I have been trying to use drawing to visualise interoceptive experiences for the past three years and although some of the drawings seem to be communicative of basic feelings such as a pain in a particular place, I have been finding that it is very hard to reach a consensus of opinion in regards to more nuanced feelings. However this is perhaps a challenge rather than a disappointment, as it is obvious that we all inhabit very different internal imaginative worlds and therefore one person's image of pain is another person's image of excitement.
The longer I work in this area the more I become aware of parallel developments in relation to visualised body images in other professions, in particular in psychotherapy. Psychotherapists use the term 'guided imagery' when referring to a situation whereby a patient is helped to recall images from long-term or short term memory. They also work with patients to create imagery from fantasy or to make them from a fusion between imagination and memory. Guided imagery is defined as 'the assisted simulation or re-creation of perceptual experience across sensory modalities'. (I.e. this is not restricted to vision alone)
The use of imagery has been central to world wide rehabilitation traditions and is a critical component of many healing experiences. When we investigate the roles played by the placebo, suggestion or faith in a recovery from illness, it is clear that as well as using modern medicine and its procedures, people often use both positive thoughts and particular imagery that can carry those thoughts, in order to help themselves recover from both mental and physical problems. Those that do, often recover much faster than those that don't. (Robson, 2022) My own work has resulted in a range of imagery that is mainly the product of self analysis, however I am very aware that when I have conducted workshops with other people the nature of the images produced keeps changing.
In his article, 'Raising Pain Tolerance Using Guided Imagery', David Bresler points out that mental images are formed long before we learn to understand and use words. He states that they 'lie at the core of who we think we are, and what we believe the world is like', His article also raises awareness of how belief systems as a whole can be shaped by our mental images and that therefore they play a very powerful role in our ability to tolerate pain or heal ourselves when ill. He defines a mental image as 'a thought with sensory qualities' and then introduces various types of guided imagery as ways to put into effect an 'active imagination' whereby elements of the unconscious are invited to appear as images that can communicate with the conscious mind. He states that:
'if people can derive not only symptomatic relief, but actual physiologic healing in response to treatments that primarily work through beliefs and attitudes about an imagined reality, then learning how to better mobilise and amplify this phenomenon in a purposeful, conscious way becomes an important, if not critical, area of investigation for modern medicine'. (Bresler, 2010)
Bresler points out that the body responds to imagery in the same way as any other external experience and in particular the autonomic nervous system easily understands and responds to the language of imagery. Therefore if you imagine you are very ill, or that your pain is hard to bear, you are very likely to find that you become very ill and that your pain will be hard to bear.
It is Bresler's statement that 'elements of the unconscious are invited to appear as images that can communicate with the conscious mind', that really resonates with myself. This could be something stated by a Surrealist artist back in the 1930s and as I strongly believe that Surrealism is still and always has been, one of our most powerful visual thinking devices, is a central plank of my personal artistic manifesto.
There is of course a dark side to this, the harsh reality is that the most common way that people develop imagery is by worrying. What we worry about is never happening in the real world, only in our imagination. In my case I have plantar fasciitis in my left foot and heel and I have to get on and do things like write this blog to distract myself from worrying about it and thinking that it will go on forever. The reality is that this is a temporary problem, but I can make it worse by worrying about it. As Bresler puts it, 'people in pain worry all the time. They worry that their pain will never end and that they will remain helplessly immobilised by something they cannot control and cannot endure. As a result, they usually have little difficulty describing an image of their pain at its very worst. Bresler quotes patients as describing their pain as being like, “a swarm of fire ants are chewing on the nerve”, or “a gigantic elephant is sitting on my chest.” If you worry about something its image becomes in effect sharper and more real, and then it can become a major focus of your life experience. In this case we need to beware of self-fulfilling prophecies, for images have the power to create their own reality in the body. Bresler goes on to state, that if a person has developed really clear images of pain, these images can have profound physiological effects on them that can increase their experience of suffering and interfere with their body’s natural pain relieving abilities. So I have to be careful not to fall into this trap and to find ways of using images to guide myself and others away from wallowing in pain, and to instead provide the imaginative waters that will allow them to swim away from it.
Getting rid of these images can be a powerful healing tool and this is where my experience of working with votives can make a difference. By making images of people's pain or problem and then ritually removing these pains by either breaking them, burying them, burning them or doing something focused on externalising the feeling that was put into the image, you are in effect also helping them resolve and perhaps remove their association with the 'real' pain or problem. For instance in one case someone I was working with imagined their cancer as a 'little man' that resided inside them, this 'person' was clinging on, and needed to be told to go.
Once visualised as an actual drawn and in this case a printed image, its reality was such that it began to overpower the previous mental image they had. The ritual process of tearing it in half and throwing the pieces away, helping to release the grip that a mental image had had on themselves and their own well being. If this area of visual thinking is to be of help to the wider disciplines of medicine and psychotherapy, then it will have to be capable of incorporating these sometimes quite difficult to visualise images that can arise from people's imaginative view of their inner feelings. This is a recognition that the subconscious workings of each person's own healing processes need to be supported and recognised if they are to access and utilise the insights, resources, and solutions that arise from their own interoceptive awareness.
If we are to develop a shared ‘visual’ vocabulary for symptoms and sensations of pain and other interoceptive sensations, we need to stockpile these various representations in order to see if there is indeed a common language or if there is not, to see if this image bank does at least help release the potential of others to visualise their interoceptive experiences. If so, because visual representations have the ability to communicate a wide array of feeling tones or intuited things more efficiently than verbal languages, especially in a situation where medical professionals are linguistically challenged, such as dealing with patients who have no or limited English; images can generate insights that otherwise might be missed and they may also develop possibilities for visually augmenting written information.
When making a more detailed analysis of the images produced, the fact that drawings are stable artefacts that can be returned to and examined in detail, means that we can use them to avoid the problems of image decay that is associated with any mental maintenance of an image in someone's head.
This issue also relates to the fact that in workshops I have found that people are at their most inventive and sensitive during the first hour or so and that after that their awareness levels drop and very few new visual ideas emerge. However the time spent in the later half of a workshop can instead be profitably spent adjusting the various images made during the first half of a session and exploring the various visual languages used, and most importantly to test out their communicative possibilities.
However it is also important to remember that the use of this process in alleviating pain or helping people improve their existing condition, is often associated with using these images to externalise inner feelings and to in doing this help in the removal of these 'bad' feelings or thoughts.
The drawings and objects made can help enormously in guided image meditation, giving people time to inspect the imagery, and to then move on to a transformation stage whereby they take control of the imagery in some way.
Once generated and maintained, a mental image and associated drawing can be reflected on interpreted and its understanding transformed and a shift in perspective made.
With the assistance of a guided imagery practitioner or in this case an artist, a participant can be helped to transform, modify, or alter the imagery, in such a way as to either substitute images that provoke negative feelings, or that reaffirm disability, for those that elicit positive emotion, or to even get rid of the negative imagery by doing something to it, such as breaking it or throwing it away. I.e. they begin to rewrite their own internal stories whilst keeping the essence of what their stories are about. These processes are similar to imagery restructuring or imagery re-scripting, (Holmes et al, 2007), all of which are about people taking control of their own journey.
Through this process, people can hopefully change their relationship with the images that have been in the past indicative of the distressing, painful, or debilitative nature of a condition, and in taking control of the image making process or sharing it with someone else, develop their capacity for self determination and the ability to cope with life.
Helping people to use their own imagination in this interactive way maintains a focus on the depth of emotional feelings that are central to therapeutic growth. Working with another person that takes them seriously is a wonderful affirmation of them as individuals and by opening doors for them into how visual imagery can carry important information, it can also become a process that leads to the development of a new interest in art itself.
These approaches acknowledge many other drawing and healing traditions, some of them being disciplines that are thousands of year old.
Payne, Levine and Crane-Godreau, (2015) point out that somatic experiencing as an aspect of interoception, is a concept that is embedded into ancient embodied wisdom traditions and their more recent offshoots. Listing Yoga, T’ai Chi and Qigong, as well as the Alexander Technique and the Feldenkrais method. When drawing and making we use our bodies to externalise our thoughts and perhaps central to the awareness that we have of the relationship between the body and the mind, is the way we breathe. This connection with breathing can take us back to the traditions of the Ayurveda, considered by many scholars to be the oldest healing science. Ayurvedic healing traditions originated in India more than 5,000 years ago and recognised that mental and physical health come together and that their interrelationship is based on the need for regulated energy flow. This awareness of the deep interconnectivity of all these ideas takes my mind back to older posts, and I don't want to duplicate what I was thinking about then, but I do want to highlight ideas about the use of drawing or image making to externalise thought and how in that externalisation hopefully we are able to have some sort of control over things that might otherwise stay hidden and undermine us from within.
However drawing and image making is not at its best when trying to illustrate a concept developed via academic research. The research can inform the background out of which an image may emerge but if the image is to be alive to its own emergence into being, it has to feed off whatever it is becoming and that means unpredictability and a certain amount of chaos is always embedded into the process. My own 'medical diagrams' tend to be records of conversations, such as the one immediately below which was made in conversation with someone who was dealing with tinnitus.
Kosslyn S.M., Ganis G., Thompson W.L. Neural foundations of imagery. Nature Reviews Neuroscience. Vol. 2, No. 9, 2001, pp. 635–642.
Pearson D.G. Mental imagery and creative thought. Proceedings of the British Academy. Vol. 147, 2007; pp. 187–212.
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