The limitations of science and language in mindbody healing

The algorithms are starting to figure me out, and I’m seeing more and more posts about psychology and healing in my Substack feed. Recently, I’ve seen a lot of articles that criticize things like polyvagal theory and nervous system regulation as being unscientific and incomplete. Many of the criticisms are valid, and they touch on two questions I’ve struggled with for much of my adult life1:

How do we heal when the techniques that may work are outside the realm of accepted, mainstream science?

How do we talk about successful techniques if we lack acceptable scientific terminology?

In this post, I talk about some of the issues that make this such a complicated problem. Specifically, I’ll look at the challenges of imprecise language and insufficient science. In the next post, I’ll go over what my “gold standard” solution was for determining whether or not I was comfortable trying a new treatment or technique, even if it wasn’t as well supported by science as I would have liked.

It’s hard to talk about mindbody healing from a scientific perspective because medical language focuses on breaking the body into parts rather than treating the body as a holistic system of systems. As a result many of the criticisms of mindbody techniques are misguided because they conflate bad scientific understanding with limited scientific language.

As an example, consider how often we distinguish between the brain and the body? To me, this is bizarre. I think of the brain as being part of the body, since the brain can’t function without a body and vice versa. Yet it turns out that we don’t have a single definition for “the body.” According to the Cambridge dictionary and Merriam-Webster, there are least three different meanings for the word “body”:

• The entirety of your physical form, which would then include things like your brain and your “nervous system” (a term I’ll get to shortly);

• Your body minus your head (thus separating your brain and body);

• Or just your torso, without your head, arms, or legs.

So when someone says something like, say, “the body keeps the score,” that could mean any number of things, and different readers will interpret the statement differently based on how they define “the body.”

Bessel Van Der Kolk’s full book title is, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. I read this a while ago, and I don’t remember how—or if—he defines the body vs the brain vs the mind. Therefore, when someone else states or contests that “the body keeps the score,” I will interpret the phrase based on how I define what the body is.

Since I define “the body” as the entirety of my physical form, it is nonsensical to me to hear that something is in my brain rather than my body. My brain is part of my body, and therefore, anything happening in my brain is happening in my body. It is equally nonsensical to me to hear that my brain and body are connected. The equivalent would be to say that my stomach and body are connected, or my skin and body are connected, or my lungs and body are connected, or my mouth and body are connected.

By my definition, all of these parts are connected to each other to form my body.

My brain is one very critical component that helps my body function, but it is not the only critical component.

Because this is how I rationalize my use of these terms, I may understand a phrase like “the body keeps the score” differently from a doctor, whose understanding may be different from a somatic therapist, whose understanding may be different from a psychotherapist, whose understanding may be different from yours.

These words have a variety of definitions, and we will interpret them differently.

This is a problem that arises again and again as we try to talk about mindbody illness and healing.

This problem also shows up in how we use the term “nervous system.” While it’s not uncommon to use the phrase “nervous system” to refer to the system of nerves connecting our brain to the rest of our body, this “system” is more commonly broken into a few systems.

So you might hear reference to the central nervous system and the peripheral nervous system, the latter of which is made up of the somatic nervous system and the autonomic nervous system, which is also made up of the sympathetic nervous system, the parasympathetic nervous system, and the enteric nervous system.

On top of that, the nervous system is still only part of our body. It is connected to but separate from our endocrine system and immune system, both of which play a role in creating and healing chronic illness.

I refer to the nervous system a lot, but I often use the term “nervous system” when I really mean all of the interconnectedness of our bodily systems, including the immune system and the endocrine system and anything else not covered by those three systems. I don’t love that solution, but I haven’t come up with a better option. (I’m open to suggestions!)

The body vs the brain vs the nervous system is just one example of how imprecise language can cause confusion. And the examples above are just examples of how I approach talking about mindbody issues. Other people will understand and discuss these issues slightly differently.

Ultimately, we don’t have good language to describe our bodily systems as one whole entity, which means we can’t discuss various mindbody treatments and issues with scientific precision.

The problem of insufficient language becomes even more complex when we’re talking about a health problems and treatments for which there is also insufficient scientific research to support or debunk various healing approaches.

All science is dogmatic, and when new research comes out that challenges traditional, scientific understanding, it can take time (often many decades) for the scientific community to accept.

The peer-review process is good, but it comes with its own limitations, especially when the reviewers are less open to new ideas or have their own biases that may limit their acceptance of new research.2

Additionally, part of the scientific process is the ability for other researchers to reproduce research that successfully made it through the peer-review process. However, scientists face the publish-or-perish mentality of research institutions, while scientific publications prefer to publish new research, as opposed to research that confirms or refutes past publications. As a result, scientists may not spend as much time confirming approaches that other researchers published.3

Those are challenges that all scientific research struggles to address. Medicine and psychology are even more complicated.

Each human is unique, and there is no such thing as an “ideal” human body. Our bodies have any number of variables and variations which can come together to make us healthy or not—our genes, our stress responses, our belief systems—and this is all compounded and exacerbated by our lived experiences and our current life situations—childhood trauma, adult trauma, poverty, wealth, physical labor, hours at the computer, a boss who is kind or who micromanages, raising children, etc. All of these things impact our health, and so causes of illness and success of treatments can vary tremendously.

Terms like “gold standard” and “evidence-based” are used because medical science cannot have the same consistent results that, say, physicists get when measuring a known quantity like gravity.

The “gold standard” is the best we have, but that doesn’t mean that “gold standard” treatments will work for everyone, and less common approaches that do no meet the “gold standard” may still work for some people.

Meanwhile, “evidence-based” is a term that I’ve come to dread. Too often, when I’ve seen a practitioner say that they only work with “evidence-based” practices, what this has actually meant is that they’re narrow minded, they don’t understand the scientific process and its challenges, and/or they aren’t very up-to-date on treatments that seem to be working on an anecdotal basis.

To be clear, anecdotes are not science, and we should be careful trusting them, but anecdotes are also often at the heart of what will later become solid research. The benefits of meditation, yoga, massage, and acupuncture were once only anecdotal in western medicine, but now it’s well accepted that these practices can help improve one’s health (even if they may or may not heal on their own).

The best doctors I've had have always been open to recommending low-cost, low-risk treatments that other patients had found helpful but which may not have been well studied.

“Evidence-based” is also at the heart of one of the most common misunderstandings I see: People often confuse science that hasn’t been done with science that has debunked something. In the first case, there are some treatments that simply haven’t been researched sufficiently—or at all—and as a result, there is little to no evidence supporting the treatments. In the latter case, lots of research has been done on a treatment, and it has been thoroughly debunked.

These two situations are very, very different, yet I often see them conflated. As a result, many people miss out on good healing options because the science just isn’t there yet.

Some of the mindbody treatments are complex. A large number of variables may need to be considered, and control groups may be difficult to assign, making some treatments more difficult to study under the “gold standard” practices for medical research. Additionally, getting funding for mindbody research can be incredibly difficult because the approach is not fully accepted by mainstream medicine yet.

Many practices that I found most useful and which seem to have helped so many others simply haven’t been studied with the kind of scientific and academic rigor—e.g large studies or frequently/successfully reproduced results—that other medical treatments receive. So, it’s true that these techniques may not be as evidence-based as I would like, but that’s not the same as debunked.

At the same time, many of the treatments that are treated as “scientifically accepted” on social media and in some mindbody communities have actually been debunked or are hotly contested.

For example, the idea of us having a “lizard brain,” also known as a triune brain, has been widely discredited. As stated in the abstract for the paper, Your Brain Is Not an Onion with a Tiny Lizard Inside: “A widespread misconception in much of psychology is that (a) as vertebrate animals evolved, “newer” brain structures were added over existing “older” brain structures, and (b) these newer, more complex structures endowed animals with newer and more complex psychological functions, behavioral flexibility, and language. This belief, although widely shared in introductory psychology textbooks, has long been discredited among neurobiologists and stands in contrast to the clear and unanimous agreement on these issues among those studying nervous-system evolution.”

Meanwhile, the role of complex trauma as a cause of chronic physical health problems is still contested, even as many large studies acknowledge a clear correlation between the two (such as research like this and this and this connected to adverse childhood experiences). Yes, correlation is not causation, but at some point there are so many causal patterns—that is, first people experience trauma and then they experience chronic pain and illness—that we should be more open to the possibility of more direct causation.4

Finally, polyvagal theory has been hotly contested for quite some time (most recent critique and defense), even as many practitioners treat it as accepted science. My understanding of these debates is that the nervous system states are generally accepted: the ventral vagal state maps to the calm state of “rest and digest”; the sympathetic state maps to the fight-or-flight stress response; and the dorsal vagal state maps to the freeze or shutdown stress response. However, where researchers disagree is on the role of the vagus nerve in moving our system between these states and on the role of the vagus nerve in social interactions.5

These examples are fairly benign. If you follow a practitioner who adheres to polyvagal theory or who encourages you to retrain your brain to overcome your ancient “reptilian” instincts, you may still end up feeling better—many people have—and at worst, you just won’t improve. Maybe you’ll get discouraged or disparaging of yourself if you don’t get better, but these practices are unlikely to put your health at risk.

Many other treatments are not so benign. There are some incredibly dubious and dangerous claims about healing made online. There are also so many very expensive programs that promise to heal you.

So much of the internet and social media seems to be filled with a lot of terrible advice for treatments, supplements and programs that don’t work, that have horrible side-effects, that might put your health at greater risk, and/or that cost a lot of money. Even with some of the benign examples above, if a practitioner suggests that you should be able to heal with their method, and that it’s your fault if you can’t, then they may cause you more harm than good.

So with all the imprecise language, misinformation, disinformation, confusion, insufficient science, and bad science, how do we decide which healing treatments and techniques are worth trying?

As noted above, I’m breaking this post into two parts. But I’ll end here with the basic framework I used to consider every single treatment, technique, or program I tried (or didn’t try).

I relied on just two questions:

1) Is there a possibility for negative side effects?

2) How much does it cost?

Next week, I’ll post more about my process for considering those two questions.