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What is Imagery, and How Does it Work?

Imagery is a flow of thoughts you can see, hear, feel, smell, or taste. An image is an inner representation of your experience or your fantasies–a way your mind codes, stores, and expresses information. Imagery is the currency of dreams and daydreams; memories and reminiscence; plans, projections, and possibilities. It is the language of the arts, the emotions, and most important, of the deeper self.

Imagery is a window on your inner world; a way of viewing your own ideas, feelings, and interpretations. But it is more than a mere window–it is a means of transformation and liberation from distortions in this realm that may unconsciously direct your life and shape your health.

Imagination, in this sense, is not sufficiently valued in our culture. The imaginary is equated with the fanciful, the unreal, and the impractical. In school we are taught the three R’s while creativity, uniqueness, and interpersonal skills are either barely tolerated or frankly discouraged. As adults, we are usually paid to perform tasks, not to think creatively. The premium is on the practical, the useful, the real, as it should be–but imagination nurtures human reality as a river brings life to a desert.

Without imagination, humanity would be long extinct. It took imagination–the ability to conceive of new possibilities–to make fire, create weapons, and cultivate crops; to construct buildings, invent cars, airplanes, space shuttles, television, and computers.

Paradoxically, our collective imagination, which has allowed us to overcome so many natural threats, has been instrumental in creating the major survival problems we face on earth today–pollution, exhaustion of natural resources, and the threat of nuclear annihilation. Yet imagination, teamed with will, remains our best hope for overcoming these same problems.

Imagery and Physiologic Change

Imagery in healing is probably best known for its direct effects on physiology. Through imagery, you can stimulate changes in many body functions usually considered inaccessible to conscious influence.

A simple example: Touch your finger to your nose. How did you do that? You may be surprised to learn that nobody knows.

A neuroanatomist can tell us the area of the brain where the first nerve impulses fire to begin that movement. We can also trace the chain of nerves that conduct impulses from the brain to the appropriate muscles. But no one knows how you go from thinking about touching your nose to firing the first cell in that chain. You just decide to do it and you do it, without having to worry about the details.

Now make yourself salivate.

You probably didn’t find that as easy, and may not have been able to do it at all. That’s because salivation is not usually under our conscious control. It is controlled by a different part of the nervous system than the one that governs movement. While the central nervous system governs voluntary movement, the autonomic nervous system regulates salivation and other physiologic functions that normally operate without conscious control. The autonomic nervous system doesn’t readily respond to ordinary thoughts like “salivate.” But it does respond to imagery.

Relax for a moment and imagine you are holding a juicy yellow lemon. Feel its coolness, its texture, and weight in your hand. Imagine cutting it in half and squeezing the juice of one half into a glass. Perhaps some pulp and a seed or two drop into the glass. Imagine raising the glass to your lips and taking a good mouthful of the tart juice. Swish it around in your mouth, taste its sourness, and swallow.

Now did you salivate? Did you pucker your lips or make a sour face when you imagined that? If you did, that’s because your autonomic nervous system responded to your imaginary lemon juice.

You probably don’t spend much time thinking about drinking lemon juice, but what you do habitually think about may have important effects on your body through a similar mechanism. If your mind is full of thoughts of danger, your nervous system will prepare you to meet that danger by initiating the stress response, a high level of arousal and tension. If you imagine peaceful, relaxing scenes instead, it sends out an “all-clear” signal, and your body relaxes.

Research in biofeedback, hypnosis, and meditative states has demonstrated a remarkable range of human self-regulatory capacities. Focused imagery in a relaxed state of mind seems to be the common factor among these approaches.

Imagery of various types has been shown to affect heart rate, blood pressure, respiratory patterns, oxygen consumption, carbon dioxide elimination, brain wave rhythms and patterns, electrical characteristics of the skin, local blood flow and temperature, gastrointestinal motility and secretions, sexual arousal, levels of various hormones and neurotransmitters in the blood, and immune system function.’ But the healing potentials of imagery go far beyond simple effects on physiology.

Imagery in the Larger Context of Healing

Recovering from a serious or chronic illness may well demand more from you than simple imagery techniques. It may also require changes in your lifestyle, your attitudes, your relationships, or your emotional state. Imagery can be an effective tool for helping you see what changes need to be made, and how you can go about making them.

Imagery is the interface language between body and mind. It can help you understand the needs that may be represented by an illness and can help you develop healthy ways to meet those needs. Let me give you another example from my practice. Jeffrey was a successful middle manager in his thirties who had recurrent peptic ulcers for many years. In our work together he learned to relax and use simple visualization to give himself temporary relief from his stomach pain. He pictured the pain as a fire in his stomach and would then imagine an ice-cold mountain stream extinguishing the fire and cooling the scorched area beneath it. He was surprised and pleased to find that relaxing and imagining this process for a few minutes would relieve his pain for several hours to a day at a time, and he used it successfully for about two weeks. Then it stopped working. His pain grew worse in spite of his visualizations, and he began to despair. In our next session I suggested he focus once more on the pain and allow an image to arise that might help him understand why the pain had returned. He soon became aware of an image of a hand pinching the inside of his stomach.

At my suggestion, he mentally asked the hand if it would tell him why it was pinching him, and it changed into an arm shaking a clenched fist. He asked the arm why it was angry, and it replied, “Because there’s a part of you locked away where no one can see it, and it’s getting badly hurt.” I asked him to form an image of the part that was locked away, and he saw a transparent sack that contained a “chaotic whirling of things inside nothing is clear, everything is zooming around, bumping into everything else.” All he could make out were colors and shapes and a sense of discomfort. After observing them for a while, he quietly said, “My heart is in there, and it’s getting bumped and bruised by all these things.”

I asked Jeffrey to imagine opening the bag, but as he began he became afraid and said there was too much pain there to let out all at once. I asked him to let just one thing out of the bag and let an image form for it. He imagined his father’s face and recalled a number of painful childhood interactions with his father, who was quite emotionally abusive. Over a series of sessions, he began to come to terms with the feelings he had locked away about this and started to feel much better emotionally and physically. In this way, he not only obtained relief from his ulcer pain, he learned a method to better express and respond to his own emotional needs.

Using imagery in this way can allow illness to become a teacher of wellness. Symptoms and illnesses indicate that something is out of balance, something needs to be adjusted, adapted to, or changed. Imagery can allow you to understand more about your illness and respond to its message in the healthiest imaginable way.

How Does Imagery Work?

The ultimate mechanisms of imagery are still a mystery. in the last twenty years, however, we have learned that imagery is a natural language of a major part of our nervous system. Critical to this understanding is the Nobel-prize-winning work of Dr. Roger Sperry and his collaborators at the University of Chicago and later at the California Institute of Technology. They have shown that the two sides of the human brain think in very different ways and are simultaneously capable of independent thought. In a real sense, we each have two brains. One thinks as we are accustomed to thinking, with words and logic. The other, however, thinks in terms of images and feelings.

In most people, the left brain is primarily responsible for speaking, writing, and understanding language; it thinks logically and analytically, and identifies itself by the name of the person to whom it belongs. The right brain, in contrast, thinks in pictures, sounds, spatial relationships, and feelings. It is relatively silent, though highly intelligent. The left brain analyzes, taking things apart, while the right brain synthesizes, putting pieces together. The left is a better logical thinker, the right is more attuned to emotions. The left is most concerned with the outer world of culture, agreements, business, and time, while the right is more concerned with the inner world of perception, physiology, form, and emotion.

The essential difference between the two brains is in the way each processes information. The left brain processes information sequentially, while the right brain processes it simultaneously. Imagine a train coming around a curve in the track. An observer is positioned on the ground, on the outside of the curve, and he observes the train to be a succession of separate though connected cars passing him one at a time. He can see just a little bit of the cars ahead of and behind the one he is watching. This observer has a “left-brain” view of the train.

The “right-brain” observer would be in a balloon several hundred feet above the tracks. From here he could not only see the whole train, but also the track on which it was traveling, the countryside through which it was passing, the town it had just left, and the town to which it was headed.

This ability of the right hemisphere to grasp the larger context of events is one of the specialized functions that make it invaluable to us in healing. The imagery it produces often lets you see the “big picture” and experience the way an illness is related to events and feelings you might not have considered important. You can see not only the single piece, but the way it’s connected to the whole. This change of perspective may allow you to put ideas together in new ways to produce new solutions to old problems. A right-brain point of view may reveal the opportunity hidden in what seems to be a problem.

The right brain has a special relationship not only to imagery but to emotions. This is another of the major strengths it brings to the healing adventure. Many studies have shown that the right brain is specialized to recognize emotion in facial expressions, body language, speech, and even music. This is critical to healing because emotions are not only psychological but physical states that are at the root of a great deal of illness and disease. Rudolph Virchow, a nineteenth century physician and founding father of the science of pathology, remarked that “Much illness is unhappiness sailing under a physiologic flag.” Studies in England and the United States have found that from 50 to 75 percent of all problems presenting to a primary care clinic are emotional, social, or familial in origin, though they are being expressed by pain or illness.2

Emotions themselves are, of course, not unhealthy. On the contrary, they are a normal response to certain life events. Failure to acknowledge and express important emotions, however, is an important factor in illness, and one that is widespread in our society. In many ways we are emotional illiterates, lacking clear guidelines and traditions for expressing emotions in healthy ways. It is difficult to know what to do with distressing emotions such as grief, fear, and anger, so we cope as best we can. We may unconsciously build layer upon layer of inner defenses to protect us from feeling unpleasant feelings. But strong emotion has a way of finding routes of expression. If not recognized and dealt with for what it is, it may manifest as pain or illness.

Social and family relationships to some extent depend on our ability to process emotions internally. We don’t need to express every emotion we feel. But strong, persistent emotions need to be expressed or resolved, as their chronic denial may lead to physiologic imbalance and disease. The story of Alice is one example of how holding back feelings can manifest as pain, and how expressing them appropriately can lead to relief.

Alice was a woman in her forties who had recently undergone surgery and radiation to treat a breast cancer discovered several months earlier. She was an intelligent, composed woman who felt that imagery and visualization had already been enormously beneficial to her in tolerating her treatment and recovering from her cancer. She continued, however, to be bothered by a persistent pain between her shoulder blades. Repeated examinations and X-rays by her cancer specialists had failed to identify any physical cause of her pain. She wanted to understand why it was there, and what she needed to do for it to go away.

We decided to use an imagery technique: a talk with an imaginary wisdom figure called an inner advisor. Alice relaxed and imagined herself on a beautiful beach at the base of a high dim She asked for an image of her inner advisor and saw a man who looked like Merlin the Magician, tending a fire. After greeting him, she asked him about her back pain.

After a few seconds of silence, she broke into tears. She told me her advisor said she needed to ask for help, and that’s what brought on the tears. She had been strong and courageous throughout the entire cancer ordeal, calming and reassuring to her husband and family. She always went for checkups and treatments alone, though it frightened her, because she felt her husband and kids would be frightened if she asked them for help or company. Though she was often aware of her own doubts, fears, and concerns about her illness and its treatment, she had never allowed herself to express them in an attempt to spare her loved ones from the anxiety it might produce.

Alice told her inner advisor her concerns about her family being scared if she asked for help. Her advisor answered, “They are already scared. They will feel better if they are included in your trials and have an opportunity to be supportive and show their love for you.” She realized at once that this was true. She imagined asking her husband John for help. She laughed, as in her mind’s eye she saw him taking out his appointment book and thumbing through it. She asked him (still in imagery), “Do you have time?” and he looked at her over his half-glasses and said, “We’ll make time.” When she came out of the imagery her pain was substantially relieved, with “just enough left to remind me that I actually need to talk with John about this in real life.”

Like Alice, we all may hold back emotions because of conflicts between our thoughts and feelings. This inner division has been recognized in the oldest stories of humanity. That it may on one level represent a disagreement between the two hemispheres is a new, potentially helpful way to understand this situation. As Dr. Joseph Bogen, of the California Institute of Technology, the neurosurgeon who helped reveal the dual nature of the hemispheres, has said, “Having two brains has allowed man to be the most creative animal on earth, since we have two chances to solve any given problem. At the same time it creates an unprecedented opportunity for inner conflict.”

When there is inner conflict, the body is the battleground. It may pay dearly for prolonged, serious struggle. Bringing the conflicting sides, whether sides of the brain or sides of the argument, to the bargaining table may be the beginning of healing. The goal, after all, is not to become a “left-brain” or “right-brain” person, but a “whole-brain” person.

In any successful arbitration, both sides must have the opportunity to express themselves, to state their grievances, their desires, their needs, and what they can offer in the interest of peace. If they speak different languages, there must be an impartial translator willing to listen and speak for both sides, or the two must attempt to learn each other’s languages. This is why imagery is important–it is a major language of the right brain.

Most of us understand and use left-brain language and logic every day. We are relatively familiar with our conscious needs and desires. Imagery gives the silent right brain a chance to bring its needs to light and to contribute its special qualities to the healing process.

Frankly, calling verbal or logical thinking “left-brained,” and symbolic, imaginal thinking “right-brained” is an oversimplification, but it is a useful model for thinking about some uses of imagery. Imagery allows you to communicate with your own silent mind in its native tongue. Imagery is a rich, symbolic, and highly personal language, and the more time you spend observing and interacting with your own image-making brain, the more quickly and effectively you will use it to improve your health.

If you are ill, you have undoubtedly thought long and hard about why you fell ill and what you need to do to get better. If your illness is chronic, or severe, you have probably consulted many doctors, whose highly educated, logical analyses may have led to a diagnosis. Yet the diagnosis may not have led to a cure, or even relief. If good “left-brained” thinking has come to nought, why not get a “second opinion” from your other brain? After all, who is likely to know more about your body, your feelings, and your life?

What Kinds of Illness can be Treated with Imagery

While preliminary studies have demonstrated that imagery can be an effective part of treatment in a wide variety of illnesses, I am reluctant to offer a list of “diseases that can be treated with imagery.” Imagery can be helpful in so many ways that it is more accurate to think of it as a way of treating people than a way of treating illnesses.

Imagery can help you whether you have simple tension headaches or a life-threatening disease. Through imagery, you can learn to relax and be more comfortable in any situation, whether you are ill or well. You may be able to reduce, modify, or eliminate pain. You can use imagery to help you see if your lifestyle habits have contributed to your illness and to see what changes you can make to support your recovery. Imagery can help you tap inner strengths and find hope, courage, patience, perseverance, love, and other qualities that can help you cope with, transcend, or recover from almost any illness.

There are, of course, certain symptoms and illnesses that seem to be more readily responsive to imagery than others. Conditions that are caused by or aggravated by stress often respond very well to imagery techniques. These include such common problems as headaches, neck pain, back pain, “nervous stomach,” spastic colon, allergies, palpitations, dizziness, fatigue, and anxiety. Other major health problems including heart disease, cancer, arthritis, and neurological illnesses are often complicated by or themselves cause stress, anxiety, and depression. The emotional aspects of any illness can often be helped through imagery, and relieving the emotional distress may in turn encourage physical healing.

I must repeat that good medical care for the serious problems mentioned above is essential and perfectly compatible with imagery. If you choose to have therapeutic treatments of any kind, acknowledge them as your allies in healing and include them in your imagery. If you are taking an antibiotic or chemotherapy, imagine the medicines coursing through your tissues, finding and eliminating the bacteria or tumor cells you are fighting. If you have surgery, imagine the operation going smoothly and successfully, and your recovery being rapid and complete. There is good evidence that this type of pre-operative preparation reduces recovery time and complications from surgery.(3)

Now that we’ve considered what imagery can do and how it might work, let’s begin your personal exploration of the imagery process.

1) A very good review of this literature is found in “Imagery, physiology, and psychosomatic illness,” Sheikh, A., and Kunzendorf, R. G. (1984). In International Review of Mental Imagery, Vol. 1, ed. Sheikh, A. New York: Human Sciences Press.

2) Rosen, G., Kleinman, A., and Katon, W. (1982), “Somatization in family practice: a biopsychosocial approach.” Journal of Family Practice, 14:3, 493-502.

Stoeckle,J. D., Zola, I. K., and Davidson, G. E. (1964), “The quantity and significance of psychological distress in medical patients.” Journal of Chronic Disease, 17:959.

3) An excellent review of psychological factors in surgical outcome is found in “Behavioral Anesthesia,” by Henry L. Bennett, Ph.D., in Aduances, 2:4, Fall, 1985.

Pickett, C., and Clum, G. A. (1982), “Comparative treatment strategies and their interaction with locus of control in the reduction of postsurgical pain and anxiety.” Journal of Consulting and Clinical Psychology, 50:3, 439-441.

Martin L. Rossman MD Written by Martin L. Rossman MD

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