6 July 2011  

Love’s role in Psychiatry
Heidi Waltos, RN, MSN, CNS

http://www.retreatatsp.org/latest-news/uncategorized/loves-role-in-psychiatry/

Every few months I ask my boss if he doesn’t agree that love is ultimately the primary ingredient in the healing equation… he smiles kindly and nods, “sure it is”….I persist, “Why then aren’t there more articles in the psychiatric literature about love, why is the “L- word” not part of our everyday lexicon?”. Though I work with an extraordinarily loving staff, love is rarely directly spoken of.

Is it possible we are being too squeamish? By not speaking of LOVE, have we been neglecting a huge opportunity for growth in all of us? Perhaps we are seeing love only in its most narrow sense, as a reflection of passion, desire, and attraction (what the Greeks termed eros). But this only a tiny piece of what love is. Widening the aperture, we see that love is also characterized by sharing and participation, something which creates relationships between people, families, communities, countries, etc (philos). And in its highest, most comprehensive form (agape), love is something which has the power to dissolve our separate existence…our false sense of self. The emotion of love is expansive, paradoxical in its ability to calm and excite at the same time, empowering yet selfless… Instead of seeking something externally to feel complete, we experience feeling our most whole and authentic when we are able to remove those obstacles which interfere with our ability to simply be loving beings. We all have the right to be loved, but more importantly we have the right to be ‘love’ itself. This lies at the core of our humanity.

If we cannot freely discuss love in the context of providing care, what are our chances of bringing values of love into other institutions, businesses, economic and political systems, (which could use some healing in these times)? There is no other profession where people more closely encounter one another than in the patient-practitioner relationship. At no time is our tendency to love stronger than when caring for someone who is vulnerable and/or suffering and at no time is there a greater need to be connected and loved than when one feels disconnected by sickness. As Dr. Naomi Remen notes, “Medicine is as close to love as it is to science and our challenge as practitioners is to relearn how to practice medicine with our hearts wide open” (Remen, 1996). Those who do manage to incorporate agape-type love, develop such astounding objective sympathy for the patient’s condition – the same sympathy that enlightened people have always brought to the human condition itself. The relationship becomes a true partnership.

Love from a scientific perspective

Perhaps love hasn’t claimed its rightful place in medicine because we don’t know a lot about the biology of love yet. So far, we can say it is a complex neurobiological phenomenon involving things like pleasure, trust, etc. which then activate specific brain regions and processes. The associated anatomical regions appear to be the limbic areas. The regulatory systems necessary for survival and beneficial biological behaviors, such as eating, sex, and reproduction also play a role. Pharmacologically, animal studies and observations of patients link central dopamine and norepinephrine with sexual motivation and arousal, serotonin with increased attachment (though, inhibited sex drive), endorphins with feelings of well-being and evidence suggests oxytocin (an endogenous neuropeptide), in part, modulates social affiliation. So far though, we do not have any exogenous compounds that reliably induce the emotion of love.

We are also learning that emotions may be emanating primarily from the heart to the brain instead of the other way around. When shown pictures of highly emotional content (either horrific or awe inspiring) the electrical signals of individual’s hearts precede those measured in their brains. Research also indicates that the heart sends more information to the brain than the brain sends to the heart. “As we experience feelings like anger, frustration, anxiety and insecurity, our heart rhythm patterns become more erratic. These erratic patterns are sent to the emotional centers in the brain which it recognizes as negative or stressful feelings. The erratic heart rhythms also block our ability to think clearly and start a chain reaction in the body – stress hormone levels increase, blood vessels constrict, blood pressure rises, and the immune system is weakened. Conversely, research also substantiates that when we experience heart-felt emotions like love, (appreciation, acceptance and compassion) the heart produces a smooth pattern that looks like gently rolling waves. Harmonious heart rhythms, which reflect positive emotions, are indicators of cardiovascular efficiency and nervous system balance.” (HeartMath, 2009).Not only are we realizing we truly do sense things with our heart but we are beginning to understand just how powerful our over-laid interpretations and actions regarding these sensations are in terms of generating changes in our over-all chemistry. For example, in a related study, actors were wired to electrodes and connected to blood catheters. They were then asked to perform various scenes. When they portrayed angry or depressed characters, endorphin levels dropped. But when the scene called for emoting joy, confidence, and love, endorphin levels shot up dramatically. Science has shown that focusing on positive thoughts can produce endorphins. Endorphins, in turn, can encourage feelings of optimism and well-being. There is a feedback loop. Furthermore, the impact of our thoughts and emotions extends beyond our person. John Wheeler (, colleague of Einstein and Bohr at Princeton), introduced the concept of a participatory consciousness/universe, far different than the one in which our model of relating is one of detached, objective observer. In writing about the Observer-Effect, Wheeler states, “This larger scientific worldview stresses the web of relationships and interdependencies between the knower and the known…that knowledge builds through connection rather than detachment, and that our emotions and thoughts contribute to this larger consciousness”. According to Humberto Maturana, (The Tree of Knowledge), love is the only emotion that expands intelligence and broadens the possibilities of what can be known. When the emotion of love is there, vision expands.

Benefits of love

While the full explanation of love may lie beyond the bio-physiological-energetic realm (possibly to be found in the ‘mystical’ spaces) there is enough compelling data on the benefits of love to warrant our full attention right now. We know that life begins and ends with love forefront in our minds. It is hopefully love which ushers us into the world and, in the final analysis, nothing really matters but how well we have loved. At the end of the day, it is not how much we have accumulated, how well known we have become or what we have achieved…it is how well we have managed to love. Hospice workers will tell you that in departing moments most people hover around the recollection of moments when they were able to give and receive love and episodes where there were regrets about not being able to do this. In research of near-death experiences, a strikingly large percentage of people report they return with an almost involuntary tendency towards forgiveness, kindness and devotion. They are often permanently altered by the experience.

Love has the capacity to drastically improve our health; encouraging us to behave in ways that are good for us, opening the door for us to share our burdens when they become too heavy, modifying our response to stress, allowing us to see one another without preconceptions, judgments, etc. Since it is estimated that sixty to seventy percent of the population who visit physicians are sick as a result of stress, a way to mitigate this stress would sure be useful. Harry Reis, PhD, co-editor of the Encyclopedia of Human Relationships identifies several measurable effects of love: People in loving relationships have fewer doctor visits and shorter hospital stays, less depression and substance abuse, lower blood pressures (unhappily married people have the highest), less anxiety (Society for , 2008), more natural pain , better stress management, heartier immune systems, faster healing (Archives of Psychiatry), longer lives and happier lives (Journal of Family Psychology).

Robert A. Emmons (University of , Davis) and Michael E. McCullough, (University of Miami) report similar findings from their research on physical/mental well-being and gratitude (a primary method for tapping into love). In an experimental comparison, those who raised their levels of gratitude simply by keeping journals (where they noted things they were grateful for on a weekly basis); exercised more regularly, reported fewer physical symptoms, felt better about their lives as a whole, and were more optimistic about the upcoming week compared to those who recorded hassles or neutral life events (Emmons & McCullough, 2003). A related benefit was observed in the realm of personal goal attainment: Those noting moments of gratitude were more likely to have made progress toward important personal goals (academic, interpersonal and health-based) and they were more likely to report having helped someone with a personal problem compared to neutral subjects. These findings remain consistent even when in the throws of a disease. For example, a study of adults with neuromuscular disease, revealed that a 21-day gratitude intervention resulted in greater amounts of high positive moods, a greater sense of feeling connected to others, more optimistic ratings of one’s life, and better sleep duration and sleep quality, relative to the control group. (McCullough et. al., 2002).Love literally has the capacity to move us. Haven’t we all experienced at one time or another the nudge of love as it impels us to make plans, seek connection, express ourselves through art, literature, music? Love is the cause not the goal. The more purely we experience our ability to love the more come alive.

So far, we have touched on those benefits occurring through the philos type of love (relational) but what of the most expansive love…the one which manifests when we are the simply the giver of this ‘energy’? When my kids were small, I used to ask them, “Do you want to use a super-power that can change the world?” (…I know… it was a set-up… what child wouldn’t say yes?). “Look for the grumpiest person you see”, I’d say “and just smile and wave…see what happens”. As they witnessed the person’s whole body language shift and received a smile in return (almost every time), they realized they could silently affect change at a distance. As they got older we would do things like anonymously picking up the restaurant tab of strangers, paying a toll for the car behind us, etc. This was not something we did for others. We did it for ourselves…as a way to literally feel the rush of our own ‘lovingness’. In reality, it isn’t ‘being loved’ which brings us joy and lightness so much as it is when we find ourselves ‘being’ loving. Someone can love us, who we have no feelings for, and we do not experience ‘love’, yet when we love someone, some moment, some thing, we feel that sense of elation regardless of reciprocation. Remember that favorite stuffed animal you poured your love into until it was frayed with attention…it was the ‘giving of your love’ you were so invested in. (As far as I know, no stuffed animal hugs back). Love is ultimately a self-generated emotion.

Costs of love lost

Although we can not make anyone love us, we always have the capacity ‘to love’, no matter what. The problem is many of us have forgotten that love originates with us. I believe it is this absence of fully realizing the higher side of our nature, (the love and creative centers), which robs us of our sense of purpose and meaning and lies at the heart of the majority of our distress. Somewhere along the line we got the false message that it is ‘being loved’ which counts most. So here is our challenge, to remember our connection, our capacity to love. According to Marianne Williamson, “Love is what we are born with. Fear is what we have learned here”. And not surprisingly our deepest fear is of not being loved. Instead of simply reclaiming our birthright to ‘lovingness’ we invest our energy in protecting ourselves from potential loss. We falsely believe love is bestowed upon us only if we meet certain conditions. Once we are in the clutches of this, it’s difficult to break free. We become infatuated with tangible, external rewards. The more we can see and measure things, the more ‘doing’ related it is, the more conditions of worthiness we ascribe. It is a vicious cycle. Our tools of socialization (including our consumption habits) primarily focus on meeting conditions, i.e. (grades, degrees, residence, income, profession, position, car, appearance, newest, latest, greatest, etc). Parenting practices are also fraught with their fair share of conditions which we tend to subconsciously adopt as our own and project onto others, believing that people will only love us if we _______________ (fill in the blank with what ever conditions you have adopted). We spend years seeking what is already in us to give. And seeking has only removed us further from the source – us.

The biggest travesty of this external orientation has been the way it has skewed our conceptualization of self-love. If we believe love comes from the outside we have no business loving ourselves, do we? We tend to view as selfish, where in actuality, loving ourselves is one of the most unselfish things we’ll ever dare to do. If we cannot love our self, we try to fill the void with the love of others. And if we demand from others what we cannot give our selves our relationships suffer as a result. The same is true when we try to love someone whose lacks self-love. We can do everything in our power to love them and it will not seem to make a difference. Yet when we learn to love ourselves fully, we become so easily lovable.
A shortage of self love poses major obstacles to creating the life we hope for. If we believe we are not acceptable, we naturally assume that we don’t deserve life’s gifts and support of others. This deep belief unconsciously sends a negative message – which is essentially saying, “I’m not worthy, so no matter how much I try I won’t be able to fulfill my hopes and dreams.” In this way, we punish ourselves by sabotaging our own efforts. We can do a remarkably good job of punishing ourselves. On the other hand those who believe in themselves keep their momentum moving upward by expecting better opportunities, good health, better family relationships, financial security, warm friendships, etc. Interviews of ‘successful’ people reveal two central shared characteristics; their positive belief in their own success before it occurred and persistence in following their belief.

It is estimated that we make between three and four hundred self-evaluations per day. Usually, those evaluations are far from kind. Research suggests that for the average person 80% of self-evaluations are negative and primarily guilt ridden (the mistake most common to all mankind). In a questionnaire I use, all but one individual in the last five years, answered positively to the statement, “I am very hard on myself”. I wonder, do we do this with the idea of absolving our guilt or because we believe that we can somehow ourselves into shape? If there was one single quality which I could magically instill in others it would have to be the internal ‘permission’ to love oneself. It is the most important relationship we’ll ever have. What a change we would see in the world. As Benjamin wisely noted, “He that falls in love with himself will have no rivals”.

Therapy’s role in retrieving our lovingness

“Love is the touch stone of psychiatric treatment…to our patient who cannot love we must say by our actions that we do love him” (Dr. Karl Menninger). Love is stronger than hate and it is capable of transforming the nature of man” (Freud). Sentiments like this are music to my ears. Although we are developing increasingly refined biological approaches and cognitive techniques we should never under-estimate the power of simply ‘being with’ a person.

Intimate conversation is one of the most important practices in the way of love. In therapy we are fully seen, perhaps for the first time. Our self disclosure, our emotional nakedness helps to open the space for love, which accepts imperfection. The more we express ourselves the more we get to hear the dialogues which endlessly entangle our minds. As we continue our investigation of ‘self’, we become increasingly aware of our historical themes and can begin to separate them from our current reality. And the more adept we become at maintaining an objective observer stance, the more we are able to let go of our attachments to what no longer serves us and strengthen those aspects which do.

The most challenging periods in our development are when we commit to consistently choosing new thoughts about ourselves. It requires us to let go of our past patterns, façades, etc. even though we may not have a clear picture of what could take its place. “Love takes off the masks that we fear we cannot live without and know we cannot live within.” (James Baldwin) Our defenses may not want to budge There are often periods of intensification of physical and emotional symptoms when the suppressed energies begin surfacing. (The ego seeks to trap us in our in-authenticity). There will be temptation to abandon the process, however in order to really love, our ego structure has to dissolve, our false pride has to be humbled so we can create anew. Otherwise we are destined to a life of mundane reactivity.

Therapy offers a fellow journeyman, who grows through this endeavor as well. If all goes well agape-type love emerges, where each individual honors the other. The who avails themselves of love brings a different energy to the work. Practicing with one’s heart wide open means to “look up to the patient with gratitude for the chance to embrace the human condition in all its imperfection. This form of love frequently elicits a similar gratitude from the client, who begins to view the treatment in a new spirit, not just as a wounded person seeking help from a healer but as someone whose wound has the power to find the wound in the healer that, as the Jungian James Hillman puts it, “becomes a well of cures.” (John Beebe, MD). When this occurs, both patient and practitioner come upon the silver lining of illness: its amazing capacity to birth full acceptance, compassion and appreciation (this is love personified).

We could even go so far as to say, the primary goal signaling closure of the therapeutic process is ‘resumption of self-love’. Inherent in this, is the individuals final recognition that what they have been seeking does not come from their family, their friends, or even therapist, but from themselves. Paradoxically, love gives up attachments in exchange for an internal sense of belonging, a home within. No longer bound to ‘seeking’, the deeper purposes of life are free to surface. Glimmers of excitement emerge about the opportunity to become a ‘new human being’.

Here are some ‘symptoms of wellness’ when love has taken root:
 You will be more present, feeling more solid, and connected to yourself.
 You will be more at peace, while having more focused energy available to you.
 You will be more outspoken yet more willing to consider the perspective of others.
 You will find yourself smiling more, and experiencing gratitude more often.
 You will have more self-awareness and authenticity.
 Because you are more genuine and authentic, people will connect with you easier and vice-versa. Your sense of isolation will decrease.
 You will take yourself less seriously, allowing yourself to have more fun.
 You will feel freer, lighter, and less fearful.
 You will begin feeling passionate about things again and taking more ‘healthy’ risks.
 Your physical self will be more settled (i.e. less fatigue, decreased physical aches and pains, improved G.I. functioning, etc.)
 People may comment that you look years younger and your sparkle is back (we often wish we had before and after pictures!)

I’d say that makes love some pretty powerful medicine.

Medical Director’s Response:

We know that love heals and that healers (the best doctors, therapists, and nurses) love their patients and their work. To my way of thinking, that says what we know. When Heidi and others try to translate love into biomedical terms, it is fascinating, but misses the point. It’s much like trying to capture or explain the beauty of a sunset by analyzing the wavelengths and angles of light. Beauty and love are appreciated, “received”, in a different way. Our patients need our love, our caring, our wisdom, and our expertise. They need the best of us from our heart and our brain. This article by Heidi is a product of an exceptional heart and brain, and I love that she brings both to her work on the Retreat every day. That is why I smile and nod and say to her questions, “Sure, love is the primary ingredient in much healing.” To me, that’s enough said.

– Don Ross, MD

Love All~ways, peter