologic means of attaining non-ordinary states of consciousness (NOSC) (Taylor 1994, 2003; Grof and Grof 2010). HB is a powerful approach to self-exploration and healing that integrates insights from modern consciousness research, anthropology, various depth psychologies, transpersonal psychology, Eastern spiritual practices, and other mystical traditions of the world. HB is a method of self-exploration that combines rapid, deep breathing, evocative music, focused body work, artistic expression and group sharing in a safe, supportive environment. It was created by the Czecho-American psychoanalyst Stanislav Grof, MD and his wife Christina Grof in the 1970’s after studying the use of NOSC in various cultures and settings. They coined the term “holotropic”: “holo” means wholeness and “tropic” means moving toward; “moving toward wholeness.” The mechanisms by which this combination of initial deep hyperventilation, music and set and setting lead to powerful “non-ordinary” or “holotropic” states of consciousness have not been directly studied and are not fully understood. It is well established that hyperventilation causes hypocapnia and respiratory alkalosis, which leads to a leftward shift in the oxyhemoglobin dissociation curve. This effect, combined with the vasoconstriction that accompanies alkalosis, can lead to decreased oxygen delivery to tissues, including the brain. It has also been demonstrated that music can profoundly affect brain states, and that repetitive rhythms such as those used in Holotropic Breathwork have EEG effects and lead to trance-like states. In any case, Grof hypothesizes that a combination of physiologic changes, rather than determining the nature of Holotropic Breathwork participants’ experiences, instead act as “nonspecific releasers” that allow access to realms of the psyche that are not usually accessible in every-day states of consciousness.
Empirical observations suggest that during an HB session the human organism moves to integrate, to make itself whole, and to heal the various injured or fragmented parts of the self. HB assists this process by inducing a NOSC and by creating a safe context within which to reconnect with self, others and spirit. Several investigators have noted the importance of spiritual transformation in the process of healing. Andrew Weil (1972) noted, “Every human being is born with an innate drive to experience altered states of consciousness periodically to learn how to get away from ordinary ego-centered consciousness.” In his letter to Bill Wilson, Carl Jung (1961) noted that “... craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.” He went on to say, “You see, ‘alcohol’ in Latin is ‘spiritus’ and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.” According to Jung, only a very deep spiritual experience can rescue an individual from alcohol’s destructive effects. Similarly, William James (1902) noted, “Religiomania is the best therapy for dipsomania.”
Int J Ment Health Addiction
Many experiences arise in the process of this work but having breathwork experiences per se (e.g., rebirth, ecstasy) is not the purpose. Rather, the goals are awareness, wholeness, healing, self-knowledge, growth and wisdom. Experiences are means to these goals and occur when the body-mind enters a non-ordinary state of consciousness (NOSC) through controlled breathing. The individual’s inner wisdom uses the opportunity to work toward physical, mental, emotional and spiritual healing and developmental change. HB operates under the principle that we are our own best healers (“Inner Healer”). HB incorporates controlled breathing, music, one-on-one supervision within a group setting, expressive art, and a flexible and open-ended time period. These elements, supported and facilitated by thoroughly trained practitioners, promote safety and healing in non-ordinary states of consciousness.
Metcalf (1995) examined the effects of HB in 20 adults (10 men & 10 women) recovering from alcoholism or other chemical addictions. Using a self-report, structured survey, major underlying issues were assessed to determine the clinical efficacy of utilizing HB in psychotherapy and treatment settings. Results indicated that HB is an effective therapeutic tool for treating alcoholism and drug addiction and that HB could prove very beneficial for relapse prevention. Each category examined showed marked improvement or a positive outcome with the highest improvements in the areas of depression, anxiety, other feelings and emotions, family relationships and intimacy, stress reduction, self-esteem and spirituality.
In a study by Jefferys (1999) the effectiveness of incorporating transpersonal psychotherapy (using HB) into traditional approaches to the treatment of chemically dependent individuals was assessed. The complementary nature of traditional psychotherapy and self-help groups such as 12-step recovery was also explored. The subjects included 29 adults (20 men & 9 women) who completed a 13 month outpatient treatment program for chemical dependency. The subjects were followed for 1 year post-treatment by an independent employee assistance-managed care firm to determine treatment outcomes. Results of the analyses of outcome data indicated that this model offers an effective treatment approach for this group of chemically dependent clients.
In 1993 HB was offered by Taylor (2007) to 56 participants in the Therapeutic Community of Sunflower House, in Santa Cruz, CA who had a mean of 2.1 HB sessions in addition to their usual therapy. Questionnaires were administered before HB, 2 weeks after HB, and upon transitioning to a point in the program where they were training to seek employment. Although only 9 respondents completed the final post-questionnaire, during the 18-month study period, 55% of residents who did HB stayed clean and sober and remained outside of the court system versus 27% of those who left treatment during this time period.
Case # 1
B.G. was a 14 y/o WM with polysubstance abuse (including inhalants, marijuana, stimulants, PCP, psychedelics & alcohol) and a history of physical/sexual abuse documented by social services from the age of 6 to 11 years old, when he was placed in foster care.
He was treated with: A) Sertraline 100 mg daily & hydroxyzine 50 mg prn agitation; B) weekly individual psychotherapy with a staff social worker, and; 3) 12-step groups (AA and NA).
After a week of abusing multiple substances, he became combative and threatened to hurt peers, staff and himself and was admitted to an inpatient facility. His sertraline was titrated to 150 mg and trazodone 50 mg was added at bedtime for insomnia.
Int J Ment Health Addiction
After being in residential treatment for 2 years he attended his first HB session with 19 other inpatients ranging widely in age and diagnostic categories. During the group sharing he reported having met his “Higher Power” and stated, “I was up in the sky and a hand came through a cloud to shake mine. The cloud parted and it was Jesus. I had never believed in that Higher Power crap but I feel really good and I think that the 12 steps are right...my Higher Power can heal me.”
His affect and mood improved markedly and the improvement was sustained. He returned to his residential facility where he continued to have HB sessions approximately once a month for 2 years during which time he achieved complete abstinence. He also continued to attend AA meetings and work the 12 steps.
At age 16 he relapsed into substance abuse for a few days but recovered without significant intervention and had another year of abstinence when he was adopted by relatives and lost to follow-up.
Case # 2
C.R. was a 31 y/o WF worker for a social service agency with suicidal major depression and a history of alcoholism and polysubstance abuse (PSA). She first experienced HB after she admitted herself to an inpatient unit due to the deterioration of her mood and to prevent an alcoholic relapse.
She had been sexually abused by her step-father during the ages of 12–14, then became a run-away living on the street as a drug addict and child prostitute when her older brother, her main support in her family, died in combat. She had recovered in her early 20’s through a 12-step program but she continued to cycle through severe major depressive episodes despite individual psychotherapy and antidepressant medications. At the time of admission, she was being treated as an outpatient with fluoxetine 60 mg and trazodone 50 mg. Her medication was unchanged during her 2 week hospitalization except for an increase in trazodone to 75 mg.
After the first HB she refused to draw or share anything, but her affect appeared improved. The next week, after hearing the reports of others in the group sessions, she decided to share her experience: “All this is too weird, but this is what happened: in the first session my dead father and dead brother showed up. They lifted me out of my body and took me to a wonderful place full of light and joy; I was so comforted. But then they dropped me back into my body. I just couldn’t talk about it, it was just too weird! In my second Breathwork session, my father and brother showed up again. This time they held my hands and stayed in the room. I could see them with my eyes open; I thought you could see them too.” As her Breathwork facilitator, I assured her, “I could not see them but that does not invalidate your experience.” This woman did well for over 3 years when she was lost to follow-up at which time she had become a leader of a 12-step program in her community.
Case # 3
D.K. was a 49 y/o WM physician with recurrent major depression, posttraumatic stress disorder (PTSD) and marijuana abuse and dependence for 30 years. History is remarkable for physical and emotional abuse at ages 3–6 in the name of religion resulting in PTSD, dysthymia, motor tics, nocturnal enuresis and episodes of encopresis
Int J Ment Health Addiction
at school. Marijuana abuse began at age 20 followed by the abuse of psychedelics (psilocybin, LSD) within 1 year.
His first major depressive episode was triggered at age 22 by the break-up with his “childhood sweetheart” of 7 years who had an affair with and married his childhood best friend. Self-treatment with imipramine was unsuccessful and resulted in an allergic rash.
Despite multiple courses of individual and group psychotherapies and antidepressants (imipramine, desipramine, phenelzine, fluoxetine, nefazodone), his depression and marijuana dependence continued unabated until he began HB at age 48. After 4 sessions he became abstinent for 6 months, then relapsed, but drug use was more egodystonic.
After 20 more HB sessions over 2 years he became completely abstinent and has remained so for over 8 years. Salient experiences during HB sessions included a strong sense of connection with the Divine, of being one with the universe, and a rapprochement experience with Jesus Christ. As a child his mother had made him kiss a large, life-like crucifix while threatening hell and damnation, and both parents had used corporal punishment liberally while telling him he was unloved by Jesus and Mary.
During HB he experienced the sense of flying through the sky with a “smiling, loving Jesus” as well as the sense of being loved unconditionally, and forgiven. In other HB sessions he expressed his anger and rage at his parents and came to a point of profound acceptance and forgiveness of them, seeing their own childhood abuse with compassion.
Case # 4
A.T. was a 42 y/o WF psychotherapist with a 29 year history of PSA (alcohol, marijuana, and cocaine), PTSD, major depressive disorder, generalized anxiety disorder, panic disorder, and migraine.
She participated in outpatient psychotherapy with one therapist for 10 years (weekly to biweekly) without attaining complete abstinence. At the suggestion of her therapist she began a series of approximately 45 HB sessions over 17 years beginning 60 days after getting sober with AA. Nineteen years after beginning HB she remains abstinent from all substances. She also continued in outpatient psychotherapy with another therapist for 6 years (every other month), as well as with AA and NA.
Early traumatic experiences reported included: a) attempted abortion by mother; b) surgeries for congenital urethral stricture (ages 3–4); c) locked in closets and crawl spaces with mice by schizophrenic mother (ages 4–5); d) had multiple medical treatments (weekly to monthly) to stretch urethral stricture using Q-tips with no sedatives (ages 3–8); e) repeatedly beaten by father, dragged out of car, hit across face and sworn at for being “stupid” and “unlovable”; f) fondling by older girls in grade school; g) date rape age 18.
“During an early breathwork session I experienced a memory at my birth...I was a C- section and was a month early...mother had been sick and the doctors tried to keep her from having me early...during the breathwork I experienced a drugged feeling and made the conscious connection to marijuana...the feeling at my birth was of being drugged...the downer of pot...and also that as an infant I wanted the doctors to save my mother and let me die...After the session I talked to my mother who told me that they had injected pain killers in her abdomen during the days preceding my birth to try to keep her from having me...So...my use of pot had replicated my earliest memories at birth.”
She also reported that during a Breathwork session, “I was an infant in the OR and I kept telling them to save mother and let me die, and then I had another breathwork where Christ came to me and told me he died for my sins and I didn’t have to die for my mother.”
Discussion
Taken together, these case reports add to previous available evidence suggesting that HB offers a powerful therapeutic modality that can lead to prolonged abstinence from alcohol and other addictive substances, even in previously treatment refractory individuals. In addition, HB appeared to help alleviate the symptoms of underlying depression, anxiety and early traumas, particularly when used in conjunction with established treatment modalities, including cognitive-behavioral therapy, psychodynamic therapy, 12-step programs, psychopharmacology, and eye movement desensitization reprocessing (EMDR).
There are a number of factors that may have contributed to the therapeutic effect of HB in these cases. Taylor (2007) identified ten opportunities for enhancing the treatment of substance abuse using HB, which include the following: 1) to enter non-ordinary states (NOS) of consciousness to seek healing and wisdom, using a natural, non-addictive method; 2) for a direct experience of one’s Higher Power; 3) to experience self- empowerment by using one’s own breath for profound healing; 4) for physical and emotional catharsis of stress and trauma by resolving past issues; 5) for bonding with others through the group sharing and the sitter/breather partnership; 6) to deal with themes of death and surrender, which are frequent and powerful issues for addicts because of drug overdoses, abortions, HIV/AIDS and other serious illnesses, crime, and encounters with the criminal justice system; 7) to experience a retreat period of inner reflection, which provides balance to the often highly structured, active lives of recovering addicts; 8) to get in touch with the body, to re-associate what has been dissociated, including feelings of pleasure and unfelt, unresolved traumas; 9) of permission for sound and movement, which facilitates self-expression and self-trust, and; 10) for insight, understanding, and acceptance of accountability for one’s life and actions.
Rhinewine and Williams (2007) reviewed the neurophysiology and psychology of HB as a novel psychotherapy treatment adjunct and hypothesized that the hyperventilation of HB may facilitate generalized extinction of avoidance behaviors which in turn results in therapeutic progress.
The successful use of HB in these cases also contributes to the growing literature attesting to the importance of spirituality in addiction recovery. Future controlled studies of HB in the treatment of substance use disorders and associated comorbidity are warranted.
References
AA Services (2002). Twelve steps and twelve traditions, Alcoholics Anonymous World Services, Inc.; 46th printing edition.
Connors, G. J., Tonigan, J. S., & Miller, W. R. (2001). A longitudinal model of intake symptomatology, AA participation and outcome: retrospective study of the Project MATCH outpatient and aftercare samples. Journal of Studies on Alcohol, 62, 817–825.
Emrick, C. D., Tonigan, J. S., Montgomery, H. A., & Little, L. (1993). Alcoholics anonymous: What is currently known? In B. S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives (pp. 41–76). New Brunswick: NJ7 Rutgers Center on Alcohol Studies.
Grof, S., & Grof, C. (2010). Holotropic Breathwork: A new approach to self-exploration and therapy. Excelsior Editions/State University of New York.
James, W. (1902). The varieties of religious experience: A study in human nature. Cosimo Classics. Jefferys, B. (1999). Transpersonal psychotherapy with chemically dependent clients. (Unpublished PhD
Dissertation, 1999).
Int J Ment Health Addiction
Int J Ment Health Addiction
Jung, C.G., (1961). Letter to Bill Wilson (January 30, 1961), Grapevine; published by the permission of the Jung estate.
Metcalf, B. A. (1995). (Unpublished Dissertation). Examining the Effects of Holotropic Breathwork in the Recovery from Alcoholism and Drug Dependence.
Moos, R. H., & Moos, B. S. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology, 72, 81–90.
Moos, R. H., Schutte, K., Brennan, P., & Moos, B. S. (2004). Ten-year patterns of alcohol consumption and drinking problems among older women and men. Addiction, 99, 829–838.
Rhinewine, J. P., & Williams, O. J. (2007). Holotropic Breathwork: the potential role of a prolonged, voluntary hyperventilation procedure as an adjunct to psychotherapy. The Journal of Alternative and Complementary Medicine, 13, 771–776.
Taylor, K. (1994). The Breathwork experience: Explorations of healing in non-ordinary states of consciousness. Santa Cruz: Hanford Mead Publishers, Inc.
Taylor, K. (Ed.). (2003). Exploring holotropic Breathwork: Selected articles from a decade of articles from the inner door. Santa Cruz: Hanford Mead Publishers, Inc.
Taylor, K. (2007). Holotropic Breathwork adjunct to substance abuse treatment in therapeutic community. In K. Taylor & S. Macy (Eds.), MFT considering holotropic Breathwork. Santa Cruz: Hanford Mead Publishers, Inc.
Tonigan, J. S., Connors, G. J., & Miller, W. R. (2003). Participation and involvement in Alcoholics Anonymous. In T. F. Babor (Ed.), Treatment matching in alcoholism (pp. 184–204). New York: Cambridge University Press.
Weil, A. (1972). The natural mind: A new way of looking at drugs and higher consciousness. Boston: Houghton Mifflin.
Timothy D. Brewerton & James E. Eyerman & Pamela Cappetta & Michael C. Mithoefer
# Springer Science+Business Media, LLC 2011
Abstract Addictions remain challenging conditions despite various promising traditional approaches. Although complete, long-term abstinence may be ideal, its attainment remains elusive. Many recovering addicts and clinicians stress the importance of spiritual issues in recovery, and 12-step programs such as AA are well-known approaches that embrace this philosophy. Holotropic Breathwork (HB) is another powerful, spiritually oriented approach to self-exploration and healing that integrates insights from modern consciousness research, anthropology, depth psychologies, transpersonal psychology, Eastern spiritual practices, and many mystical traditions. HB offers the addict many opportunities that may enhance addiction treatment, including entering non-ordinary states of consciousness to seek healing and wisdom via a natural, non-addictive method, a direct experience of one’s Higher Power, and for physical and emotional catharsis associated with stress and prior trauma. We report the successful use of HB in 4 cases in which complete abstinence was obtained and maintained for extended periods of time (2–19 years).
Keywords HolotropicBreathwork.Addiction.Substanceusedisorders.Psychotherapy. Spirituality. Comorbidity. Abstinence . Follow-up
Oral paper presentation at the Annual Meeting of the International Society of Addiction Medicine, November 2008, Cape Town, South Africa
T. D. Brewerton
Medical University of South Carolina, Charleston, SC, USA
J. E. Eyerman
University of California, San Francisco, CA, USA
P. Cappetta
Private Practice, Williamsburg, VA, USA
T. D. Brewerton : M. C. Mithoefer Private Practice, Mt. Pleasant, SC, USA
T. D. Brewerton (*)
216 Scott Street, Mt. Pleasant, SC 29464, USA e-mail: drtimothybrewerton@gmail.com
J. E. Eyerman
Private practice, Mill Valley, CA, USA
Int J Ment Health Addiction
Addictions to alcohol and various substances of abuse remain challenging conditions to treat, despite various promising traditional approaches. Although complete, long-term abstinence may be ideal, the attainment of this goal is often elusive. Many recovering addicts and clinical investigators alike have stressed the importance of spiritual or transpersonal issues in the recovery process, and 12-step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are well-known, successful approaches that incorporate this philosophy (Connors et al. 2001; Emrick et al. 1993; Moos and Moos 2004; Moos et al. 2004; Tonigan et al. 2003). Bill Wilson and other founders of AA and the 12-step philosophy emphasize the importance of a “spiritual awakening” or transformation in the process of recovery (AA Services 2002).
Holotropic Breathwork (HB) is another spiritually oriented approach that provides a non-pharmacologic means of attaining non-ordinary states of consciousness (NOSC) (Taylor 1994, 2003; Grof and Grof 2010). HB is a powerful approach to self-exploration and healing that integrates insights from modern consciousness research, anthropology, various depth psychologies, transpersonal psychology, Eastern spiritual practices, and other mystical traditions of the world. HB is a method of self-exploration that combines rapid, deep breathing, evocative music, focused body work, artistic expression and group sharing in a safe, supportive environment. It was created by the Czecho-American psychoanalyst Stanislav Grof, MD and his wife Christina Grof in the 1970’s after studying the use of NOSC in various cultures and settings. They coined the term “holotropic”: “holo” means wholeness and “tropic” means moving toward; “moving toward wholeness.” The mechanisms by which this combination of initial deep hyperventilation, music and set and setting lead to powerful “non-ordinary” or “holotropic” states of consciousness have not been directly studied and are not fully understood. It is well established that hyperventilation causes hypocapnia and respiratory alkalosis, which leads to a leftward shift in the oxyhemoglobin dissociation curve. This effect, combined with the vasoconstriction that accompanies alkalosis, can lead to decreased oxygen delivery to tissues, including the brain. It has also been demonstrated that music can profoundly affect brain states, and that repetitive rhythms such as those used in Holotropic Breathwork have EEG effects and lead to trance-like states. In any case, Grof hypothesizes that a combination of physiologic changes, rather than determining the nature of Holotropic Breathwork participants’ experiences, instead act as “nonspecific releasers” that allow access to realms of the psyche that are not usually accessible in every-day states of consciousness.
Empirical observations suggest that during an HB session the human organism moves to integrate, to make itself whole, and to heal the various injured or fragmented parts of the self. HB assists this process by inducing a NOSC and by creating a safe context within which to reconnect with self, others and spirit. Several investigators have noted the importance of spiritual transformation in the process of healing. Andrew Weil (1972) noted, “Every human being is born with an innate drive to experience altered states of consciousness periodically to learn how to get away from ordinary ego-centered consciousness.” In his letter to Bill Wilson, Carl Jung (1961) noted that “... craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.” He went on to say, “You see, ‘alcohol’ in Latin is ‘spiritus’ and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.” According to Jung, only a very deep spiritual experience can rescue an individual from alcohol’s destructive effects. Similarly, William James (1902) noted, “Religiomania is the best therapy for dipsomania.”
Int J Ment Health Addiction
Many experiences arise in the process of this work but having breathwork experiences per se (e.g., rebirth, ecstasy) is not the purpose. Rather, the goals are awareness, wholeness, healing, self-knowledge, growth and wisdom. Experiences are means to these goals and occur when the body-mind enters a non-ordinary state of consciousness (NOSC) through controlled breathing. The individual’s inner wisdom uses the opportunity to work toward physical, mental, emotional and spiritual healing and developmental change. HB operates under the principle that we are our own best healers (“Inner Healer”). HB incorporates controlled breathing, music, one-on-one supervision within a group setting, expressive art, and a flexible and open-ended time period. These elements, supported and facilitated by thoroughly trained practitioners, promote safety and healing in non-ordinary states of consciousness.
Metcalf (1995) examined the effects of HB in 20 adults (10 men & 10 women) recovering from alcoholism or other chemical addictions. Using a self-report, structured survey, major underlying issues were assessed to determine the clinical efficacy of utilizing HB in psychotherapy and treatment settings. Results indicated that HB is an effective therapeutic tool for treating alcoholism and drug addiction and that HB could prove very beneficial for relapse prevention. Each category examined showed marked improvement or a positive outcome with the highest improvements in the areas of depression, anxiety, other feelings and emotions, family relationships and intimacy, stress reduction, self-esteem and spirituality.
In a study by Jefferys (1999) the effectiveness of incorporating transpersonal psychotherapy (using HB) into traditional approaches to the treatment of chemically dependent individuals was assessed. The complementary nature of traditional psychotherapy and self-help groups such as 12-step recovery was also explored. The subjects included 29 adults (20 men & 9 women) who completed a 13 month outpatient treatment program for chemical dependency. The subjects were followed for 1 year post-treatment by an independent employee assistance-managed care firm to determine treatment outcomes. Results of the analyses of outcome data indicated that this model offers an effective treatment approach for this group of chemically dependent clients.
In 1993 HB was offered by Taylor (2007) to 56 participants in the Therapeutic Community of Sunflower House, in Santa Cruz, CA who had a mean of 2.1 HB sessions in addition to their usual therapy. Questionnaires were administered before HB, 2 weeks after HB, and upon transitioning to a point in the program where they were training to seek employment. Although only 9 respondents completed the final post-questionnaire, during the 18-month study period, 55% of residents who did HB stayed clean and sober and remained outside of the court system versus 27% of those who left treatment during this time period.
Case # 1
B.G. was a 14 y/o WM with polysubstance abuse (including inhalants, marijuana, stimulants, PCP, psychedelics & alcohol) and a history of physical/sexual abuse documented by social services from the age of 6 to 11 years old, when he was placed in foster care.
He was treated with: A) Sertraline 100 mg daily & hydroxyzine 50 mg prn agitation; B) weekly individual psychotherapy with a staff social worker, and; 3) 12-step groups (AA and NA).
After a week of abusing multiple substances, he became combative and threatened to hurt peers, staff and himself and was admitted to an inpatient facility. His sertraline was titrated to 150 mg and trazodone 50 mg was added at bedtime for insomnia.
Int J Ment Health Addiction
After being in residential treatment for 2 years he attended his first HB session with 19 other inpatients ranging widely in age and diagnostic categories. During the group sharing he reported having met his “Higher Power” and stated, “I was up in the sky and a hand came through a cloud to shake mine. The cloud parted and it was Jesus. I had never believed in that Higher Power crap but I feel really good and I think that the 12 steps are right...my Higher Power can heal me.”
His affect and mood improved markedly and the improvement was sustained. He returned to his residential facility where he continued to have HB sessions approximately once a month for 2 years during which time he achieved complete abstinence. He also continued to attend AA meetings and work the 12 steps.
At age 16 he relapsed into substance abuse for a few days but recovered without significant intervention and had another year of abstinence when he was adopted by relatives and lost to follow-up.
Case # 2
C.R. was a 31 y/o WF worker for a social service agency with suicidal major depression and a history of alcoholism and polysubstance abuse (PSA). She first experienced HB after she admitted herself to an inpatient unit due to the deterioration of her mood and to prevent an alcoholic relapse.
She had been sexually abused by her step-father during the ages of 12–14, then became a run-away living on the street as a drug addict and child prostitute when her older brother, her main support in her family, died in combat. She had recovered in her early 20’s through a 12-step program but she continued to cycle through severe major depressive episodes despite individual psychotherapy and antidepressant medications. At the time of admission, she was being treated as an outpatient with fluoxetine 60 mg and trazodone 50 mg. Her medication was unchanged during her 2 week hospitalization except for an increase in trazodone to 75 mg.
After the first HB she refused to draw or share anything, but her affect appeared improved. The next week, after hearing the reports of others in the group sessions, she decided to share her experience: “All this is too weird, but this is what happened: in the first session my dead father and dead brother showed up. They lifted me out of my body and took me to a wonderful place full of light and joy; I was so comforted. But then they dropped me back into my body. I just couldn’t talk about it, it was just too weird! In my second Breathwork session, my father and brother showed up again. This time they held my hands and stayed in the room. I could see them with my eyes open; I thought you could see them too.” As her Breathwork facilitator, I assured her, “I could not see them but that does not invalidate your experience.” This woman did well for over 3 years when she was lost to follow-up at which time she had become a leader of a 12-step program in her community.
Case # 3
D.K. was a 49 y/o WM physician with recurrent major depression, posttraumatic stress disorder (PTSD) and marijuana abuse and dependence for 30 years. History is remarkable for physical and emotional abuse at ages 3–6 in the name of religion resulting in PTSD, dysthymia, motor tics, nocturnal enuresis and episodes of encopresis
Int J Ment Health Addiction
at school. Marijuana abuse began at age 20 followed by the abuse of psychedelics (psilocybin, LSD) within 1 year.
His first major depressive episode was triggered at age 22 by the break-up with his “childhood sweetheart” of 7 years who had an affair with and married his childhood best friend. Self-treatment with imipramine was unsuccessful and resulted in an allergic rash.
Despite multiple courses of individual and group psychotherapies and antidepressants (imipramine, desipramine, phenelzine, fluoxetine, nefazodone), his depression and marijuana dependence continued unabated until he began HB at age 48. After 4 sessions he became abstinent for 6 months, then relapsed, but drug use was more egodystonic.
After 20 more HB sessions over 2 years he became completely abstinent and has remained so for over 8 years. Salient experiences during HB sessions included a strong sense of connection with the Divine, of being one with the universe, and a rapprochement experience with Jesus Christ. As a child his mother had made him kiss a large, life-like crucifix while threatening hell and damnation, and both parents had used corporal punishment liberally while telling him he was unloved by Jesus and Mary.
During HB he experienced the sense of flying through the sky with a “smiling, loving Jesus” as well as the sense of being loved unconditionally, and forgiven. In other HB sessions he expressed his anger and rage at his parents and came to a point of profound acceptance and forgiveness of them, seeing their own childhood abuse with compassion.
Case # 4
A.T. was a 42 y/o WF psychotherapist with a 29 year history of PSA (alcohol, marijuana, and cocaine), PTSD, major depressive disorder, generalized anxiety disorder, panic disorder, and migraine.
She participated in outpatient psychotherapy with one therapist for 10 years (weekly to biweekly) without attaining complete abstinence. At the suggestion of her therapist she began a series of approximately 45 HB sessions over 17 years beginning 60 days after getting sober with AA. Nineteen years after beginning HB she remains abstinent from all substances. She also continued in outpatient psychotherapy with another therapist for 6 years (every other month), as well as with AA and NA.
Early traumatic experiences reported included: a) attempted abortion by mother; b) surgeries for congenital urethral stricture (ages 3–4); c) locked in closets and crawl spaces with mice by schizophrenic mother (ages 4–5); d) had multiple medical treatments (weekly to monthly) to stretch urethral stricture using Q-tips with no sedatives (ages 3–8); e) repeatedly beaten by father, dragged out of car, hit across face and sworn at for being “stupid” and “unlovable”; f) fondling by older girls in grade school; g) date rape age 18.
“During an early breathwork session I experienced a memory at my birth...I was a C- section and was a month early...mother had been sick and the doctors tried to keep her from having me early...during the breathwork I experienced a drugged feeling and made the conscious connection to marijuana...the feeling at my birth was of being drugged...the downer of pot...and also that as an infant I wanted the doctors to save my mother and let me die...After the session I talked to my mother who told me that they had injected pain killers in her abdomen during the days preceding my birth to try to keep her from having me...So...my use of pot had replicated my earliest memories at birth.”
She also reported that during a Breathwork session, “I was an infant in the OR and I kept telling them to save mother and let me die, and then I had another breathwork where Christ came to me and told me he died for my sins and I didn’t have to die for my mother.”
Discussion
Taken together, these case reports add to previous available evidence suggesting that HB offers a powerful therapeutic modality that can lead to prolonged abstinence from alcohol and other addictive substances, even in previously treatment refractory individuals. In addition, HB appeared to help alleviate the symptoms of underlying depression, anxiety and early traumas, particularly when used in conjunction with established treatment modalities, including cognitive-behavioral therapy, psychodynamic therapy, 12-step programs, psychopharmacology, and eye movement desensitization reprocessing (EMDR).
There are a number of factors that may have contributed to the therapeutic effect of HB in these cases. Taylor (2007) identified ten opportunities for enhancing the treatment of substance abuse using HB, which include the following: 1) to enter non-ordinary states (NOS) of consciousness to seek healing and wisdom, using a natural, non-addictive method; 2) for a direct experience of one’s Higher Power; 3) to experience self- empowerment by using one’s own breath for profound healing; 4) for physical and emotional catharsis of stress and trauma by resolving past issues; 5) for bonding with others through the group sharing and the sitter/breather partnership; 6) to deal with themes of death and surrender, which are frequent and powerful issues for addicts because of drug overdoses, abortions, HIV/AIDS and other serious illnesses, crime, and encounters with the criminal justice system; 7) to experience a retreat period of inner reflection, which provides balance to the often highly structured, active lives of recovering addicts; 8) to get in touch with the body, to re-associate what has been dissociated, including feelings of pleasure and unfelt, unresolved traumas; 9) of permission for sound and movement, which facilitates self-expression and self-trust, and; 10) for insight, understanding, and acceptance of accountability for one’s life and actions.
Rhinewine and Williams (2007) reviewed the neurophysiology and psychology of HB as a novel psychotherapy treatment adjunct and hypothesized that the hyperventilation of HB may facilitate generalized extinction of avoidance behaviors which in turn results in therapeutic progress.
The successful use of HB in these cases also contributes to the growing literature attesting to the importance of spirituality in addiction recovery. Future controlled studies of HB in the treatment of substance use disorders and associated comorbidity are warranted.
References
AA Services (2002). Twelve steps and twelve traditions, Alcoholics Anonymous World Services, Inc.; 46th printing edition.
Connors, G. J., Tonigan, J. S., & Miller, W. R. (2001). A longitudinal model of intake symptomatology, AA participation and outcome: retrospective study of the Project MATCH outpatient and aftercare samples. Journal of Studies on Alcohol, 62, 817–825.
Emrick, C. D., Tonigan, J. S., Montgomery, H. A., & Little, L. (1993). Alcoholics anonymous: What is currently known? In B. S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives (pp. 41–76). New Brunswick: NJ7 Rutgers Center on Alcohol Studies.
Grof, S., & Grof, C. (2010). Holotropic Breathwork: A new approach to self-exploration and therapy. Excelsior Editions/State University of New York.
James, W. (1902). The varieties of religious experience: A study in human nature. Cosimo Classics. Jefferys, B. (1999). Transpersonal psychotherapy with chemically dependent clients. (Unpublished PhD
Dissertation, 1999).
Int J Ment Health Addiction
Int J Ment Health Addiction
Jung, C.G., (1961). Letter to Bill Wilson (January 30, 1961), Grapevine; published by the permission of the Jung estate.
Metcalf, B. A. (1995). (Unpublished Dissertation). Examining the Effects of Holotropic Breathwork in the Recovery from Alcoholism and Drug Dependence.
Moos, R. H., & Moos, B. S. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology, 72, 81–90.
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