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2015-11-05 07:57:25
By William Kremer BBC World Service
4 November 2015
People suffering from stress can tackle it in various ways - from counselling
sessions to yoga classes or listening to mindfulness CDs. But it's only
recently that sleeping and doing very little - the ways human beings have
always rested - have come to be seen as an insufficient response to life's
difficulties.
Paul Lehrer lay on a couch looking at the ceiling of a room on the third floor
of the Commodore Hotel in New York and tried to relax.
But it wasn't, he recalls, "the most ideally relaxing situation". There was no
music playing softly on the stereo, no aromatherapy or tea lights. Instead,
because of the heat, the windows were thrown open and the air was filled with
the fumes of buses and trucks. Lehrer's ears hummed with the clanging of the
construction site across the street, where they were putting up a new
skyscraper, and underneath that cacophony he could hear the bustle of Grand
Central Station next door.
Worst of all, every few minutes an old man would come into the room and sharply
upbraid him for not relaxing the right way. It was 1973 and Lehrer, a
psychotherapist, had come to be treated and to train under an 85-year-old
doctor called Edmund Jacobson.
Forty-four years earlier, in 1929, Jacobson had published a forbiddingly
technical book called Progressive Relaxation, which detailed a procedure for
removing muscular tension. But since the exercises in the book were designed to
relieve pressure that was as much psychological as physical, Jacobson's work
led to a surge in the use of the word "relax", in the sense of "to become less
tense, anxious or stressed, to calm down".
Jacobson's book asks patients to tighten their muscles and then release them
slowly, paying close attention to the sensations of tiny amounts of residual
tension. The idea is that after much practice, they become able to detect any
tension and then work on eliminating it.
In his body, man was blessed with a "wonderful living instrument", Jacobson
wrote. "He needs to learn how to run himself properly, just as he needs to
learn to drive a motor car properly."
He demanded that trainees practise for an hour a day. If they said they didn't
have time he told them to wake up an hour earlier, as his exercises were more
important than sleep.
This idea - that special exercises could be more beneficial than pure rest -
was relatively new to the West.
"From the 1920s, 1930s, there were these relaxation practitioners saying,
'That's not enough. The therapeutic effect of say, just 20 minutes of proper
bodily relaxation is going to be worth more than several hours of bad sleep,"
says Ayesha Nathoo from the University of Exeter, who is currently researching
the history of relaxation therapies.
The reason for the change was the widely held belief that modern life was
placing special pressures on the body.
"A much-repeated narrative in the literature is that with the advent of
modernity, natural and communal rhythms such as day and night, the seasons,
festive holidays, and so on were replaced by unnatural ones that do damage to
people's energy economies and also to communal structures," says Anna
Schaffner, the author of Exhaustion: A History, to be published next year.
The specifics of these ailments of modernity varied as the 20th Century
progressed. The German sociologist Georg Simmel's 1903 essay The Metropolis and
Mental Life examined the effect of city life on the intellectual. Later
commentators focused on the effect of rapid transport and changing technology -
a theme that still recurs today. "Many argue that new technologies have
enslaved us such that we are constantly 'switched on', never properly resting,"
says Schaffner.
Herbert Benson's 1975 blockbuster book The Relaxation Response catalogued a
long list of modern ills, ranging from job insecurity to the rapid change in
the role of women in society, to the ever-present fear of sudden nuclear
annihilation. The result, Benson wrote, was that our innate "fight-or-flight"
mechanism was working in overdrive, leading to an "epidemic" of hypertension.
But whether all these anxieties were justified is an open question. "Exhaustion
has always been with us from the very beginning of time," says Schaffner, "and
what changes is the narratives we tell ourselves about its causes."
Image caption These two books were essential reading in the 70s for anyone
interested in relaxation
Jacobson's progressive relaxation was just one of the therapies that sprang up
to deal with the perceived problem. A rival technique was devised by the German
psychiatrist Johannes Schultz. Unlike Jacobson's programme, with its emphasis
on patients playing close attention to their physical sensations, Schultz's
system of "autogenic training" required patients to adopt certain postures, and
visualise a calming image twice or three times a day.
Jacobson and Schultz disagreed vehemently about relaxation, and when Schultz
visited the US in the 1930s there was no meeting of minds. Schultz was working
for the German Medical Society for Psychotherapy, a fascist organisation run by
Hermann Goering's cousin, and Jacobson later said Shultz refused to dine with
him because he was Jewish.
Jacobson's strict relaxation technique would go on to be modified by other
practitioners. Some performed the muscle exercises but instead of getting
patients to explore the sensation of minimal tension, they emphasised the sense
of relief that followed straining them.
Other therapists removed the need for patients to be aware of feelings of
tension by employing devices that measured their muscle activity, sweat levels
or heart rate. They found that consciously or unconsciously, patients responded
to this information by adjusting their stress levels. The health and fitness
apps on watches and phones today are in some ways a development of a machine
called an "integrating neurovoltmeter" which Jacobson invented in 1940.
Meanwhile, throughout the 20th Century, the practice of yoga in the West moved
from being a niche activity for those interested in Eastern spirituality to a
more secularised exercise programme with wide appeal to the mainstream. While
pictures of the Maharishi Mahesh Yogi practising yoga with the Beatles were
beamed around the world, government-funded evening classes in yoga were
starting in London.
Image copyright Getty Images
Image caption The Beatles and their partners in India with the Maharishi Mahesh
Yogi, March 1968
People signing up may have thought they were taking part in an ancient Indian
ritual, but it was a very modified and modernised form of yoga. BKS Iyengar,
the only guru whose yoga was permitted in these classes, had stripped away the
references to spirituality, and there were elements that owed more to people
like Jacobson than they did to the yogis of India.
"At the end of an Iyengar yoga class, there's this idea that there is a
practice of lying in 'shavasana' or 'corpse pose' in which you should be
completely relaxed, without any thoughts but conscious," says Suzanne Newcombe,
a historian of yoga at Inform, based at the London School of Economics.
"There's a lot of different ways to teach that and the progressive relaxation
of tighten-and-release is sometimes taught, but that's definitely a Western
medical imposition, it's nowhere in the medieval yoga texts. But at the same
time it's not inconsistent with the goal of classical yoga in 'stilling the
fluctuation of the mind'."
Newcombe says that it was the publication of Benson's wildly popular book The
Relaxation Response in 1975 that really made "relaxation" a buzzword in much
the same way that "mindfulness" is now. Indeed, the approaches have some common
ground. Benson was a cardiologist who had become convinced of the benefits of
transcendental meditation techniques on physical health, and he instructed
patients to adopt a passive attitude and hold a thought or word in their minds
for an extended period.
Image copyright Thinkstock
Image caption Shavasana, or corpse pose
"Essentially what he did is have people close their eyes and say the word 'one'
to themselves and exhale," says Paul Lehrer. "He had people paying attention to
their breath and relaxing. We have people now, doing work on mindfulness
meditation, asking people to pay attention to how their breath feels, how their
clothing feels, how the floor feels. That's what the Zen Buddhists do.
"All these techniques have some similar effects - Benson's technique and
meditation methods, and mindfulness and muscle relaxation and breathing
techniques - they all have some common effects in relaxation. Although they
also have some very specific effects because they work by different pathways."
Edmund Jacobson, however, never stopped believing that all stress - indeed all
thought - was manifest in the muscles of the body. But his cherished and
influential idea received a blow in 1966 when a young psychiatrist at Harvard
named Lee Birk undertook an extraordinary experiment.
Birk allowed himself to be administered a dose of curare, the plant extract
that is used by some South American tribes on the tip of poison arrows, and
which has the effect of cutting off the brain's ability to control muscles. He
was therefore completely paralysed, and in need of artificial ventilation.
In this state, Birk showed two things. Firstly, thanks to a biofeedback device
that showed him his heart rate and sweat level, he was able to control these by
mental effort alone. Secondly, the very fact that he felt terrified during the
experiment showed that muscle tension was not necessary to the experience of
anxiety.
Birk's experiment would go on to be cited by psychologists advocating a new
approach to the treatment of anxiety, one which would become dominant in the
last part of the century. In cognitive behavioural therapy (CBT), patients
learn, with help from a therapist, techniques which adjust their patterns of
thought to forestall the onset of physical symptoms.
For Lehrer, Birk's experiment is striking but did not strike a definitive blow
against the techniques he learned in the Commodore Hotel in 1973, which he
still uses alongside other therapies. True, muscles don't always play a role in
relaxation, but they do sometimes and for some patients.
"I think unfortunately what it did is it led psychologists to de-emphasise
really meticulous muscle learning in the way Jacobson taught it, to the point
that very few therapists train people as thoroughly as Jacobson did," says
Lehrer, "and that's too bad because Jacobson's method worked."