Hope, expectation and interoception (Review)

Lena Maria Lorenz, PhD student at Durham University, reviews the ‘Interoception: Sensation and Embodied Awareness’ workshop at the Institute for Medical Humanities, Durham University on 8th November 2018. Lena Maria’s research includes an interdisciplinary investigation of chronic pain.

We live on hope. Sometimes past experiences give us reason to hope, often the present forces us to hope, the future always appeals to hope. In healthcare, hope – alongside love and faith – seems to play a crucial, but underestimated role. In particular, hope in a Christian perspective may be useful in a clinical context because – unlike philosophical concepts of hope – it gives “hope against hope”. Those who witnessed the crucifixion of Jesus Christ were certainly without any hope, but His resurrection three days later changed their perspective. In the secular medical world, the “hopeless case” that unexpectedly fully recovers might be the equivalent. In other words, experience (or in the case of Christianity, the tradition of faith) nurtures hope and creates expectations. Expectations, in turn, shape one’s perception of illness and health and, as explored in this workshop, the sensations of the body experienced through interoception.

This one-day workshop on Interoception: Sensation and Embodied Awareness drew together scholars and practitioners of different disciplines ranging from psychiatry, medicine and counselling to philosophy, sociology, literature studies and dance. Various concepts, research and experience were presented and passionately debated. Despite recognised conflicting approaches, our common desire to better understand the individual’s perception of the body in ill-health created a safe and creative atmosphere to discuss this topic.

The first two papers were strikingly contrasting and yet beautifully complementing. Sarah Garfinkel (University of Sussex) presented neuroscientific research which seems to aim at a precise image of interoception. Her talk included the link between interoceptive accuracy, emotion, memory and decision making. This may have some clinical relevance, for example for the concept of Autism Spectrum Condition. Andy Hamilton (Durham University) countered this neurobiological approach with some philosophical arguments. He used the term proprioception to propose the idea of a non-sensory, but primordial capacity. That is, awareness of oneself and bodily movement is based on direct, non-inferential knowledge. The two papers were followed by a brief panel debate with questions from the audience. Here, two notions implicitly concerned the body-mind (or mental/extra-mental) duality. Namely, the concept of muscle memory and the question of how one knows oneself including the role of consciousness. In my view, supposing a body-mind duality is problematic for health care because it opposes the individual’s experience of body and mind as one. Therefore, if we want to better understand someone’s perception of the self, our underlying assumptions of human being should be in line with the patient’s framework.

Krzysztof Bierski (Durham University) carefully guided the group through two short sessions of body practices and movement techniques. This way, we could physically engage with (or “sense” in its literally meaning) some of the ideas on extero-, intero- and proprioception.

The following two talks both addressed the impact of experience on interoception and its relevance for one´s outlook on the present and the future. Exemplarily focusing on the clinical condition of breathlessness, Kyle Pattinson (University of Oxford) introduced interoception as inference from internal bodily sensations and the individual´s knowledge (which is based on experience). George Deane (University of Edinburgh) added to the preceding paper with another philosophical perspective reflecting on predictive processing. Generalizing the ideas from both approaches in terms of their clinical value, I want to say, the relevant point is: One feels what one expects to feel. The subsequent lively discussion raised the topic of early childhood experience and trauma which may (as “embodied experience”) interact with interoception.

The final set of papers were built on the presenters´ first-hand experiences with bodily movement. Drawing on her expertise in counselling and psychotherapy, Caroline Dower (Durham University) elucidated the interaction between mental health and movement. She described how mental health matters are expressed in movement patterns. Consequently, seemingly uncontrollable psychological issues such as anxiety can be improved by ‘movement therapy’ (as offered in the ‘Calm to the Core’ programme for Durham University students) constituting an alternative to talking therapy. Rick Telford (Durham) gave us personal insight into living with Parkinson’s disease and the ‘Get Moving’ dance initiative. When asked how he thinks dance changes his interoception, he says: “I get lost in the movement and that’s part of the enjoyment.” Comments from other participants showed the wider perspective of movement and dance. They highlighted the importance of creating bodily states that convey security. One participant mentioned how getting better at something, for example dancing, provides hope.

To conclude the workshop, we summarised the acquired knowledge and further ideas around four topics: Measuring interoception, Interoception and health, Existing projects, and Opportunities for collaboration. Bringing together the main points of the group discussions revealed once more the complexity of the concept of interoception and our keen enthusiasm for its clinical application.

Overall, I think everyone agreed that they had been inspired by new perspectives and were taking something home to further think about or implement in their practices. Personally, I wish that future efforts in medical humanities will keep their focus on the individual, and be guided by the premise of helping people in illness and advancing general public health. To achieve this, we might need to deviate from well-established theories and concepts and even challenge some scientific principles to give way to new approaches and perspectives. Like the initially mentioned “hope against hope”, I would like to encourage us to boldly imagine the impossible and let science blur the line between reality and utopia – not yet developed measures might proof ‘true’ what we presently consider an illusion.

 

You can read a different perspective on this workshop in ‘What our bodies are telling us’ by Emine Gurbuz

 

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