As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Shen Harmony: The Normal Mental Condition in Chinese Medicine, Part 2
Editor's note: Part 1 of this article appeared in the September issue.
Shen Flexibility
The flexibility property of shen relates to the ability to respond effectively to differing and complex scenarios. Conscious awareness while sustaining this flexible state of shen is a key property. This relates to an agile ability to switch concentration or to follow a complex process in its evolution. It involves the ability to shift attention between subjects. The shen flexibility has, as a key property, the ability to shift perspectives or to operate entirely without a perspective. This allows various ideas and thoughts to emerge while the mind moves deeply or changes view and position. Wisdom and creative abilities require shen flexibility.
Human beings have a wonderful level of shen flexibility that is much more powerful than the physical abilities. In this domain, the shen has the power to shape-shift the body, creating a sense of unlimited being, flying in the sky or diving into deep waters. Further, one may even encounter people who have been passed away for many years. Through the imaginable and dream worlds, this flexible state of shen provides access to wisdom of the ages in the form of ancient medical sages or access to other massive, terrible, unreal situations.
The flexible and healthy shen sustains emotional balance. In daily life, people sometimes feel sadness after anger or they may generate the anger component of shen when facing fearful situations by preparing to fight. When negative thoughts or emotions disturb the mind, the shen has the capacity to replace them with other thoughts or feelings. Contemporary psychology identifies this process as a psychological defense mechanism.
In the clinic, the lack of shen flexibility may cause character armoring where there are holding behaviors. This may extend into holding onto ideas or thoughts to such a degree that is considered to be a type of obsessive-compulsive disorder (OCD). It may also be much milder in expression, with rigid patterns of lifestyle and stereotyped behaviors. In situations of catalepsy or catatonia, the shen has lost its flexibility, and patients are holding onto the one position with which they may not be comfortable. This may also be found in cases of schizophrenia.
Shen Stability
The shen also has a stability property, which involves the mental power to keep the attention and concentration focused upon the inner work. This may involve processing thoughts, emotions and other shen activities. Concentration is required so that the stable shen may focus on the issues and achieve resolution. The person typically identified as a thinker, and especially as a deep thinker, has good shen stability. Strategic planning is dependent upon the shen stability function.
Shen may become irritable and confused when it is disturbed by internal or external stimulation forming the subjective and objective states of the body-mind. In general, the shen stability function may allow the mental and emotional irritabilities to become a normal state. Therefore, it is important to modulate emotional or other shen disturbances that may occur due to social and environmental pressures. This concern is not limited to exterior pressures. Interior desires or dissatisfaction with the real life can create great pressures for the shen , causing shen irritability with emotional reactions. Furthermore, it may cause shen confusion with loss of control over emotional expressions and behaviors. Many shen exercise programs attempt to create stable conditions for the shen. This is accomplished through qigong, tai ji or meditation. A regular, daily life rhythm and schedule can provide the shen a basis for stable conditions. Otherwise, the shen may become irritated, causing anxiety and shen disturbance.
Shen Reactivity
The Ling Shu (Ben Shen, Chapter 8) indicates: "When one makes a settlement regarding external matters, it is by the heart." In this instance, the shen reactivity responds to events that are outside the mind. The healthy shen always has good reactivity, so that interpersonal skills, social ability and emotional activity are responding in a proper way. We refer to this as harmony.
The reactivity varies in terms of strength, speed and style. Some individuals respond with strong emotional reactivity such as continuous crying, a feeling of sadness for more than a year or such levels of anger that they destroy themselves or others. Further, contemporary social conditions may lead to global suffering in terms of addiction, including drug and substance abuse. The need for elevated moods and fantasy feelings may cause hypersensitivity or numbness forms of shen disharmony.
If the shen has reduced or - worse - no reactivity, there may be little or no emotional or behavioral actions. In the shen numbness condition, the patient's clinical picture involves a flat affect, less talk and conversation, poor thought with slower speech patterns and slower physical activities. If the shen reactivity is too high, the person may feel weak with poor emotional control and may be overly sensitive to mental and physical pressures. These patients may have physical pain and discomfort in addition to labile emotional states with excitement, sadness or anger.
The shen reactivity function may be fast or slow. A fast person easily and quickly responds to stimuli while the slow person takes time to form responses. Ideally, the shen is balanced and harmonious yet appropriately responsive shen reactions. The clear and balanced shen is quick to respond yet stable, without hypersensitivity or easily triggered emotional states.
Shen Initiation
The shen initiation property is related in the desire and motivation. In the Ling Shu (Ben Shen Chapter 8), it mentions: "When the heart recalls something and leaves an impression, it is called 'idea.'" This passage clearly provides the theoretical basis for the concept that the "idea" comes from the heart: This is suggestive of the shen initiation function. Human beings have complicated desires and motivations that emerge from within or may originate from external conditions such as social, cultural, economic and environmental influences. When individuals sustain a high desire level but are frustrated with failures in terms of social or economic results, the shen easily becomes disturbed. The Ling Shu (Shu Wu Guo Lun, Chapter 77) discusses changes of class in which an individual once held a noble social position and finds themselves in a humble condition leading to an "exhaustion of nutrition" disease. When a person was initially rich and later becomes poor, the disease was called "depletion of essence." This is characterized as shen injury or the shen-injured inside.
Patients who have excessive desires or set up unreachable goals may become easily frustrated and depressed, which may lead to shen irritability. Patients with such a condition may have anxiety, weakness, sluggishness and lassitude. They may then lose desire and motivation, which is similar to shen numbness, one of the forms of shen disharmony.
Shen Processing
The processing function of the shen involves the application and synthesis of ideas and thoughts. Shen processing has an integral quality that functions continuously. The Ling Shu (Ben Shen Chapter 8) discusses shen processing as communication between the heaven qi and the Earth qi. Similarly, the yin and yang essences combine to create new life with shen. The shen-processing function involves initiative and idea generation to recollection and lasting impressions. The hun follows shen to perform the deeper levels of shen activities. At a more superficial level of shen activity, the po combines with the essence, connecting through the senses. The concept of "holding the idea" involves a willingness to do so, and reflection and contemplation of the future and its possibilities. Such ways of engaging thought may be called pondering. Accordingly, when one makes a decision after pondering, it is called wisdom.
Shen processing is required for each of the shen, po, hun, zhi and yi functions, which all require body support from the essence, qi, blood, organs and meridians. From the perspective of shen processing, we know that the shen may range from simple images and ideas to complicated social environments. When one can perform activities as a wise person, the shen processing is reaching a high activity level. In the clinic when the patients are in an emotional, psychological or spiritual crisis in a shen disharmony condition, they lose not just the ability for wisdom. The ability to ponder, understand, think, desire, and have ideas is all disturbed as well.
We have presented the primary shen properties and functions that are encountered in daily clinical practice. Understanding the shen harmony state provides a normative baseline from which to assess the disharmonies of shen. The evaluation and diagnosis of shen requires this starting point, with special attention as to which of the shen properties are disturbed.