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My second example of the usefulness of an ethological approach to medicine has quite a different history. It concerns the work of a very remarkable man, THE LATE F.M. ALEXANDER. His research started some 50 years before the revival of ethology, for which we are now being honored, yet his procedure was very similar to modern observational methods, and we believe that his achievernents and those of his pupils deserve close attention.
Alexander, who was born in 1859 in Tasman'a, became at an early age a "reciter of' dramatic and, humorous pieces". Very soon he developed serious vocal trouble and he came very near to losing his voice altogeiher. When no doctor could help him, he took matters into his own hands. He began to observe himself in front of a mirror, and then he noticed that his voice was at its worst when he adopted the stances which to him felt appropriate and right for what he was reciting. Without any outside help he worked out, during a series of agonizing years, how to improve what is now called the "use" of his BODY MUSCULATURE IN ALL HIS POSTURES AND MOVEMENTS. And the remarkab1e outcome was that he regained control of his voice. This story, of perceptiveness, of intelligence, and of persistence, shown by a man without medica1 training, is one of the true epics of medical research and practice.
Once Alexander had become aware of the misuse of his own body, he began to observe his fellowmen, and he found that, at least in modern Western society, the majority of people stand, sit, and move in an equally defective manner.
Encouraged by a doctor in Sydney, he now became a kind of missionary. He set out to teach - first actors, then a variety of people - how to restore the proper use of their MUSCULATURE. Gradually he discovered that he could in.his way alleviate an astonishing variety of somatic and mental illlnesses. He also wrote extensively on the subject. And finaliy he taught a number of his pupils to becone teachers in their turn, and to achieve the same results with their PATIENTS. Whereas it had taken him years to work out the technique and to apply it to his own body, a successful course became a matter of months, with occasional refresher sessions afterward. Admitedly, the training of a good Alexander teacher takes a few years.
For scores of years a srnall but dedicated number of pupils continued the work. Their combined successes have recently been described by Barlow. I must admit that his physiological explanations of how the TREATMENT could be suopposed to work (and also a touch of hero worship in his book) made me initially a little doubtful and even sceptical. But the claims made, first by Alexander, and reiterated and extended oy Barlow, sounded so ex.traordi nary that I felt I ought to give the METHOD at least the benefit of the doubt. And so, arguing that medical practice of ten goes by the sound empirical principle of "the proof of the pudding is in the eating", my wife one of our daughters, and I dacided to undergo TREATMENT ourselves, and also to use the opportunity for observing its effects as critically as we cculd. For obvious reasons each of us went to a different Alexander teacher.
We discovered that the THERAPY is based on exceptionally sophisticated observation, not only by means of vision but also to a surprising extent by using the sense of touch. It consists in essence of no more than A VERY GENTLE, FIRST EXPLORATORY, AND THEN CORRECTIVE MANIPULATION OP THE ENTIRE MUSCULAR SYSTEM. This starts with the head and neck, then very soon the shoulders and chest are involved, and finally the pelvis, 1egs, and feet, until the whole body is under scrutiny and TREATMENT. As in our own observations of children, the THERAPIST is continuously monitoring the body, and adjusting his procedure all the time. What is actually done varies from one PATIENT to another, depending on WHAT KIND OF MlS- USE THE DIAGNOSTIC EXPLORATION REVEALS. And naturally, it affects different people in different ways. But between the three of us, we already notice, with growing amazement, very striking improvements in such diverse things as high blood pressuxe, breathing, depth of sleep, overall cheerfulness and mental alertness, resili- ence against outside pressures, and also in such a refined skill as playing a STRINGED instrument.
So from personal experience we can already confirm some of the seemingly fantastic claims made by Alexander and, his follpwers, namely, that many types of underperformance and even ailments, both mental and physical, can be alleviated, sometimes to a surprising extent, by teachi.ng THE BODY MUSCULATURE TO FUNCTION DIFFERENTLY. And although we have by no means finished our course, the evidence given and documented by Alexander and, Barlow of beneficial effects on a variety of vital functions no longer sounds so astonishing to us. Their long list includes first of all what Barlow calls the "rag bag" of rheumatism, including various forms of arthritis, then respiratory troubles, and even potentially lethal asthma; following in their wake, circulation defects, which may lead to high blood pressure and also to some dangerous heart conditionsg gastrointestinal disorders of many types; various gynecological conditions; sexual failures; migraines and depressive states that often lead to suicide; in short, a very wide spectrum of diseases, both somatic and mental, that are not caused by identifiable parasites.
Although no one would claim that the Alexander TREATMENT is a cure all in every case, there can be no doubt that it often does have profound and beneficial effects; and I repeat once more, both in the mental and somatic sphere.
The importance of the TREATMENT has been stressed by many prominent people, for instance John Dewey, Aldous Huxley, and, perhaps more convincing to us, by scientists of renown, such as Coghill, Dart, and the great neurophysiologist Sherrington. Yet, with few exceptions, the medical profession has largely ignored Alexander perhaps under the impression that he was the center of some kind of cult, and also because the effects seemed difficult to explain. And this brings me to my next point.
Once one knows that an empirically developed THERAPY has demonstrable effects, one likes to know how it could work - what its physiological explanation could be. And here some recent discoveries in the borderline field between neurophysiology and ethology can make some aspects of the Alexander THERAPY more understandable. and more plausible than they could have been in Sherrington's time.
One of these new discoveries concerns the key concept of reafference. There are many strong indications that, at various levels of integration, from single muscle units up to complex behavior, the correct performance of many movements is continuously checked by the brain. It does this by comparing a feedback report that says "Orders carried out with the feedback expectation for which with the initiation of each movement, the brain has been alerted
Only wben the expected feedback and the actual feedback match does the brain stop sending out commands for corrective action. Already the discoverers of this principle, von Holst aad Miittelstaedt, knew that the functioning of this complex mechanism could vary from moment to moment with the internal state of the subject - the "target value" or 'Sollwert' of the expected feedback changes with the motor commands that are given. But what Alexander has discovered beyond this is that a lifelong MISUSE OF THE BODY MUSCLES (SUCH AS CAUSED BY. FOR INSTANCE, TOO MUCH SITTING AND TOO LITTLE WALKING) can make the entire system go wrong. As a consequence, reports that "all is correct" are received by the brain (or perhaps interpreted as correct) when in fact all is very wrong. A person can feel at ease, for example, when slouching in front of a television set, when in fact he is grossly abusing his body. I can show you only a few examples, but they will be familiar to all of you.
It is still an open question exactly where in this complex mechanism the matching procedure goes wrong under the influence of consistent misuse. But the modern ethologist feels inclined, with Alexander and Barlow, to blame phenotypic rather than genetic causes for misuse. It is highly unlikely that in their very long evolutionary history of walking upright, the hominids have not had time to evolve the correct mechanisms for bipedal locomotion.
This conclusion receives support from the surprising, but indubitable fact that even after 40 to 50 years of obvious misuse one's body can (one might say) snap back into proper, and in many respects more healthy, use as a result of a short series of half-hourly sessions. Proper stance and movement are obviously genetically old, environment-resistant behaviors. Misuse, with all its psychosomatic, or rather somatopsychic consequences must therefore be considered a result of modern living conditions of a culturally determined stress. I might add here that I am not merely thinking of too much sitting, but just as much of the cowed posture that one assumes when one feels that one is not quite up to one's work, when one feels insecure.
Second, it need not cause surprise that a mere GENTLY HANDLING OF BQDY MUSCLES can have such profound effects on both body and mind. The more that is being discovered about psychosomatic diseases, and in general about the extremely complex two-way traffic between the brain and the rest of the body, the more obvious has become that too rigid a distinction between mind and body is of on1y limited use to medical science, in fact can be a hindrance to its advance.
A third biologically interesting aspect of the Alexander THERAPY is that every session clearly dernonstrates that the innumerable muscles of the body are continuously operating as an intricately linked web. Whenever a GENTLE PRESSURE IS USED TO MAKE A SLIGHT CHANGE in leg posture, the neck muscles react imnediately. Conversely, when the THERAPIST helps one to release the neck muscles it is amazing to see quite pronounced movements, for instance of the toes, even when one is lying on a COUCH.
In this short sketch, I can do no more than characterize, and recommend, the Alexander TREATMENT as an extremely sophisticated form of rehabilitation, or rather of redeployment, of the entire MUSCULAR EQUIPMENT, and through that of many other organs. Compared with this, many types of physiotherapy which are now in general use look surprisingly crude and restricted in their effect, and sometimes even harmful to the rest of the body.
Dear Professor Tinbergen,
My name is Noan Renen. I am a teacher of tne F.M. Alexander Technique. Ny teachers were Mr. Patrick J. Macdonald and Mr. Peter Scott, who succeeded F.M. Alexander in the Alexander Foundation from 1956 till it was closed down.
I read with great interest your article in the "Science" magazine of 5th Juily 1974, volume 185, number 4145. I am glad that you could express the value and importance of the Alexander Technique in an international forum with the possibility of widespread echoes. I hope these echoes will not get lost in the space. But I would like, with your kind permission, to make some remarks, as I disagree with some of your descriptions and terminology. My disagreement is based on the way I was taught the Alexander Technique and on my own experience in teaching it for more than ten years.
Well, the teacher of the Alexander Technique (Technique and not, method) is a TEACHER and not a THERAPIST. He TEACHES and does not TREAT. He gives LESSONS and not TREATMENTS. He has PUPILS and not PATIENTS. It is very important to be clear about these terms. The terms used by the teacher express his basic approach to Alexander's discoveries, experiences and conclusions.
When a PUPIL comes to have lessons in the Alexander Technique he should understand that he comes to learn how to improve the USE QF SELF IN HIS DAILY ACTIVITIES (SELF as a whole - integral entity - interbalanced mechanism). Not to restore the ... "BODY MUSCULATUJRE IN ALL HIS POSTURES AND MOVENENTS". The teacher does not deal with issues as symptoms. The teacher's concern is to improve the relationship between the HEAD and the SPINE. Alexander called this relationship PRIMARY CONTROL. (I would use the term BASIC RELATIONSHIP as well.) This PRIMARY CONTROL dictates the way we use ourselves in daily activities. When the PRIMARY CONTROL is right - it means: NECK FREE, to let the HEAD go FORWARD and UP, to let the BACK LENGTHEN an WIDEN - the whole body will function properly, or at least will improve its functioning. But when we interfere with the PRIMARY CONTROL, when we upset it, it will interfere and upset the whole balance of the entire body, not just that of the MUSCULAR SYSTEM.
While teaching, the teacher works on himself, giving himself directions - as one should do in daily life. The teacher should use his CONSCIOUS CONTROL (I would call it simply AWARENESS) while directing himself and his pupils. What the teacher does with his hands on the pupils is not ".. A VERY GENTLE, FIRST EXPLORATORY, AND THEN CORRECTIVE MANIPULATION OF THE ENTIRE MUSCULAR SYSTEM". The teacher uses his hands as communication channels through which the directions, or messages, or stimuli, go from his PRIMARY CONTROL to the PRIMARY CONTROL of the pupil. I would describe the "directions" as STIMULI SENT CONSCIQUSLY (conscious control) FROM THE BRAIN TO THE PRIMARY CONTROL, AND THROUGH IT TO THE WHOLE BODY IN ORDER TO INDUCE EXPANSION THAT WILL REPLACE THE HABITUAL CONTRACTION. While projecting the "directions" one should be aware not to "DO" it, but "LET IT HAPPEN"and NOT TO ENPLOY THE SENSORY APPRECIATION AS A CRITERION,WHETHER THE PERFORMANCE IS RIGHT OR WRONG.
The teacher' s directions bring about reactions in the pupils body. The pupil participates in the lesson through application of the CONSCIOUS CONTROL . He consciously allows the new contidions produced in him by the teacher's directions to take place. The pupil is supposed not to interfere with this process by the HABITUAL USE OF THE SELF (INHIBITION in Alexander's terminology; I would use the term NEUTRAL).