The Breath
Bodywork's Companion in Healing
By Shirley Vanderbilt
What is breath? From a pragmatic standpoint, we can describe it simply as the air we take into our lungs and then release during the physiological function of respiration. The body takes in oxygen and expels carbon dioxide—in with the new, out with the old. But at its most complex, breath is life and, for some, spirit or life essence.
From the beginning to the end-point of life, breath keeps us going. What happens in between—the way we breathe—has much to do with how well our body functions throughout the living state and, in many ways, for how long. Andrew Weil, MD, well known for his contribution to the growing acceptance of complementary and alternative medicine, writes, “Breath is the master key to health and wellness, a function we can learn to regulate and develop in order to improve our physical, mental, and spiritual well-being.”1
Breath and the Body
Breathwork has always been around in one form or another. From ancient medicine to modern therapeutic approaches, it’s been a common denominator in healing. Bodyworkers use breathing techniques for grounding and focusing. Shamans use the breath to extract negative energies from the body, then blow those energies out to the winds. Guided regulation of the breath is an integral part of labor and delivery for expectant mothers. In the martial arts, breathwork is used to stimulate the flow of energy. And when we are stressed, we are encouraged to take a deep breath, then let go of the tension and anxiety with our exhalation.
In an eloquent essay on breathwork, Joy Manne, PhD, writes: “Breathwork is bodywork. Well, it has to be, hasn’t it? Our breathing takes place in our body. Through breath awareness we can find the blockages in our body and by taking our breath to them, work with them and release them. There is no bodywork that can succeed without using the breath to support it.”2
From the earliest healing arts in China to the mechanistic biofeedback techniques of today, breathwork has held a pivotal role in establishing and enhancing balance and well-being of the human body. While some forms are rooted in hundreds—even thousands—of years of tradition, others have emerged as part of our contemporary exploration into the science of body-mind connection.
To capture a sense of how this work has evolved in Western therapies, and how it relates to breathwork’s ancient past, I turned to Wolf Mehling, MD, of the Osher Center for Integrative Medicine at the University of California, San Francisco. Mehling’s background includes training in Germany and the United States in family medicine, manual medicine, and psychotherapy, with a special interest in breath therapy and other body-mind approaches. His research on breath therapy for low-back pain, featured in Massage & Bodywork (“Breath Therapy,” December/January 2007, page 140), was conducted with the assistance of breath therapists from the Middendorf Breath Institute in Berkeley, California. Conversations with Mehling, related to this project and others he has completed, sparked a curiosity to explore more fully the roots and evolution of the field. What started with Middendorf history, opened the doors wide to an intriguing look at the dynamic accomplishments and impact of those who contributed to the many forms of breathwork as it is practiced today.
Spiritual Origins
In many ancient cultures, the word for breath and spirit are the same, and use of the breath was and is an integral part of spiritual practice, as well as health and healing, according to Weil. For the Greeks, it was pneuma, and in Latin, spiritus. The Sanskrit, prana.3 Ken Cohen, an expert and scholar of qigong and Native American medicine, provides another example. “In the Lakota (Sioux) language, the word for soul, waniya, is derived from the word for breath, ni,” he writes. And qigong, he notes, is often translated as “breathing exercises,” with qi meaning “air or breath and the subtle energy carried by the breath,” and gong meaning the work or practice.4
Pranayama involves controlled breathing to extend and balance vital energy in the body. “Pranayama is the oldest known discipline where they use breathing; one of the forms of yoga from the world of Hindu religion,” Mehling says. “They used it to help with spiritual development. All yoga work originated as a spiritual practice.”
Although there are some who follow the original precepts, for the most part yoga has been watered down in our society. “Now in the West, it is stripped of its spiritual value and reduced to postures,” Mehling says. “Yoga was particularly useful for people who are not working mentally. It was mostly used for people working physically, who lived without furniture, sitting on the floor, to open their mind to the spiritual realm. Here, in the West, it is used to re-embody yourself when you are working mentally and are in your mind all day long. Its popularity seems to come from a cultural need to get back into your body. Pranayama, or yogic breath regulation, is not as popular here.
“All religious traditions from the East—from Sufism to Hinduism to Buddhism, including Zen—all use this in meditation. They watch their breathing. You could sort them into two groups.” In one, breathing is voluntarily regulated in a given frequency. “There’s a certain breathing rate you try to breathe at, most often at a lower respiratory rate as your everyday rate. But sometimes they have other instructions, such as holding the inhale longer or taking more time for exhalation or other specifications (i.e., pranayama). The other direction in these Eastern traditions is the same as in the European Middendorf school and just lets the breath come on its own. You don’t have to regulate it, you just have to allow it and be present to it, whatever the actual breath rate and rhythm truly is at the moment.”
While the ancient and revered practice of qigong includes techniques for regulating the breath, Cohen emphasizes the importance of naturalness and spontaneity. As one learns and trains, the habits of breathing will change naturally, he writes, and in so doing will fit the individual situation. The purpose of learning the techniques is to uncover dysfunctional patterns and offer the body new choices. “We learn various methods of breathing in order to find freedom of the breath, so that the body can adapt in a healthy way to the needs of the moment.” And although there is this focus on the respiratory impact on health, it is within the context of freeing up qi, or vital life energy.5
European Pioneers
The pioneers of European breathwork intended to explore this work without the Oriental framework,” Mehling says, noting it doesn’t fit the Western way of thinking. “They don’t talk about chakras and spirituality. They came more from gymnastics, dancing, singing, and the cultural explosion in the twenties and thirties. There were schools where you could learn singing, improve your voice for which you need to have a full breath. In those places and in gymnastics, the breathwork started. Only later these breath educators noticed, to their own big surprise, that it had benefits for health.”
It was a time for freedom of expression, between the World Wars, Mehling writes in one of his research reports. “Women, youth, and nature movements discovered the natural beauty of their physical bodies, the joy of the senses and of natural movement.” The emergence of Freudian and Jungian analysis intermingled with a growing popularity of Oriental spiritual disciplines and psychotherapies utilizing body sensations, all in a dynamic atmosphere of cultural growth. “The first ‘breath school’ was founded in Berlin in 1910 by singing and music teachers. Breath therapy gained recognition as an adjunct to psychotherapy in 1931 and entered psychiatry textbooks in 1935, and in 1936 breath therapists worked regularly in the German Institute for Psychological Research and Psychotherapy in Berlin.”6 But it was not to last. As Hitler’s power expanded, the free expression of some of these early pioneers was quashed. Those who were Jews had to flee into exile or go underground, with the institute crumbling from the loss.
Among the early breath pioneers was a young woman named Ilse Middendorf, whose work continues in Berlin and abroad. Inspired by her training in dance movement and her association with Jungian analysis, she focused on breathwork as an expression of the inner self, developing her own artistic form of breath education called The Experience of Breath. The expansion of her work to the United States was established with the founding of the Middendorf Breath Institute of San Francisco in 1991. It later moved to Berkeley, where it is now known as the U.S. Middendorf Institute for Breathexperience.7 The Middendorf approach emphasizes awareness of breath in the body using touch and verbal cues, as well as movement (see “Breathexperience: The Art of Living,” page 54).
Another significant player in this burgeoning field was Wilhelm Reich, a German physician and psychoanalyst who lived in Berlin. While Reich’s theories regarding body armor and its role in preventing the release of the energy by virtue of physical blocks within muscles and organs were compatible with Freud’s views, his methods were questioned within the psychoanalytic community. His conflicts with the political environment came to a head when he published a work citing fascism as a symptom of sexual repression. He fled to Scandinavia, then eventually to the United States. In later years, his development of orgone therapy contributed to another split with his contemporaries and eventually legal trouble and imprisonment. Although he died behind bars, his contribution to the work of breath therapy remains in the soundness of his body-mind theories.8
Alongside the breath explorers in Berlin, psychiatrist Johannes Schultz developed Autogenic Training, which Mehling notes is comparable to the mindfulness-based stress reduction now popular in the United States. Used to induce physical and mental relaxation, Autogenic Training focused on turning off the flight-fight mechanism induced by stress.9 “Schultz was at the leading psychological institute in Berlin,” Mehling says. “He conceptualized this stress management system as self-hypnosis. There were six or seven self-hypnotic phrases you trained with.
“Autogenic Training was for decades part of the basic psychosomatic training for physicians in Germany. An example of an auto-suggestion is ‘my left arm is warm’ or ‘heavy.’ And, very similar to Middendorf, another auto-suggestion was the phrase ‘it breathes me’—not ‘I breathe’ but ‘it breathes,’ giving breathing more autonomy.”
With the expanding acceptance of Eastern meditation practices, Autogenic Training lost some of its popularity, Mehling says. “I think for a Westerner the idea of hypnosis is not very easy to swallow. It sounds too much like ‘manipulation.’ In meditation, they know and talk more about ‘awareness.’ When you’re hypnotized, you try to persuade yourself to feel a certain way. It’s not very intellectually satisfying. In meditation, you become aware that, for example, your arm is not warm, but you also might become aware how this can change. You loosen up the control of your head. When you are less controlled by the mind, you can find a state of self-regulated homeostasis. The European breath therapy adds the element of touch. There is the awareness exercise component and an additional individual hands-on approach which is an element that helps in learning how to focus attention and how to sustain attention allocated to a certain region in your body.”
Breath Takes Hold
By the 1960s, the foundations of new-thought philosophy and body-oriented psychotherapy had taken up residence in California and
across the country, with breath at center stage. Stanislav Grof, a psychiatrist trained in Prague, Czechoslovakia, was a part of that movement. Grof’s early work in Prague included research on LSD and non-ordinary states of consciousness. Leaving the political upheaval of Prague behind, Grof relocated to the United States in the late sixties and eventually to Esalen Institute in Big Sur, California, where he served as scholar in residence and became one of the founders of transpersonal psychology. During this time, Grof developed Holotropic Breathwork, which combines accelerated breathing with evocative music to bring about inner healing, with the breath facilitating the work.10
From the fertile gardens of new thought in California during the seventies, we also have Rebirthing Breathwork, created by Leonard Orr. (This spiritually-based breath approach should not be confused with the rebirthing psychotherapy technique that led to the death of a child in Colorado in April 2000.) Orr’s breathwork focuses on connecting the person to conscious energy by going through stages of relaxation and tension release, often eliciting memories of birth and the first breath of life.11
“The big thing in these days in the medicine and business world is mindfulness-based stress reduction, MBSR,” Mehling says. Developed by Jon Kabat-Zinn, MBSR has mindful breathing at its core. Combining his scientific training with years of study in Zen and other Eastern practices, Kabat-Zinn created an eight-week program for cultivating nonjudgmental mindfulness as a way to reduce the effects of stress.12 Mehling recounts an anecdote regarding one of Kabat-Zinn’s training programs. “One year after the eight-week program, participants were asked, ‘What do you remember?’ They said, ‘The breathing.’ It’s awareness of breath, although not a hands-on approach.”
Personal growth trainer Gay Hendricks is also prominent in the business world, as well as in spiritual communities. Hendricks, who, with his wife Gayle, conducts workshops in the body-mind approach to personal transformation, has developed conscious breathing exercises to revitalize energy and increase awareness and relaxation. “He has a method similar to Reichian ideas,” Mehling says. Rebirthing goes back to Reich’s work in Berlin, too, Mehling notes, and is also parallel to pranayama. “Grof’s Holotropic Breathwork also is voluntary hyperventilation based on pranayama. Voluntary hyperventilation loosens the control of the mind over the body. It’s used to loosen up rigid psychological structures and allows the emergence of suppressed memory and traumas. Some psychotherapists use the same process for psychological release and to obtain material for verbal cognitive processing. Yoga uses it for spirituality, within the frame of personal religious development.” Thus, we come full circle, old blending with the new, all within the one constant of breath.
Into the Scientific Realm
Across the many forms of breathwork are varying ideas about breathing rates and effects on the body. Some approaches maintain simple awareness is the key, while others engage in controlled manipulation. As the field of breath therapy has expanded, so has research on the subject. But in many ways, as Mehling’s further comments attest, the jury is still out.
Let’s take a look at a few examples. Utilizing biofeedback, psychologist and researcher Richard Gevirtz has conducted several studies on the use of breathing retraining in patients with cardiac symptoms related to hyperventilation. In one follow-up study, his team found long-term benefits sustained with subjects maintaining lower respiratory rates accompanied by higher CO2 levels.13
“(Gevirtz) has the best knowledge in the United States in biofeedback and breathing,” Mehling says. “He strongly supports the hypothesis that a reduction of your respiratory rate to six or less breaths per minute is the key step to help with headaches, muscle tension, and chronic pain. The autonomic nervous system regulates all body organs. If you are stressed, the sympathetic system is activated and that triggers activation of brain stem receptors to breathe faster. To control that by breathing slower does have an effect on that system.
“For me, this is a somewhat mechanistic approach based on the hypothesis that hyperventilation is the problem,” Mehling says. “But in chronic tension, worry, and depression, you don’t have hyperventilation. I think it’s a kind of medicalized, mechanistic view.” A case in point is research from David Anderson and Margaret Chesney at the National Institutes of Health. They reported that high perceived stress over a period of time is associated with a slower (or inhibited) breathing pattern and higher CO2 levels, and more predominantly so in women.14
Mehling says the biofeedback goal of regulating to a reduced frequency of breathing makes sense from the standpoint that anxiety can effect an increase in respiration rate and a tendency to hyperventilate. “In anxiety, worry, tension, it’s one of the main symptoms of stress. If you reduce the frequency of your breathing, you become calmer and feel better. There are actually good arguments from physiology that this would make sense. But as soon as you get any deeper into the physiology of respiration with blood gases, volumes, pH, and other measures, it really gets complicated and often contradictory.
“For example, one group says the problem is that you usually breath too fast, and too little CO2 is retained in the blood, so you get a decrease in the acidity of your blood. They argue this is the physiological background for symptoms of stress and fatigue. By reducing your breath rate you’re bringing CO2 back up into the normal range. But others, such as Anderson, actually think there’s often a shallow, depressed breathing caused by too much CO2 retention. And this possibly leads to essential hypertension, which is associated with chronic stress. These are contradictory arguments. If you try to explain that breath therapy works through regulating parameters of respiratory physiology, you get conflicting arguments. As soon as you try to integrate these views, you run into unexplained contradictions.
“My way of getting through this is that I don’t really believe that a change in CO2 is the key thing, and I think that the body self-regulation system is so sensitive and so fine tuned that we should not interfere by controlling it,” Mehling says. “What I do buy is that awareness of the subtle sensations associated with the movement of your breath brings you back into your body. I’d rather loosen the control over and the subsequent distortions of your breathing because your mind is trying to control everything. Your breath generally is either unmanipulated, autonomous, and unconscious (i.e., when you sleep) or you are aware of it but cannot allow it to be autonomous. When you learn to let breath be on its own and be fully aware of it at the same time, you get in contact with what some people call the true self or your essence. So if you focus on it and let it go on its own without interfering, what Middendorf and some schools of meditation do, you get into a state where you are more in touch with yourself, experience less stress and more inner peace. That is not really easily parallel to physiological parameters of respiration. At least, I have not found a convincing physiological argument for that.”
Taking a Breath
As Manne says, breathwork is bodywork. Our breathing takes place throughout our body and, as such, is essential to any approach in which holistic healing is the goal. The field of breathwork, whether as a specific modality or part of a broader approach to bodywork, is so wide reaching that we have only just brushed the surface here. There are other pioneers in the wings—experts in yoga, biofeedback, and breath awareness, as well as the researchers addressing breath’s role in healing. One could spend a lifetime exploring this subject, and many have, gifting us with the benefits of their dedication and accomplishments.
Shirley Vanderbilt is a staff writer for Massage & Bodywork.
Notes
1. Andrew Weil, Natural Health, Natural Medicine: A Comprehensive Manual for Wellness and Self-Care (Boston: Houghton Mifflin, 1990), 84.
2. Joy Manne, “What is Breathwork?” Breathe Magazine,
www.breathe-mag.co.uk/What%20is.html (accessed February 2007).
3. Weil, Natural Health, 84.
4. Ken Cohen, The Way of Qigong: The Art and Science of Chinese Healing (New York: Ballantine, 1997), 3Ð4, 25, 111.
5. Ibid., 128.
6. Wolf Mehling, “The Experience of Breath as a Therapeutic Intervention: Psychosomatic Forms of Breath Therapy,” Forschende KomplementŠrmedizin und Klassische Naturheilkunde 8 (2001): 360.
7. Juerg Roffler and Margot Biestman, “Background of Middendorf Breathexperience,” provided by Middendorf Institute for Breathexperience.
8. Elsworth F. Baker, “Wilhelm Reich,” American College of Orgonomy,
www. orgonomy.org/wr/reich_bio_01_.html (accessed March 2007).
9. Christa Hall-Sanford, “Autogenic Training,” www.infinityinst.com/articles/autogenic.html (accessed March 2007).
10. “Holotropic Breathwork,” www.breathwork.com/aboutholo.htm (accessed March 2007).
11. Tatiana Ginzburg, “Interview with Leonard Orr,” Breathwork, www.breathwork.be/ Articles/BreathWork/Interview-with-Leonard-Orr (accessed March 2007).
12. Lawrence Pintak, “Jon Kabat Zinn: The Prescription is Meditation,” Shambhala Sun, www.shambhalasun.com/index.php?option=com_content&task=view&id=1859 (accessed March 2007).
13. S. DeGuire et al., “Breathing Retraining: a Three-Year Follow-Up Study of Treatment for Hyperventilation Syndrome and Associated Functional Cardiac Symptoms,” Biofeedback and Self-Regulation 21 (1996): 191Ð8.
14. D.E. Anderson and M.A. Chesney, “Gender-Specific Association of Perceived Stress and Inhibited Breathing Pattern,” International Journal of Behavioral Medicine 9, no. 3 (2002): 216-27.
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