Flat, Quiet, Still: How to Step Down from Vigilance
You may think that as an acupuncturist my most important duty is to “put pins in people,” as many of my patients like to phrase it. This is true to a degree, but I don’t always use needles to treat people, and when I do there’s something even more basic and arguably more important that I do for each patient that comes in. It sounds simple, but is easier said than done: It’s to get every patient to lay flat, quiet, and still.
Hyper-vigilance is common among many of my patients as a consequence of trauma, or a function of our modern over-busy, over-stimulated, over-stressed way of life. It manifests as nervousness, anxiety, muscle tension and guarding, digestive issues, over-sensitivity to pain, sleep disorders, blood pressure issues, hormonal imbalances, cognitive and behavioral disorders, immune imbalances, and even inflammation and poor injury healing. It’s the kind of root cause that most medical doctors are helpless to address, yet relates to so many of our society’s chronic health issues.
Over the years I've observed many different patterns of vigilance in my patients. There are those who, when asked to lay down, stay upright on the table while trying to talk or explain things to me, and need to be told another time or two to lay down so I can start examining. There are those who, upon laying down, seem uncomfortable with stillness, talking a lot (often with the hands), asking a lot of questions, keeping the eyes open and watchful, and tensing up the body.
Hyper-vigilant patients often take shallow breaths at a fast pace, and they tend to be more intolerant of needle sensation. I consider some nervousness to be normal if experiencing acupuncture for the very first time, but I see guarding sometimes in patients I've known for years and whom I know to look forward to their appointments. It’s a clear sign to me that their nervous system is in an over-stressed, over-protective state.
More of a problem in recent years, I also get patients who delay in putting their phones away or even must have one at their side. I can sympathize with the occasional pending emergency or urgent matter, but for some folks this is a constant need. Being unable to tolerate an hour of isolation is a form of extreme vigilance.
From fight-or-flight to rest, assimilate and heal
How easily a patient can lay flat, tolerate stillness and endure disconnection from their phone can tell me a lot about the state of their autonomic nervous system (ANS), the branch of our nervous system that controls many of our autonomic functions such as heart rate, digestion and blood pressure. When the autonomics are more sympathetic branch-dominant, the patient is revved up, in fight-or-flight mode. In a sympathetic dominant-state it's hard to sleep, digest properly and repair the body. Blood circulation is impeded, muscles get tight (especially in the neck and back) and the mind tends to feel anxious.
When the sympathetic branch starts to quiet down, the parasympathetic branch of the autonomics can express itself. Too many times to count, I've had acupuncture patients apologize bashfully about the spontaneous gurgles we hear in their abdomen at the start of a treatment. This is called "borborygmus," a sign of smooth muscle contraction in the GI tract. It's from parasympathetic nerves firing, up-regulating digestion and assimilation! In addition to enabling digestion, more tone in the parasympathetic branch is also going to improve the body’s tissue repair, immune health, quality of sleep, and hormonal balance, and will actually lower pain levels.
As we dial back the sympathetic branch I also get to watch as patients sigh or yawn a little as they begin to breathe more deeply and slowly (though some folks require extra coaching on this). I'll observe muscle tone in the neck and shoulders relaxing, pulse rates slowing. Many patients start to get a sleepy or spaced-out feeling; this is a really nice sign of the vigilance falling away. (Another frequent question I get is, “Is it normal to feel like I could fall asleep right now?”)
I often select specific acupuncture points to encourage regulation of the ANS, but I also believe the stillness experienced during an acupuncture session is therapeutic. Stillness helps the body and mind to better experience feedback from the acupoints, changing up the usual proprioceptive scripts, cognitive habits and neuromuscular holding patterns. It also starts to reset the ANS by sending a message that there's nothing urgent going on, so we might as well take a moment to rest, assimilate and heal. Even if I don't have another patient overlapping, I typically make an effort to step out of the room to give the patient the opportunity to practice a moment of quietude and isolation while the needles do their work.
A couple of acupuncture sessions tends to provide good practice in being comfortable with stillness and helps patients access their parasympathetic state. Some folks require a bit more practice, but their nervous systems can gradually re-learn the ability to voluntarily, consciously tone down the fight-or-flight response and re-establish a sense of safety. This can of course be lost again with trauma or mounting stress, but patients who have reconnected to their parasympathetic state using acupuncture and mindful breathing more easily find it again.
We need to be less vigilant, now more than ever
With the COVID epidemic we have been forced to be more vigilant every single day. As soon as we leave the home it’s all about masking up, avoiding getting too close to whomever you see, rushing through shopping, being stressed-out about touching normal things... It’s a lot to have to constantly worry about. Perhaps you even have the unusual pressure of working in a high risk environment. Stresses have sometimes grown worse inside the home as well, such as with juggling childcare and schooling, being quarantined in an atmosphere of marital or family disharmony, or feeling pressure to protect loved ones from imminent danger. Maybe on top of this you have the stress of wondering if your sneeze or cough was the beginning of COVID, or you have had to actually struggle with an infection, or even the illness or death of a loved one. I’m sure everyone out there can relate to some aspect of what I just described.
On top of all this there’s the worry about the future-- what will things be like in the fall? In the winter? With the economy? With the schools? In Brazil, in India? With the election? It’s much more than our usual mental burdens that take us out of the present and into our non-stop monkey minds.
Even before the pandemic, the way our society has been trending toward vigilance had become a matter of concern to me and many other observers. This became apparent to me in the yoga studio recently, when I went back to doing some regular classes after a few years of mostly home practice. At the end of a yoga class instructors typically encourage you to “stay as long as you’d like” in savasana, the "corpse pose" where you are only asked to cease making an effort, and lay on your back, palms up with eyes closed. I’m accustomed to staying five, ten minutes. But lately, compared to just a decade or two ago, it seems like most people cannot wait to immediately bust out of the room at the end of class. Once the teacher leaves the room it takes no time at all before the buzz of mats being picked up, water bottles knocking over, doors banging and even conversation inside the studio. Dare I mention the folks who start checking the phones and smart watches they brought in with them… I’ll just say, it’s a thing.
And then there’s the unique vigilance being amplified by the political polarization we are all familiar with. Yesterday I saw on social media that an old friend from Yale had been out taking an educational walk with his 10-year-old son in the French Quarter of New Orleans. They were reading signage about historical sites that discussed the slave trade, and as they wrapped up the walk they paused to discuss current politics as they looked at some MAGA hats prominently displayed in a parked car window. The apparent owner of the car rushed out of a nearby building and, calling them the N-word, told them to step away from the car. What followed was a violent verbal battle that was documented on video; after watching even I needed a few deep breaths to bring down my heart rate. I can imagine the vigilance that boils after such a fight; I can only try to imagine the vigilance still required just to be black on your own neighborhood streets in America.
Everyone's on edge. As a cyclist I've noticed the increase lately in road rage and unsafe, pushy driving behavior. It's great to see lots of new people, especially kids, out on bikes, but having been in a couple bad crashes I find myself getting stressed about all the folks who aren't wearing helmets. We've all probably oscillated between concern toward other people's COVID safety practices, to concern toward those who are over-concerned with other's safety practices.
Finally, I'm sure you don't need another tirade against the over-use of phones and devices, but the impact this is having on everyone's nervous systems is real and needs to be combated. This kind of technology will either further put us into its yoke, or we will one day look back on it the way we now look at smoking in the 50s-- how quaint that you used to see it in playgrounds, inside restaurants, and even among doctors and pregnant women!
It seems we could all use extra measures to re-set vigilance patterning in order to maintain our health in these COVID times, and in these modern times going forward. Here are a few suggestions to try. I'd love to hear what else works for you.
Practice some focused, deep belly breathing.
Six counts in, six counts out, gently and silently, letting go of any tension in the chest and shoulders. Then pause at the end before you let yourself inhale again. Breathe through your nose and slow it down as much as is comfortable. This is a proven way to enter a more parasympathetic state and will grow easier the more you practice it.
Lay flat on the floor.
Practice savasana, “corpse pose,” and don't let fear of death stop you! Just lay flat on your back on the floor, no pillows, with your palms facing up at your sides. If you cannot lay without a pillow, use pillows as minimally as you can manage in order to allow your joints to gently stretch on the hard surface. Start with two minutes, then work your way up to five, then ten, then maybe more...
Go for a walk in a green place without your phone.
If the idea of this brings up panicky feelings, this advice is definitely for you. Don't worry, you can start at 2 minutes and work your way up from there. It gets easier with practice!
Power that phone down when you come for acupuncture, and savor your hour of laying flat, quiet and still.