The Clinic of the future Part III: Experiential Medicine

02 Aug The Clinic of the future Part III: Experiential Medicine

 

This this post was originally posted here

“What you resist, persists.”

—Carl Jung

If you read this newsletter, you are likely picking up on the scent of emerging frontiers or New Paradigms across a variety of subdisciplines—neuroscience, psychology, metabolic science, contemplative practice, and technology—that are converging together to reshape how we define many categories and disciplines.

We should probably start referring to it as the Meta-Paradigm.

For our purposes, we are most concerned with how the emergent therapies, technologies, frameworks, and scientific developments of the Meta-Paradigm will be used to treat mental, emotional, and spiritual suffering and the promotion of human flourishing and resilience.

To that end, this series on The Clinic of the Future (CoF) is a wayfinding exercise in which we consider how these things might fit together to alleviate suffering and promote well-being.

In Part I, I posited that there are four subdomains that we can use to categorize modalities of the CoF:

• Relational

• Experiential

• Energetic

• Metabolic

In this rendering, the pinnacle of care will be the multimodal, collaborative, and holistic combination of two or more categories1.

In Part II, we looked at the Relational building blocks of the human experience—Attachment Theory—and put forward the concept of Communities of Practice—therapeutic or otherwise—to expand the scope and scale of relational opportunities amidst a rapid society-wide move towards isolation and atomization.

Today, in Part III, we’re looking at the second category of the Clinic of the Future—the Experiential.

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Before we jump in, here is a quick note to say it’s been a year of The Trip Report Podcast! 

The team and I are so grateful for our incredible guests and listeners who make it all worthwhile!

We’re doing some fun anniversary-style stuff in the coming weeks, so stay tuned.

Direct Experience, Experiential Avoidance & Experiential Therapeutics

The dominant narratives around mental illness are predicated on either personal history or molecular causes.

That is, as most people conceive it, the causes of mental illness fall into one or both of these categories.

Brain chemistry imbalances, genetics, and faulty neural circuits (molecular) on the one hand; adverse childhood experiences, insecure attachment, and past trauma (personal history) on the other2.

These are the things that talk therapy, medication, and other interventions are supposed to target and resolve.

As this story goes, SSRIs “rebalance brain chemistry,” talk therapy unearths and makes sense of the past, and transcranial magnetic stimulation (TMS) disrupts pathological neural pathways.

Direct Experience

However, at the end of the day, people seek treatment not because we know our brain chemistry is off, or their neural pathways are dysfunctional, or because of something we can’t remember from our past.

We seek treatment because of how we feel.

We feel tired, we feel frightened, we feel threatened, we feel frozen, we feel frazzled, we feel constricted, we feel lethargic, we feel pain, we feel sad, we feel ashamed, we feel anger, we feel loneliness, we feel impulsive, we feel obsessive.

Addressing the molecular causes and the narratives we live by can undoubtedly help us feel better, but they are indirect and often seem to fail.

A core feature of the CoF hypothesis is that to help people feel better we should prioritize the immediate, subjective, sensation-level experience—the Experiential.

In Phenomenology is the New Psychology, we posited:

Somatic approaches have gained renewed interest as modalities to address trauma and stress-related conditions, which, of course, include a narrative account or memory of traumatic experiences or traumatic periods of one’s life. But the emphasis of these approaches is rooted in the here and now—specifically, the landscape of sensations in the body that are available to conscious awareness: pressure, heaviness, rushing sensation, tension, heat, cold, the beating of the heart, the contraction of the breathing, the pressure in the head.

These phenomena are the substrate of somatic and body-oriented psychotherapeutic approaches and are categorically different from psychoanalytic and cognitive strategies.

If the psychoanalyst asks, “Why do you think that is?” the somatic practitioner asks, “Where do you feel that in your body, what is it’s quality, and how is it changing”?

In other words, psychological interventions that shift focus from analysis and narrative to somatic experience seem to facilitate change more reliably.

Experiential Avoidance

A key piece of the puzzle here is that it is not just the fact that unpleasant, undesirable, and painful feelings are present but our active avoidance of them.

Experiential Avoidance is the term psychologists and cognitive scientists use to describe the inability or unwillingness to remain in contact with aversive experiences such as painful feelings, thoughts, and emotions.

Many pathological conditions, mental health issues, and related forms of suffering are rooted in the avoidance of sensations perceived as threatening or too intense. As a result, our psyches try to sidestep them by any number of dissociation strategies.

These dissociative patterns, developed to avoid sensations, lock us into perceptual, cognitive, and behavioral patterns to shield us from perceived threats, thus preventing us from experiencing the full range of feelings and sensations.

The role of experiential medicine is to use sensation to modulate these pathological setpoints, thus allowing people to feel the full range of sensations without resistance.

Experiential Medicine

In Part I of CoF I described the Experiential domain as follows:

The value of experiential therapies is their ability to recalibrate maladaptive patterns of perception that lead to unnecessary suffering.

The brain is the organ of prediction and protection. The chief aim is to ensure survival by predicting future states and scenarios and being prepared for them.

Nearly all of the difficult-to-treat mental health conditions are predicated on disruption or miscalibration of the nervous system’s ability to perceive and assign threat value to incoming sensory information.

Experiential therapies that support a recalibration of this process will be an invaluable toolset in holistic, patient-centered care.

Ok, what the hell does that mean?

Over the last few decades, the field of neuroscience has converged on two chief functions of the brain and nervous system: prediction and protection.

As we noted in our dispatch on the Predictive Mind Hypothesis, it is much more thermodynamically efficient for the brain to predict incoming information3 about the environment and issue commands than it is to receive the information, process it, make a decision, and then issue a command.

Importantly, the chief imperative of these predictions is not to be as accurate as possible but to ensure survival (protection).

Bringing this back to direct experience and experiential avoidance in the context of psychopathology, so much of what our brains and psyches deem as threatening and unsafe is, in fact, completely safe.

Instead, a miscalibrated nervous system interprets non-threatening sense data as threatening.

The implication is that subjective, phenomenological, direct experience is the interface through which we, as agentic, sentient organisms, can interact with our nervous system.

In other words, experience is the ‘layer of the stack’ where we can actively recalibrate maladaptive setpoints and patterns of dissociation.

To this end, we have relational interventions that leverage this “experiential interface,” like Somatic Experiencing and Sensorimotor Psychotherapy, among others.

But we also are in the early days of a new class of Experiential Therapeutics that will offer innovative—and perhaps more effective and scalable—ways to tap into the experiential domain and recalibrate aberrant setpoints.

Experiential Therapeutics include psychedelics as well as multisensory immersive experiences like virtual reality, haptic stimuli, algorithmically programmed light and sound, and thermal conditioning—deliberate hyperthermia and cold water immersion.

A helpful metaphor for thinking about the non-psychedelic experiential therapeutics is exercise.

Lifting weights stresses the muscles, tendons, ligaments, and bones. After a period of recovery, these tissues are stronger. Do this repeatedly over a period of time, and the body undergoes an incredible transformation.

Experiential therapeutics are like lifting weights, but instead of bigger muscles, the brain and nervous system develop more robust and resilient sensory tolerance setpoints.

Sensory information previously deemed threatening and intolerable can become recognized as safe and tolerable, thus increasing the variety of feelings and sensations one can experience without avoidance. 

In conclusion, integrating Experiential Medicine within the Clinic of the Future offers a transformative approach to mental health and well-being.

By prioritizing immediate, subjective sensations over abstract narratives, we can recalibrate the nervous system’s response to perceived threats and reduce unnecessary suffering.

This multimodal, holistic approach—combining relational, experiential, energetic, and metabolic therapies—promises to enhance human resilience and flourishing.

As we continue to explore and innovate within this Meta-Paradigm, we can move closer to a future where mental, emotional, and spiritual well-being are not just addressed but profoundly transformed.