The widespread availability of medicines has made it possible for us to avoid suffering in a way that no previous generation from any era could. But in many cases, drugs just mask the symptoms of our illnesses, discomforts and disorders without addressing the underlying disorders that cause them. This is not to denigrate pharmacological psychiatry and its many successes and advances, or clinical psychology, or molecular medicine. The alleviation of suffering is a natural and worthy aim, and often the only thing we can do.
But drugs can cause their own problems: getting rid of heartburn with omeprazole and other proton-pump inhibitors, for example, can hide serious gastrointestinal issues, and might allow us to continue eating foods that are ultimately harmful. Benzodiazepines such as Valium dull anxiety but also create profound dependence, and they also can sidetrack investigation and treatment of underlying causes. Antidepressants, though often necessary and life-saving, have side effects including weight gain, constipation, drowsiness, nausea, blurred vision and sexual dysfunction; more worryingly, many appear to double the risk of suicidal ideation. And so on.
Our use of drugs to mask symptoms has contributed to a lack of awareness about our own bodies. So has the emergence of technologies such as computers, smartphones, remotes and game controllers, which only involve our bodies—usually just our fingers—as control inputs.
This lack of connection to our bodies can be looked at through a concept called interoception, which describes our awareness of internal bodily signals, including the detection of sensations such as hunger, thirst and heartbeat. Interoception is a process by which our brains/minds make sense of these signals, which serve as a running commentary or mental map of the body’s internal world across conscious and unconscious levels of perception.
Our culture, technology and medicine have progressively made us into poor interoceptors.
Disrupted interoception is now understood to play an important role in mental health conditions including anxiety and mood disorders, eating disorders and addiction, and it is thought to be a feature of most psychiatric disorders. Scientific American has previously explored the role of interoception in eating disorders (“A Broken Sense of Self Underlies Eating Disorders”), emotional awareness (“Emotional Ignorance Harms Health”), and the location and function of such awareness in the brain (“Where Mind and Body Meet”). And results from relatively recent neuroanatomical and neuroimaging studies have shown how dysfunctional interoception can cause or exacerbate anxiety and depression.
However, a number of logistic and theoretical challenges have so far made it difficult for interoception to be measured accurately, so it has seen little application in mental health research and therapeutics. Recent studies have shown, however, that some progress has been made in not only measuring interoception but also in training it in order to potentially improve resilience to mental illness. In addition to direct effects on symptoms, an increased ability to represent one’s internal state is linked to increased ability to understand the emotions and thoughts of others, as found in a recent study linking interoception, emotion and theory of mind. This increased ability to read, understand and respond to other individuals is likely to lead to increased levels of social support, which is of proven efficacy in increasing resilience and wellbeing.
Interoception training could thus be used to help us form a better, healthier sense of our own bodies by focusing on our internal sensations both at the visceral level (interoception) and that of our body’s movement (proprioception). This is in fact what ancient health systems like yoga try to do, by combining calisthenics with interoceptive and mindful awareness. And in one of technology’s redeeming qualities, whereby it can offer data on our bodies never before available to us, new forms of biofeedback could help enhance our interoception by illuminating internal body signals, to help us be more aware of and in concert with them.
The history of interoception science goes back to Charles Darwin, who discussed the role of visceral sensations in emotion in The Expression of the Emotions in Man and Animals, and then William James and Carl Lange, who explored the relationship between interoception and emotional experience and developed the James-Lange theory of emotion. Not much later, in 1906, Charles Sherrington published The Integrative Action of the Nervous System, a collection of lectures where he spoke of “interoceptors” as part of his explanation of the visceral system. The scientific community wasn’t going to use the word in scientific journals until the 1940s, and by the 1960s there was an increased focus on interoception as a result of interest in biofeedback interventions.
We can, however, look much further back than modern psychology: contemplative traditions have all explored the idea of the “subtle body,” grounded in traditions and medical practices that proposed holistic rather than dualistic understandings of body and mind. Indian, Tibetan and Chinese medicine have all explored body sensations and their modulation, creating anatomical maps of energy points (chakras in Sanskrit, dan t'ian in Chinese) and channels in the subtle body for the movement of energy known variously as ch’i, prāṇa or lung. In those practices, all mental states were understood to travel the energy currents described in their maps.
Although it isn’t currently clear whether or how such conceptualizations map onto current scientific understandings of interoception, these ideas suggest that attention to somatic, embodied experience has been important in self-understanding and well-being for millennia. They potentially support the hypothesis that overreliance on abstract and disembodied concepts, as opposed to information grounded in bodily awareness, could significantly limit our ability to relate to ourselves and others.
The clear benefits of training interoceptive awareness should therefore be explored in new forms of digital therapeutics. We might begin simply by adapting typical mindfulness practice concepts: developing an awareness of bodily sensation in time was outlined as a primary goal in early texts of both Indian and Chinese contemplative practice. To tell apart this kind of awareness from pure thought, contemporary forms of biofeedback could incorporate recent neuroscientific understanding of the networks involved in our sense of bodily experience versus our understanding of the experience itself, helping better use our corporeal intelligence (the gut, the heart) rather than relying largely on our cerebral intelligence.
In this age of disembodiment, learning to attend to signals from within could thus reconnect long-lost networks of perception that used to root us to the world, to inform our experience of love, affection, belonging and coherence with our environment. We perhaps need that now more than ever. As Thomas Joiner has lucidly written in Mindlessness, we’ve been sold an idea that “mindfulness” is a miracle drug, a quick remedy to our attention-starved, frantic perception of the world as ever-increasingly fast-moving and out of reach.
Our culture—in Joiner’s words, a culture of “superficiality, mediocrity and selfishness”—has adopted mindfulness as a way to “empty the mind,” a way to stop caring and to observe the world in a detached, disembodied way. Instead of fully investing in our awareness of the world, we have hawked thousands of years of understanding in how our bodies and minds interact for a quick fix of undifferentiated, narcissistic self-preoccupation, a contemplative extension to the selfie.
True mindfulness is currently being usurped by a loud, strutting imposter who lacks social empathy (and if this sounds familiar and political, it is so because the nature of the problem is the same). There could be no stronger sign that we are looking inward in the wrong way. To build better well-being, individually and societally, we must look within, as the signals that give us insight into the emotional world come from there. But to build a better world, to exist usefully within it and improve it, we must look without and learn again to pay sustained, compassionate attention.