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The Flexibility Hypothesis of Healing

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.

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Notes

  1. We consider “mind-set” in the broad sense that may include the cognitive and emotional frame by which a situation is viewed (Ben-Naim et al. 2013; Dweck 2008; Haager et al. 2014)

  2. We use the term “shifters” here in a broader sense than its use for indexicals in linguistics (Silverstein 1976), to denote any symbolic action aimed to evoke a change or transformation in experience.

  3. Depending on the context, healers and participants may be variably aware that inducing flexibility is a function of the healing practice. Certain cultures or traditions may have more explicit imagery and discourse about flexibility as a core value (e.g., the image of the flow of water in Taoism; Allan 1997). However, even when it remains entirely implicit, flexibility may be an important adaptive outcome of healing.

  4. Erickson’s work gave rise to contemporary forms of strategic, family, narrative, and solution-focused therapy (Zeig 1987).

  5. In hypnosis, this type of mirror-and-shift is sometimes called “pacing” and “leading,” a technique often used by Erickson (Haley 1973).

  6. The images need not be plausible to work; indeed, improbable images may have added beneficial effects because they evoke amusement or laughter.

  7. This type of metaphoric transformation is used in many Western methods without an explicit ontology. In progressive muscle relaxation, for example, the release of tension is often matched with the phrase, “just let go of all your problems,” or some other such metaphor; or in hypnosis, the therapist may use statements of this kind when the person exhales. In these cases, the therapeutic metaphor is synchronized with bodily experience, and in addition to the sensory reinforcement of positive affect, this may result in a form of verbal-somatic conditioning so that the metaphor increasingly evokes the bodily state. As another example, in yoga, the act of stretching in an asana may be linked to the statement that one needs to be flexible in one’s life. Visual imagery can be added as well, so that there are three parallel layers encoding flexibility: bodily stretching, verbal statement, and image (e.g., of a leaf moving flexibly in the wind). Of course, in yoga practice, stretching has actual biological effects of muscle relaxation. Thus there may be a sort of associative learning or conditioning strengthening links between the physiological process of relaxation and the cognitive-emotional process of flexibility. This process is naturalized and automatized by the use of metaphors that imply ease or lack of effort.

  8. One might translate “arâm” and “ceut” as “attentional-focus/mood.” So these phrases could be translated as the following: “cutting the ‘attentional-focus/mood’” (gat ceut), “pulling the ‘attentional-focus/mood’” (dâ ceut), and “turning the ‘attentional-focus/mood’” (beunlâp arâm). In these expressions, the role of the attentional focus in generating emotion is emphasized.

  9. Our use of the term “transformagram” and the related theory of healing resembles Dow’s (1986) theory of ritual healing, according to which the patient’s problem is re-cast in terms of a culturally salient and emotionally charged symbol and then that symbol is changed to bring about healing. However, we aim to go beyond Dow’s account in specifying the central role of metaphor in cognitive-affective, sensorial, and social transformation (for a review, see Kirmayer 1993). In symbolic healing, a symptom or emotion may be linked through metaphor to other representational processes and then transformed (Lee et al. 2010).

  10. In instances where a person suffers from recurrent intrusive imagery, a shift to verbal depiction may provide similar benefits by disrupting the arresting image.

  11. So, for instance, contrasting deities are contrasting “patterns” in the broad sense.

  12. Here we use “multi-strand” as a general term to represent the analogue of polyrhythm across sensory domains. As indicated, multi-strands involve patterns, which co-occur either sequentially (one after another) or simultaneously (all at once). And as indicated above, the pattern may be auditory (e.g., a rhythm), visual (e.g., clothing patterns), or involve other sensory modalities (e.g., olfaction or taste). In addition, a multi-strand may be the co-occurrence, either sequentially or simultaneously, of different modes of consciousness or experiencing.

  13. We use the term “icon” here to indicate that some quality of that represented is present in the symbol, establishing a relationship of “iconicity,” rather than pure abstraction (Roseman 1988).

  14. We use the term state here in the broad sense of a nexus of process and experience that includes the mode of being-in-the-world, which encompasses physiological, psychological, and socially marked states of identity. Although the aim in healing may be consonance between these different facets of state, in any given case they may be only partially aligned and their tensions or contradictions will be part of the full analysis of states of affliction and healing trajectories.

  15. Csordas (1994) uses the term “modulation” to capture a similar concept, but though modulation in respect to music means a change in key, when used more generally as a kind of metaphor, it normally has the meaning of a slight change or adjustment rather than the radical shift indicated here.

  16. For this effect to occur, the person may not need to be conscious of the shifting, and may not be aware of the attentional “choice” of strand and shift from one to the other. Instead, these shifts may have their own cumulative effect, creating a sense of flexibility. The meta-message of flexibility can be conveyed through other sensory domains as well.

  17. By experiencing a shift from A to B, the person is experiencing profound shift, which opens up the possibility of change in other experiential domains.

  18. In many cases, the ritual seems to highly represent the idea of flexibility to promote a shift from state A to state B. Whether this flexibility emphasis simply serves as a way to move the person to state B or whether it helps to open up to the possibility of change are distinct issues. In addition, processes that promote a shift from state A to state B may not involve flexibility, but they are flexibility primers in the sense they create a sense of shift and further ways of being-in-the-world. In this sense, “shifters” are a broader category.

  19. Friedson (1996:169) remarks that a key aspect of the healing ritual is a doubling of consciousness in which there is normal consciousness and the new consciousness that occurs through possession, with each deity associated with a specific rhythm, story, and manner of dance. He sees the three-against-two rhythm as facilitating an openness to shift, to doubling of consciousness; that is, sees it as acting as a musical shifter, or an analogue of doubling. While he does not explain why this doubling is therapeutic, we argue that it is by promoting a more general psychological flexibility and a sense of transformative shift.

  20. Adding to the complexity, a compound duple meter has a strong inherent threeness in it because of the cluster of three pulses per beat.

  21. Friedson’s main point is that there is playing of three-against-two in different instruments (hand clapping as also an instrument) and shifting in a particular instrument from a twoness to a threeness and back again.

  22. In which each of the three beats is two pulses long.

  23. There is a profound transformation with each deity associated with a certain story, mannerisms, dance motions, and rhythmic pattern (Friedson 1996). And normally the person is possessed by more than one deity.

  24. There is vertical hemiola, meaning co-present 3-pulse and 2-pulse beats, and sequential hemiola, meaning one instrument changing from a 3-pulse to a 2-pulse beat or visa versa: 1 2 3/1 2 3 to 1 2/1 2/1 2 (Brandel 1961).

  25. In possession by a demonic force, there is again a dual self or two registers of being, but the goal is expulsion.

  26. To make the key component of the kaen, the tubes, one must do the following: cut off ââ tubes (a bamboo-like reed that grows in clumps); puncture with a rod each tube’s inner partitions (which are located at the level of the joints); cut a small hole (about an inch long) at the side of each tube about half the way up its length; and place a metal-tongue-containing small rectangle over that hole (the metal has been cut to form a metal tongue that swivels on its base). To form the kaen, two rows of eight tubes prepared in this way are placed inside a “wind chest,” with the part of the tubes holding the metal tongues placed in that wind chest; the wind chest has a mouthpiece through which one blows to move the metal tongues to create sound.

  27. The player’s fingers lie parallel to the pipes––jointed fingers alongside jointed ââ tubes. If one includes the two rows of ââ tubes (eight in a row), one has an impressive number of juxtaposed jointed columns: two rows of vertically aligned, jointed columnar shapes. Looking at this in terms of layers, one discerns a five-fingered hand, then a row of eight tubes, then another row of eight tubes, and finally a hand of five fingers. And each of these rows has multiple “joints”—the three joints of each finger.

  28. As described above, each tube of the kaen has been notched (this part of the tube is hidden within the wind chest) so as to create a one-half by one-inch hole (the one-inch length laying along the long axis of the tube). The maker slides a square sheet of metal into this hole in the ââ tube. In the middle of this square sheet of metal, the maker previously cut a tapering column of sorts, this now attached to the metal sheet only at its base. Hence, this tapering column can swing back-and-forth within the metal sheet, analogous to the manner in which a piece of bamboo might swing back-and-forth pivoting at its base. This tapering metal column is called the “tongue of the kaen” (lin kaen). As the player blows, if he fingers a particular hole, then air rushes down that tube, and the metal piece inserted on the side of that particular tube must flexibly bend back-and-forth in order for sound to be created.

  29. Because metaphor provides the cross-modal links in human conceptual activity, thinking about these different modes of symbolizing in terms of metaphor may capture much of their cognitive effect (Danesi 2013). In different sensory zones there may be icons of flexibility, with icon here meant in the Peircean sense of a sign that bears a likeness to what it represents. Thus, images of something pliable moving or multiple shifting rhythmic patterns can convey flexibility. It may be that such icons actually activate biological systems related to flexibility, for example, those related to attention, and directly promote cognition based on shifting gestalts. But how participants in a culture think about and enact these images is key.

  30. One key process involves metaphoric cognition, here considered in the broad sense of resonating icons or images that structure domains (e.g., abstract encoders of shift ability such as shifting pattern and the flexile element, which act as metaphors of change ability), key conceptual metaphors (e.g., that of “flexibility), and the process of using metaphor to bring about shift (e.g., transformagrams).

References

  • Allan, S. 1997. The Way of Water and Sprouts of Virtue. Albany: State University of New York Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Bonanno, G. A. 2013. Meaning Making, Adversity, and Regulatory Flexibility. Memory 21:150-6.

    Article  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Chernoff, John Miller. 1979. African Rhythm and African Sensibility: Aesthetics and Social Action in African Musical Idioms. Chicago: University of Chicago Press.

    Google Scholar 

  • 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 

  • Csordas, Thomas J. 1994. The Sacred Self: A Cultural Phenomenology of Charismatic Healing. Berkeley: University of California Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Danesi, M. 2013. On the Metaphorical Connectivity of Cultural Sign Systems. Signs and Society 1:33-49.

    Article  Google Scholar 

  • Desjarlais, R. R. 1989. Healing through Images: The Magical Flight and Healing Geography of Nepali Shamanism. Ethos 17:289-307.

    Article  Google Scholar 

  • Dow, J. 1986. Universal Aspects of Symbolic Healing: A Theoretical Synthesis. American Anthropologist 88:56–69.

    Article  Google Scholar 

  • Dweck, C. S. 2008. Mindset: The New Psychology of Success. New York: Ballantine Books.

    Google Scholar 

  • Feld, Steven. 2012. Sound and Sentiment: Birds, Weeping, Poetics, and Song in Kaluli Expression. Durham, NC: Duke University Press.

    Book  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Frank, Jerome D., and Julia Frank. 1991. Persuasion and Healing: A Comparative Study of Psychotherapy. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Friedson, Steven M. 1996. Dancing Prophets: Musical Experience in Tumbuka Healing. Chicago: University of Chicago Press.

    Google Scholar 

  • Friedson, Steven M. 2009. Remains of Ritual: Northern Gods in a Southern Land. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Geurts, Kathryn Linn. 2002. Culture and the Senses: Bodily Ways of Knowing in an African Community. Berkeley: University of California Press.

    Google Scholar 

  • Gibbs, R. W. 2006. Embodiment and Cognitive Science. Cambridge: Cambridge University Press.

    Google Scholar 

  • Gridley, Mark C., and David Cutler. 2003. Jazz Styles: History & Analysis. Upper Saddle River, N.J.: Prentice Hall.

    Google Scholar 

  • Haager, J. S., C. Kuhbandner, and R. Pekrun. 2014. Overcoming Fixed Mindsets: The Role of Affect. Cognition Emotion 28(4):756-767.

    Article  Google Scholar 

  • Haley, Jay. 1973. Uncommon Therapy: the Psychiatric Techniques of Milton H. Erickson, M.D. New York: Norton.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Herzfeld, Michael. 1986. Ours Once More: Folklore, Ideology, and the Making of Modern Greece. New York: Pella.

    Google Scholar 

  • Hinton, DE 2000 Musical Healing and Cultural Syndromes in Isan: Landscape, Conceptual Metaphor, and Embodiment, Dissertation Abstracts International 60:2553, Harvard University.

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 15:255-63

    Article  Google Scholar 

  • Hinton, D. E., and L. J. Kirmayer. 2013. Local Responses to Trauma: Symptom, Affect, and Healing. Transcultural Psychiatry 50:607-621.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Kashdan, T. B. 2010. Psychological Flexibility as a Fundamental Aspect of Health. Clinical Psychology Review 30(7):865-878.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Kirmayer, L. J. 1993. Healing and the Invention of Metaphor: The Effectiveness of Symbols Revisited. Culture, Medicine, and Psychiatry 17(2):161-195.

    Article  Google Scholar 

  • Kirmayer, L. J. 2003. Asklepian Dreams: The Ethos of the Wounded-Healer in the Clinical Encounter. Transcultural Psychiatry 40(2):248-277.

    Article  Google Scholar 

  • Kirmayer, L. J. 2004. The Cultural Diversity of Healing: Meaning, Metaphor and Mechanism. British Medical Bulletin 69:33-48.

    Article  Google Scholar 

  • Kirmayer, L. J. 2008. Culture and the Metaphoric Mediation of Pain. Transcultural Psychiatry, 45(2):318-338.

    Article  Google Scholar 

  • Kirmayer, L. J. 2011. Unpacking the Placebo Response: Insights from Ethnographic Studies of Healing. Journal of Mind-Body Regulation 1:112-124.

    Google Scholar 

  • 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.

  • 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 

  • Koen, Benjamin D. 2009. Beyond the Roof of the World: Music, Prayer, and Healing in the Pamir Mountains. Oxford: Oxford University Press,.

    Google Scholar 

  • Koen, Benjamin D. 2013. “My Heart Opens and My Spirit Flies”: Musical Exemplars of Psychological Flexibility in Health and Healing. Ethos 41:174-198.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Lambek, Michael. 1981. Human Spirits: A Cultural Account of Trance in Mayotte. Cambridge: Cambridge University Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Lévi-Strauss, Claude. 1963. Structural Anthropology. vol. 2 New York: Basic Books.

    Google Scholar 

  • Lewis, Sara. 2013. Trauma and the Making of Flexible Minds in the Tibetan Exil Community. Ethos 41:313-336.

    Article  Google Scholar 

  • 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.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Meier, B. P., S. Schnall, N. Schwarz, and J. A. Bargh. 2012. Embodiment in Social Psychology. Topics in Cognitive Science 4(4):705-716.

    Article  Google Scholar 

  • Miller, Terry E., and Sean Williams. 2008. The Garland Handbook of Southeast Asian Music. New York: Routledge.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Moore, A., and P. Malinowski. 2009. Meditation, Mindfulness and Cognitive Flexibility. Consciousness and Cognition 18(1):176-186.

    Article  Google Scholar 

  • Nations, M. 2013. Dead-Baby Dreams, Transfiguration and Recovery from Infant Death Trauma in Northeast Brazil. Transcultural Psychiatry (50):662-682.

    Article  Google Scholar 

  • Obeyesekere, Gananath. 1990. The Work of Culture: Symbolic Transformation in Psychoanalysis and Anthropology. Chicago: University of Chicago Press.

    Google Scholar 

  • Porges, S. W. 2007. The Polyvagal Perspective. Biological Psychology 74(2):116-143.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Roseman, M. 1988. The Pragmatics of Aesthetics: The Performance of Healing among Senoi Temiar. Social Science and Medicine 27(8):811-818.

    Article  Google Scholar 

  • Roseman, M. 1991. Healing Sounds from the Malaysian Rainforest: Temiar Music and Medicine. Berkeley: University of California.

    Google Scholar 

  • Rouget, Gilbert. 1985. Music and Trance: A Theory of the Relations between Music and Possession. Chicago: University of Chicago Press.

    Google Scholar 

  • Sax, William Sturman, Johannes Quack, and Jan Weinhold. 2010. The Problem of Ritual Efficacy. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Scheff, Thomas J. 1979. Catharsis in Healing, Ritual, and Drama. Berkeley: University of California Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Sherzer, Joel. 1983. Kuna Ways of Speaking: An Ethnographic Perspective. Austin: University of Texas Press.

    Google Scholar 

  • 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 Publishing

    Google Scholar 

  • 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

  • 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.

    Article  Google Scholar 

  • 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.

  • Thompson, Robert Farris. 2011. Aesthetic of the Cool: Afro-Atlantic Art and Music. New York: Periscope Publishing.

    Google Scholar 

  • Turner, Mark. 1996. The Literary Mind. Oxford: Oxford University Press.

    Google Scholar 

  • Turner, Victor W. 1967. The Forest of Symbols: Aspects of Ndembu Ritual. Ithaca, New York: Cornell University Press.

    Google Scholar 

  • Turner, Victor W. 1995. The Ritual Process: Structure and Anti-Structure. New York, NY: Aldine de Gruyter.

    Google Scholar 

  • Van Gennep, Arnold. 1961. The Rites of Passage. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Vitebsky, Piers. 2001. Shamanism. Norman: University of Oklahoma Press.

    Google Scholar 

  • 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 

  • Zeig, Jeffrey K. 1987. The Evolution of Psychotherapy. New York: Brunner/Mazel.

    Google Scholar 

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Hinton, D.E., Kirmayer, L.J. The Flexibility Hypothesis of Healing. Cult Med Psychiatry 41, 3–34 (2017). https://doi.org/10.1007/s11013-016-9493-8

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Keywords

  • PTSD
  • Trauma
  • Healing ritual
  • Anthropology
  • Flexibility
  • Resilience
  • Mood