Culture, Medicine, and Psychiatry

, Volume 41, Issue 1, pp 3–34 | Cite as

The Flexibility Hypothesis of Healing

Original Paper

Abstract

Theories of healing have attempted to identify general mechanisms that may work across different modalities. These include altering expectations, remoralization, and instilling hope. In this paper, we argue that many forms of healing and psychotherapy may work by inducing positive psychological states marked by flexibility or an enhanced ability to shift cognitive sets. Healing practices may induce these states of cognitive and emotional flexibility through specific symbolic interventions we term “flexibility primers” that can include images, metaphors, music, and other media. The flexibility hypothesis suggests that cognitive and emotional flexibility is represented, elicited, and enacted through multiple modalities in healing rituals. Identifying psychological processes and cultural forms that evoke and support cognitive and emotional flexibility provides a way to understand the cultural specificity and potential efficacy of particular healing practices and can guide the design of interventions that promote resilience and well-being.

Keywords

PTSD Trauma Healing ritual Anthropology Flexibility Resilience Mood 

References

  1. Allan, S. 1997. The Way of Water and Sprouts of Virtue. Albany: State University of New York Press.Google Scholar
  2. Ben-Naim, S., G. Hirschberger, T. Ein-Dor, and M. Mikulincer. 2013. An Experimental Study of Emotion Regulation During Relationship Conflict Interactions: The Moderating Role of Attachment Orientations. Emotion 13:506-519.CrossRefGoogle Scholar
  3. Bonanno, G. A. 2013. Meaning Making, Adversity, and Regulatory Flexibility. Memory 21:150-6.CrossRefGoogle Scholar
  4. Bonanno, G. A., and C. L. Burton. 2013. Regulatory Flexibility: An Individual Differences Perspective on Coping and Emotion Regulation. Psychological Science 8:591-612.Google Scholar
  5. Brandel, R. 1961. The Music of Central Africa: An Ethnomusicological Study: Former French Equatorial Africa, the Former Belgian Congo, Ruanda-Urundi, Uganda, Tanganyika. The Hague: M. Nijhoff.Google Scholar
  6. Brockmeyer, T., K. Ingenerf, S. Walther, B. Wild, M. Hartmann, W. Herzog, H. Bents, and H. C. Friederich. 2014. Training Cognitive Flexibility in Patients with Anorexia Nervosa: A Pilot Randomized Controlled Trial of Cognitive Remediation Therapy. International Journal of Eating Disorders 47(1):24-31.CrossRefGoogle Scholar
  7. Chartrand, T. L., and J. A. Bargh. 1999. The Chameleon Effect: The Perception-Behavior Link and Social Interaction. Journal of Personality and Social Psychology 76(6):893-910.CrossRefGoogle Scholar
  8. Chernoff, John Miller. 1979. African Rhythm and African Sensibility: Aesthetics and Social Action in African Musical Idioms. Chicago: University of Chicago Press.Google Scholar
  9. Classen, C., J. P. Toner, R. Newhauser, H. Roodenburg, A. C. Vila, and D. Howes. 2014. A Cultural History of the Senses. London, UK: Bloomsbury Academic.Google Scholar
  10. Csordas, Thomas J. 1994. The Sacred Self: A Cultural Phenomenology of Charismatic Healing. Berkeley: University of California Press.Google Scholar
  11. Dalton, A. N., T. L. Chartrand, and E. J. Finkel. 2010. The Schema-Driven Chameleon: How Mimicry Affects Executive and Self-Regulatory Resources. Journal of Personality and Social Psychology 98(4):605-617.CrossRefGoogle Scholar
  12. Danesi, M. 2013. On the Metaphorical Connectivity of Cultural Sign Systems. Signs and Society 1:33-49.CrossRefGoogle Scholar
  13. Desjarlais, R. R. 1989. Healing through Images: The Magical Flight and Healing Geography of Nepali Shamanism. Ethos 17:289-307.CrossRefGoogle Scholar
  14. Dow, J. 1986. Universal Aspects of Symbolic Healing: A Theoretical Synthesis. American Anthropologist 88:56–69.CrossRefGoogle Scholar
  15. Dweck, C. S. 2008. Mindset: The New Psychology of Success. New York: Ballantine Books.Google Scholar
  16. Feld, Steven. 2012. Sound and Sentiment: Birds, Weeping, Poetics, and Song in Kaluli Expression. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  17. Fledderus, M., E. T. Bohlmeijer, J. P. Fox, K. M. Schreurs, and P. Spinhoven. 2013. The Role of Psychological Flexibility in a Self-Help Acceptance and Commitment Therapy Intervention for Psychological Distress in a Randomized Controlled Trial. Behaviour Research and Therapy 51(3):142-151.CrossRefGoogle Scholar
  18. Frank, Jerome D., and Julia Frank. 1991. Persuasion and Healing: A Comparative Study of Psychotherapy. Baltimore: Johns Hopkins University Press.Google Scholar
  19. Friedson, Steven M. 1996. Dancing Prophets: Musical Experience in Tumbuka Healing. Chicago: University of Chicago Press.Google Scholar
  20. Friedson, Steven M. 2009. Remains of Ritual: Northern Gods in a Southern Land. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  21. Garland, E. L., B. Fredrickson, A. M. Kring, D. P. Johnson, P. S. Meyer, and D. L. Penn. 2010. Upward Spirals of Positive Emotions Counter Downward Spirals of Negativity: Insights from the Broaden-and-Build Theory and Affective Neuroscience on the Treatment of Emotion Dysfunctions and Deficits in Psychopathology. Clinical Psychology Review 30:849-864.CrossRefGoogle Scholar
  22. Geurts, Kathryn Linn. 2002. Culture and the Senses: Bodily Ways of Knowing in an African Community. Berkeley: University of California Press.Google Scholar
  23. Gibbs, R. W. 2006. Embodiment and Cognitive Science. Cambridge: Cambridge University Press.Google Scholar
  24. Gridley, Mark C., and David Cutler. 2003. Jazz Styles: History & Analysis. Upper Saddle River, N.J.: Prentice Hall.Google Scholar
  25. Haager, J. S., C. Kuhbandner, and R. Pekrun. 2014. Overcoming Fixed Mindsets: The Role of Affect. Cognition Emotion 28(4):756-767.CrossRefGoogle Scholar
  26. Haley, Jay. 1973. Uncommon Therapy: the Psychiatric Techniques of Milton H. Erickson, M.D. New York: Norton.Google Scholar
  27. Hayes, S. C., J. B. Luoma, F. W. Bond, A. Masuda, and J. Lillis. 2006. Acceptance and Commitment Therapy: Model, Processes and Outcomes. Behaviour Research and Therapy 44(1):1-25.CrossRefGoogle Scholar
  28. Herzfeld, Michael. 1986. Ours Once More: Folklore, Ideology, and the Making of Modern Greece. New York: Pella.Google Scholar
  29. Hinton, DE 2000 Musical Healing and Cultural Syndromes in Isan: Landscape, Conceptual Metaphor, and Embodiment, Dissertation Abstracts International 60:2553, Harvard University.Google Scholar
  30. Hinton, D. E. 2008. Healing through Flexibility Primers. In The Oxford Handbook of Medical Ethnomusicology. B. Koen, ed. pp. 121–163. Oxford: Oxford University Press.Google Scholar
  31. Hinton, D. E., D. Howes, and L. J. Kirmayer. 2008. Toward a Medical Anthropology of Sensations: Definitions and Research Agenda. Transcultural Psychiatry 45:142-62.CrossRefGoogle Scholar
  32. Hinton, D. E., S. G. Hofmann, M. H. Pollack, and M. W. Otto. 2009. Mechanisms of Efficacy of CBT for Cambodian Refugees with PTSD: Improvement in Emotion Regulation and Orthostatic Blood Pressure Response. CNS Neuroscience and Therapeutics 15:255-63CrossRefGoogle Scholar
  33. Hinton, D. E., and L. J. Kirmayer. 2013. Local Responses to Trauma: Symptom, Affect, and Healing. Transcultural Psychiatry 50:607-621.CrossRefGoogle Scholar
  34. Hinton, D. E., E. Rivera, S. G. Hofmann, D. H. Barlow, and M. W. Otto. 2012. Adapting CBT for Traumatized Refugees and Ethnic Minority Patients: Examples from Culturally Adapted CBT (CA-CBT). Transcultural Psychiatry 49:340–365.CrossRefGoogle Scholar
  35. Hinton, D. E., V. Pich, S. G. Hofmann, and M. W. Otto. 2013. Mindfulness and Acceptance Techniques as Applied to Refugee and Ethnic Minority Populations: Examples from Culturally Adapted CBT (CA-CBT). Cognitive and Behavioral Practice 20:33–46.CrossRefGoogle Scholar
  36. Hirsch, C. R., S. Hayes, A. Mathews, G. Perman, and T. Borkovec. 2012. The Extent and Nature of Imagery During Worry and Positive Thinking in Generalized Anxiety Disorder. Journal of Abnormal Psychology 121(1):238-243.CrossRefGoogle Scholar
  37. Kashdan, T. B. 2010. Psychological Flexibility as a Fundamental Aspect of Health. Clinical Psychology Review 30(7):865-878.CrossRefGoogle Scholar
  38. Kirmayer, L. J. 1988. Word Magic and the Rhetoric of Common Sense: Erickson’s Metaphors for Mind. International Journal of Clinical and Experimental Hypnosis 36(3):157-172.CrossRefGoogle Scholar
  39. Kirmayer, L. J. 1993. Healing and the Invention of Metaphor: The Effectiveness of Symbols Revisited. Culture, Medicine, and Psychiatry 17(2):161-195.CrossRefGoogle Scholar
  40. Kirmayer, L. J. 2003. Asklepian Dreams: The Ethos of the Wounded-Healer in the Clinical Encounter. Transcultural Psychiatry 40(2):248-277.CrossRefGoogle Scholar
  41. Kirmayer, L. J. 2004. The Cultural Diversity of Healing: Meaning, Metaphor and Mechanism. British Medical Bulletin 69:33-48.CrossRefGoogle Scholar
  42. Kirmayer, L. J. 2008. Culture and the Metaphoric Mediation of Pain. Transcultural Psychiatry, 45(2):318-338.CrossRefGoogle Scholar
  43. Kirmayer, L. J. 2011. Unpacking the Placebo Response: Insights from Ethnographic Studies of Healing. Journal of Mind-Body Regulation 1:112-124.Google Scholar
  44. Kirmayer, LJ, and MJD Ramstead in press Embodiment and Enactment in Cultural Psychiatry. In Embodiment, Enaction, and Culture: Investigating the Constitution of the Shared World. C Durt, T Fuchs, and C Tewes, eds. Cambridge, MA: MIT.Google Scholar
  45. Kleinman, A. 1980. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley: University of California Press.Google Scholar
  46. Koen, Benjamin D. 2009. Beyond the Roof of the World: Music, Prayer, and Healing in the Pamir Mountains. Oxford: Oxford University Press,.Google Scholar
  47. Koen, Benjamin D. 2013. “My Heart Opens and My Spirit Flies”: Musical Exemplars of Psychological Flexibility in Health and Healing. Ethos 41:174-198.CrossRefGoogle Scholar
  48. Kok, B. E., and B. L. Fredrickson. 2010. Upward Spirals of the Heart: Autonomic Flexibility, as Indexed by Vagal Tone, Reciprocally and Prospectively Predicts Positive Emotions and Social Connectedness. Biological Psychology 85(3):432-436.CrossRefGoogle Scholar
  49. Krakow, B., M. Hollifield, R. Schrader, M. Koss, D. Tandberg, J. Lauriello, L. McBride, T. D. Warner, D. Cheng, T. Edmond, and R. Kellner. 2000. A Controlled Study of Imagery Rehearsal for Chronic Nightmares in Sexual Assault Survivors with PTSD: A Preliminary Report. Journal of Traumatic Stress 13(4):589-609.CrossRefGoogle Scholar
  50. Lambek, Michael. 1981. Human Spirits: A Cultural Account of Trance in Mayotte. Cambridge: Cambridge University Press.Google Scholar
  51. Lane, R. D., L. Ryan, L. Nadel, and L. Greenberg (2015) Memory Reconsolidation, Emotional Arousal, and the Process of Change in Psychotherapy: New Insights from Brain Science. Behavioral and Brain Sciences, 38, e1. doi:10.1017/S0140525X14000041.CrossRefGoogle Scholar
  52. Lee, B. O., L. J. Kirmayer, and D. Groleau. 2010. Therapeutic Processes and Perceived Helpfulness of Dang-Ki (Chinese Shamanism) from the Symbolic Healing Perspective. Culture, Medicine and Psychiatry 34(1):56-105.CrossRefGoogle Scholar
  53. Lee, J. K., and S. M. Orsillo. 2014. Investigating Cognitive Flexibility as a Potential Mechanism of Mindfulness in Generalized Anxiety Disorder. Journal of Behavior Therapy and Experimental Psychiatry 45(1):208-216.CrossRefGoogle Scholar
  54. Leitan, N. D., B. Williams, and G. Murray. 2015. Look up for Healing: Embodiment of the Heal Concept in Looking Upward. PLoS One 10(7):e0132427.CrossRefGoogle Scholar
  55. Leung, A. K., W. W. Maddux, A. D. Galinsky, and C. Y. Chiu. 2008. Multicultural Experience Enhances Creativity: The When and How. American Psychologist 63(3):169-181.CrossRefGoogle Scholar
  56. Lévi-Strauss, Claude. 1963. Structural Anthropology. vol. 2 New York: Basic Books.Google Scholar
  57. Lewis, Sara. 2013. Trauma and the Making of Flexible Minds in the Tibetan Exil Community. Ethos 41:313-336.CrossRefGoogle Scholar
  58. Lock, J, WS Agras, KK Fitzpatrick, SW Bryson, B Jo, and K Tchanturia 2013 Is Outpatient Cognitive Remediation Therapy Feasible to Use in Randomized Clinical Trials for Anorexia Nervosa? International Journal of Eating Disorders 46(6): 567–575.Google Scholar
  59. Luhrmann, T. M. 2013. Making God Real and Making God Good: Some Mechanisms through Which Prayer May Contribute to Healing. Transcultural Psychiatry 50:707-725.CrossRefGoogle Scholar
  60. Lutz, A., H. A. Slagter, J. D. Dunne, and R. J. Davidson. 2008. Attention Regulation and Monitoring in Meditation. Trends in Cognitive Science 12(4):163-169.CrossRefGoogle Scholar
  61. McLaughlin, K. A., and S. Nolen-Hoeksema. 2011. Rumination as a Transdiagnostic Factor in Depression and Anxiety. Behaviour Research and Therapy 49(3):186-193.CrossRefGoogle Scholar
  62. Meier, B. P., S. Schnall, N. Schwarz, and J. A. Bargh. 2012. Embodiment in Social Psychology. Topics in Cognitive Science 4(4):705-716.CrossRefGoogle Scholar
  63. Miller, Terry E., and Sean Williams. 2008. The Garland Handbook of Southeast Asian Music. New York: Routledge.Google Scholar
  64. Moerman, D. E., J. Benoist, E. B. Brody, M. Giovannini, M. F. Gracia, E. T. Hall, and D. H. Spodick. 1979. Anthropology of Symbolic Healing [and Comments and Reply]. Current Anthropology 20:59-80.CrossRefGoogle Scholar
  65. Moore, A., and P. Malinowski. 2009. Meditation, Mindfulness and Cognitive Flexibility. Consciousness and Cognition 18(1):176-186.CrossRefGoogle Scholar
  66. Nations, M. 2013. Dead-Baby Dreams, Transfiguration and Recovery from Infant Death Trauma in Northeast Brazil. Transcultural Psychiatry (50):662-682.CrossRefGoogle Scholar
  67. Obeyesekere, Gananath. 1990. The Work of Culture: Symbolic Transformation in Psychoanalysis and Anthropology. Chicago: University of Chicago Press.Google Scholar
  68. Porges, S. W. 2007. The Polyvagal Perspective. Biological Psychology 74(2):116-143.CrossRefGoogle Scholar
  69. Porges, S. W. 2009. The Polyvagal Theory: New Insights into Adaptive Reactions of the Autonomic Nervous System. Cleveland Clinical Journal of Medicine 76 Suppl 2:S86-90.CrossRefGoogle Scholar
  70. Ramseyer, F., and W. Tschacher. 2011. Nonverbal Synchrony in Psychotherapy: Coordinated Body Movement Reflects Relationship Quality and Outcome. Journal of Consulting and Clinical Psychology 79(3):284-295.CrossRefGoogle Scholar
  71. Roseman, M. 1988. The Pragmatics of Aesthetics: The Performance of Healing among Senoi Temiar. Social Science and Medicine 27(8):811-818.CrossRefGoogle Scholar
  72. Roseman, M. 1991. Healing Sounds from the Malaysian Rainforest: Temiar Music and Medicine. Berkeley: University of California.Google Scholar
  73. Rouget, Gilbert. 1985. Music and Trance: A Theory of the Relations between Music and Possession. Chicago: University of Chicago Press.Google Scholar
  74. Sax, William Sturman, Johannes Quack, and Jan Weinhold. 2010. The Problem of Ritual Efficacy. Oxford: Oxford University Press.CrossRefGoogle Scholar
  75. Scheff, Thomas J. 1979. Catharsis in Healing, Ritual, and Drama. Berkeley: University of California Press.Google Scholar
  76. Seligman, R., and R. A. Brown. 2010. Theory and Method at the Intersection of Anthropology and Cultural Neuroscience. Social Cognitive and Affective Neuroscience 5(2-3):130-137.CrossRefGoogle Scholar
  77. Sherzer, Joel. 1983. Kuna Ways of Speaking: An Ethnographic Perspective. Austin: University of Texas Press.Google Scholar
  78. Silverstein, Michael. 1976. Shifters, Linguistic Categories, and Cultural Description. In K.H. Basso and H.A. Selby, eds. Meaning and Anthropology (pp. 11-55). Amsterdam: John Benjamins PublishingGoogle Scholar
  79. Southwick, SM, GA Bonanno, AS Masten, C Panter-Brick, and R Yehuda 2014 Resilience Definitions, Theory, and Challenges: Interdisciplinary Perspectives. European Journal of Psychotraumatology 5. doi:10.3402/ejpt.v5.25338
  80. Stokes, C., and C. R. Hirsch. 2010. Engaging in Imagery Versus Verbal Processing of Worry: Impact on Negative Intrusions in High Worriers. Behaviour Research and Therapy 48(5):418-423.CrossRefGoogle Scholar
  81. Tan, S, Y Zou, T Wykes, C Reeder, X Zhu, Fude Yang, Y Zhao, Y Tan, F Fan, and D Zhou. 2015 Group Cognitive Remediation Therapy for Chronic Schizophrenia: A Randomized Controlled Trial. Neuroscience Letters. doi:10.1016/j.neulet.2015.08.036.
  82. Thompson, Robert Farris. 2011. Aesthetic of the Cool: Afro-Atlantic Art and Music. New York: Periscope Publishing.Google Scholar
  83. Turner, Mark. 1996. The Literary Mind. Oxford: Oxford University Press.Google Scholar
  84. Turner, Victor W. 1967. The Forest of Symbols: Aspects of Ndembu Ritual. Ithaca, New York: Cornell University Press.Google Scholar
  85. Turner, Victor W. 1995. The Ritual Process: Structure and Anti-Structure. New York, NY: Aldine de Gruyter.Google Scholar
  86. Van Gennep, Arnold. 1961. The Rites of Passage. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  87. Vitebsky, Piers. 2001. Shamanism. Norman: University of Oklahoma Press.Google Scholar
  88. Wilcken, L. E. 2010. The Vodou Kase: The Drum Break in New York Temples and Dance Classes. The Journal of the New York Folk Society 36:3-9.Google Scholar
  89. Zeig, Jeffrey K. 1987. The Evolution of Psychotherapy. New York: Brunner/Mazel.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Harvard UniversityCambridgeUSA
  2. 2.McGill UniversityMontrealCanada

Personalised recommendations