Engaging the Brain’s Homunculus

Abstract

This paper deals with the interactions of brain, brain circulation, and consciousness; and this with a view to explore the potential of awareness’ expansion, not only to enhance the brain’s capacities, but also to specifically counter stroke genesis, and stroke rehabilitation.

Stroke presents multiple public health challenges with massive costs relative to quality of life, mental balance, and rehabilitative care.

One may ask why consciousness training would have anything to do with nervous system dynamics as they relate to the mechanisms responsible for stroke formation, namely disorders of brain blood circulation, and how focused awareness’ involvement could ever become a force in stroke prevention and rehabilitation.

While this report does not purport to have cleared research rigors, its premise nevertheless is based on clinical observations spanning decades, and it is this: None of the 20 patients studied who embarked in serious meditative practices developed strokes, while others, who could be called a large control group, developed stroke pathologies commensurate with general population statistics.

The meditative strategies studied in this paper find inspiration in varied techniques developed since ancient times, among them Yoga science and meditative disciplines, and more recently, Autogenic Training and medical hypnosis. Information about these and other techniques may be accessed on the following website: www.triroc.com/sunnen

Can probabilities for stroke be mitigated? Certainly! Carefully controlling risk factors such as hypertension, sugar utilization and lipid profiles, all in the context of optimal nutrition and lifestyle hygiene, are important for keeping the nervous system’s support lifelines functioning at their best. Added to that, however, are selected meditative practices that can train the nervous system to even greater harmony, and higher performance.

The author previously reported on the use of hypnosis in stroke rehabilitation (DeBetz, Sunnen 1985). The current paper, supported by extensive meditation research, proposes mind-body strategies for bolstering neuronal networks and their associated vascular and tissue supports in stroke dynamics. Enhanced resilience of neuronal networks is herewith posited to provide better defense against stroke formation, and to encourage convalescence in vascular accident challenges.

Stroke dynamics

A condensed review of stroke pathologies is beyond the scope of this article and the reader is guided to the references below. Easily ignored, is that strokes account for the third cause of mortality in the adult population and as a first cause for functional incapacity (Kandel 2013).

We are reminded, as guiding principles, of the constant need for brain tissues to be supplied with glucose, and crucially, with oxygen. Deprived of these elements, the brain’s hardware can rapidly deteriorate. Once compromised, time pressures for preventing neuronal damage are gauged in spans of minutes. Yet, there are many situations where the brain’s circulatory challenges – often manifested in symptoms such as dizziness, language and orientation stumbles, numbness and weakness – are transient and reversible, because of the brain’s remarkable vascular backup systems, and its robust capacity for recovery.

Several conditions encourage stroke. Hypertension stresses the brain’s arterial system; and if chronic, vessels progressively thicken, thus weakening and obstructing their walls. Diabetes, a condition with both metabolic and vascular features, promotes the formation of occlusive arterial plaques. Sustained attention to these maladies is important for stroke prevention.

Brain circulation’s rich circuitry, however, provides backup for steady delivery of the molecular and gaseous nutrients vital for the function of the billions of neurons needed for all things human do. The brain’s arterial supply routes, amongst them, the carotid, vertebral, basilar, cerebellar and cerebral arteries, and the circle of Willis, the roundabout vascular pipeline in the center of the brain, insure the feeding of hungry neurons as they equitably distribute precious blood supplies.

Strokes are occlusive (embolic, thrombotic), or hemorrhagic. Thrombotic and embolic strokes derive their effects from blockages to brain tissues, causing anoxia, ischemia and/or infarction. Various bodily sources can generate emboli, especially when blood flow is sluggish, as in atrial fibrillation. Thrombi diminish then halt blood supply via vessel narrowing. Brain regions, if starved to death by stroke, become prodded by other parts of the brain that begin to clamor for their reawakening. Healing begins, and neurogenesis, as in the formation of new neurons is called to action.

Hemorrhagic strokes derive their destructiveness from blood’s escape into brain’s substance. Spilled blood is stagnant and drowns neurons. Drowned neurons, like humans, can either revive, or succumb to the waves.

The middle cerebral artery is one most affected by strokes. Large by cerebral standards, it exits the circle of Willis to feed wide swaths of the lateral cortex and its underlying white matter communication bundles. Affected by stroke in this artery are sensory perception and willful motion for the opposite side of the body, along with visual impairments. Due to differences of each brain hemisphere, lesions in the left brain, where language comprehension and enunciation mostly reside, versus the right side, the domain of spatial appreciation, will determine each stroke’s aftermath. Any artery in the cerebrum and cerebellum, however, may suffer stroke.

The anterior cerebral artery is much smaller than its middle partner, much less affected by stroke, and supplies innervation to the legs. The brain’s vascular network, however, involves more than arteries: The venous and lymphatic systems provide essential drainage functions, and the cerebrospinal fluid, protecting this precious organ from mechanical shocks, works to provide a perfect homeostatic milieu for the brain to find happiness.

The brain, 2.2 lbs. of dense grey mass of neurons and supporting cells, is a universe of circuitry that constantly wires and rewires itself, in wakefulness as in sleep. Comprising 2% of body weight, it receives 15% of cardiac output and consumes 20% of total oxygen. Brain blood flow is anywhere from 750 ml to 1 liter per minute, all needed for delivering a substance that accepts electrons from brain’s metabolism, oxygen; and this while supplying glucose and other essential nutrients, and removing metabolism’s waste molecules, including lactic acid and gases (Sunnen: Ozone, a physiological gas, is created in vivo: www.ozoneinmedicine.com).

Brain circuitry can be thought as composed of soft wiring that receives, sends out and connects. The tendrils of bio-electrochemical wires are pliable and always in motion. Strokes disrupt these sensitive connections. Strokes, however, disrupt more than wiring.

There is yet another dimension bathing the brain that goes beyond the wealth of its circuitry and its chemical makeup. Beginning at the cellular level and readily seen by microscope, individual neurons constantly move in time and space. That dimension is the magic of cellular aliveness. As neurons coalesce in embryonic development, their mass expanding daily, a communal phenomenon emerges. The neuronal colony begins to work in a holistic manner. And sometime along the way, out of the colony and as if by magic, emerges a new dimension: Neuronal colony feeling.

In a yet unfathomable leap from biology to mind, ever greater complexity gives birth, or invites, phenomena we recognize as consciousness, awareness, experiencing, and the ultimate dimension, awareness of self. Contemporary science is forced to accept the inexplicable until some illumination is shed on how the wealth of molecules of the brain can ever bridge the abyss to explain the dimension of spirit.

Every morsel of brain’s fabric contributes to overall consciousness, and ultimately, self-awareness. Predicated on the specific networks impaired in stroke, any one portion of brain matter contributing to consciousness and self-awareness, once injured, will need restoration and rehabilitation.

Consciousness from below, self-awareness from above

The feeling of aliveness connects to the totality of cellular activities occurring at any instant in every neuron and in the entire brain. In full wakefulness, this provides us with a poignant experiencing of “me,” or “I. While Descartes, speaking philosophically, stated, “I think therefore I am,” someone speaking neurologically would say, “I am because I think, I feel, I sense things and I move through space and time.”

No one yet can even sketch the brain networks generating the sense of “I,” although the frontal and pre-frontal lobes have a lot to do with it. The pathways that express its superior functions, namely its capacity for willful action, for retrieving memories, for projecting into the future, and for sentiently creating new connections into itself. “I,” that special dimension connected to self-awareness and to ego functions, is capable of seeking and forming neurological links within its own brain. Sustained attention is a capacity central to the focused expansion of awareness into the nervous system and to the genesis of higher connections.

Parts of the brain contribute more than others to the awareness of aliveness. Consciousness can be measured for its intensity, as it can for its quality. Intensity is provided by the total energies generated by neurons and their power factories, neuronal mitochondria. Much as an electric car derives its pep from its central battery, several brain systems generate raw biological energy to kindle awareness systems. A major player is the neuronal billions-dense reticular activating system (RAS), common to all higher life forms, and its heightened concentrations of mitochondria generators.

A car’s battery also provides central power to its peripherals: Radios, clocks, phones, lights, horns. In the nervous system, central awareness is required for all specialized operations. Central power is needed so that sounds can eventually be made into music, colors and forms combined with concepts into art, body movements and abstract meaning into dance, and thoughts and nuances of emotions into their most sophisticated insights. Given this fundamental energy, the brain makes possible all the amazing things humans can and will do.

A central energy system determines the flame of aliveness, and can be thought of as “coming from below,” emanating from ancient nervous system networks. Yet, if challenged, as in certain strokes, the mind’s primal energy sources can digress downward, in scales ranging from sedation to coma.

The awareness that “comes from above,” consists of refinements of the raw power of primal consciousness. They are the colors apposed to an Impressionist painting once its canvas has been primed white. Multitudes of hues of all senses connects to the palette of thoughts and their connected emotions, all becoming possible by the newest evolutionary addition to the nervous system, the giant human cortex.

Meditation changes the functions, and even the structures of the brain

Numerous studies have shown that sustained attention practices not only stabilize a host of psychological functions, yielding greater emotional harmony, but also, unexpectedly, have the capacity to change the very physical structure of the brain. Among the numerous papers found in the literature, and the papers cited in the references section, are selected reports of the following changes brought about by sustained attention:

• In 8 Tibetan meditators, cerebral blood flow increased in the cingulate gyrus, the inferior and orbital frontal cortex and the thalamus (Newberg 2001). And in 12 advanced meditators, compared to 14 non-meditators, cerebral blood flow was significantly higher in the pre-frontal cortex, the thalamus, putamen and caudate nuclei, representing networks that have to do with attention, emotion regulation and autonomic functions (Newberg 2010).
• In 10 meditators, two different types of meditation resulted in two different blood flow increase configurations in the brain. One meditation style was focus-based while the other was breath-based. Each type of meditation resulted in two different subjective states in the same individual (Wang 2011).
• Different styles of meditation: Focused Attention (FA), Open Monitoring (OM), Transcendental Meditation (TM), and Loving Kindness (LK) lead to beneficial cognitive outcomes such as improvements in concentration abilities, stress reduction, and decrease in anxiety and depression symptoms. All were associated with global increases in brain EEG oscillations (Lee 2018). Sustained attention thus leads to selected regional increase in neuronal metabolism.
• A meta-analysis of studies involving experienced meditators showed significant differences in the morphology of the prefrontal cortex and body awareness regions (Fox 2014).
• Studies of dedicated string players showed in increase in the homunculus’ left finger representation (Elbert 1995). This study demonstrates that sustained attentiveness to bodily networks concretely augments their corresponding cortical representation.

Now established, is that the brain, once stimulated by sustained attention, as in dedicated concentration, focusing, contemplation and meditation, changes its baseline functions, namely its regional blood flow, its metabolism and its electro-chemical output. What is more, in time, it changes its material structure! In other words, whatever the interactions between mind and brain, mind is capable of changing the very physicality of its own nervous system!

Engaging the brain’s homunculus

What happens when you look at an apple held, seen and felt in your hand? Where do all the messages from our senses end up? All sensations translate into electro-chemical messaging. Transiting through the spinal cord and its outcroppings, they eventually progress to the brain’s central station, the thalamus. Once triaged there, they are distributed to its multi-layered, highly inter-communicative cortical layers.

In the higher cortex, sensory signals construct a brain’s proprietary map of the body. Some parts are given priority over others. The face and especially the lips, tongue and eyes are large. The hands and fingers, especially their tips, are prominent. The large feet hang over the edge of the cortex falling into the midline crevasse, like Humpty Dumpty. A complete body map has no resemblance to the real body; it is called the homunculus (Kabat-Zinn 2018), a gargoylesque figure that highlights the importance of body parts most important to navigating the world. This fact is important as it relates to the practice of anti-stroke meditation.

The homunculus (Latin: little human) is more than a surface map because it branches far into the brain, and the body, via myriad connections. Each homunculus receives its messages from the other side of the body. Although there is some bilateral representation for some senses, such as hearing, sensations from the right side of the body will be felt in the left hemisphere of the brain, and vice versa. The homunculus continuously changes in shape and form. As we endow attention to selected parts of our bodies, our homunculus evolves (Elbert 1995).

How does one contact his or her own homunculus? The connection is from the self to the body. The center of our self-awareness is a diffuse system with nebulous boundaries in the brain. By all evidence, it has no boundaries in mind. Although heavily influenced by the deep forces of the unconscious mind--which by definition operate below ordinary levels of awareness - the higher executive mind, with determination, is capable of overriding most challenges to its chosen path. To this end, it is bestowed the capability of sustaining attentive power for protracted periods of time, all essential for meditative therapies.

Selected meditative strategies for stroke prevention

The objective of meditation for stroke prevention centers on bolstering the tissue support systems to brain areas most affected by vascular accidents. Much like muscles that can be made to increase in size, vascularity and performance with dedicated exercise, the brain’s resilience, similarly, can toughen its vascular and cellular support networks in case of need.

Sustained attention in any of its several forms may be recruited in the process of strengthening this stunning organ. Herewith presented, is a clinical procedure that has been streamlined over time:

The client is asked to reach a baseline relaxation state. This phase may be self-induced by means of a previously learned meditation, or may be assisted by guidance from the therapist. In any case the goal is to reach a personal body/mind state that may be called deep relaxation or, a hypnoid, meditative, or “trance” state, such that it becomes possible to experience one’s body feeling space as poignantly as possible. Breath-centered meditation is a preparatory quasi-universal preparatory relaxation induction method, except in certain medical conditions.

Since the goal is to contact, then stimulate sensory cortical brain areas, the meditator, once this state is reached, is asked to send feelings to one hand or other, as per their choice. Eyes closed and centered internally on their chosen hand, the meditator will be able to slowly identify each finger in turn, then the palm and wrist. Staying on meditative target is key as the hand begins to experience a larger mental prominence. As meditation progresses, different sensations may emerge such as feelings of increased hand volume, heaviness, warmth, or gentle tingling, as if energy were coursing through.

Emerging in consciousness, the entire arm is eventually added to the experience, from the wrist upward, to include the shoulder. Eventually, the arm may experience sensations of lightness, or heaviness, or both simultaneously, of increased mass, and/or of feelings of moving energies likened to magnetism or electricity (Sunnen G. The Sunnen Trance Scale, www.triroc.com/sunnen). With dedication, it becomes possible to experience both hands and both feet in expanding consciousness.

According to brain blood flow research relative to meditation, even early in this meditation, regional blood flow probably begins to increase in the brain. The same process may then involve the other arm in order to engage the opposite homunculus. In this training, both arms may eventually be held in awareness at the same time.

The meditator, via this technique, is connecting to their homunculi. From the center of one’s “I,” a gentle push directs awareness to contact and enhance the sensations coming from the hands. The seat of these sensations is, of course, not in the hand, but actually in the brain’s right and left homunculi.

This is not to say that this process does not impact the hand itself. Indeed, the sensory homunculus emits massive signals, most prominently to the adjacent motor centers in the pre-central cortical gyrus. As the homunculus receives, it also sends out, in ubiquitous brain redundant feedback loops. This principle gives rise to variations of this meditation that can be applied to the activation and healing of numerous bodily organs.

Consistently practiced, this meditation increases vascularity of the sensory homunculus, but also, based on findings of the meditative brain, encourages growth of all brain tissues including glial cells. It is posited that this enhanced brain tissue buildup will keep brain tissues in good working order and ensure against future circulatory compromise.

Meditative approaches to stroke rehabilitation

The primary goals of meditative techniques applied to stroke rehabilitation are to stabilize the psyche in the face of a new assault on the nervous system, and to bolster the positive forces, mental and physical, that will encourage rehabilitation to achieve its goals. There needs to be comprehensive care strategies that span from physical therapies to mental therapies, and to the all-important role of adapted nutrition.

Once a stroke has manifested, there needs to be a period of acute resolution of neurological and systemic functions. This phase, which may take some time and require enlightened patience from both patient and caregivers, is greatly stimulated by loving presence.

This is not to say that passive waiting for stabilization is a substitute for active engagement and intervention. The patient, even in this early phase, can already initiate meditative self-therapy, all the more routine if training has taken place beforehand.

In the meditative approach to the rehabilitation of stroke, the principles remain the same as in prevention of stroke, but the technique is somewhat different. A stroke, whether occlusive or thrombotic, involves a certain volume of brain tissue that, devoid of lifelines, has perished. There, neurons and glial cells, without means of recovery, undergo consolidation and scarring.

Immediately surrounding this dead zone, however, is an area of challenged neurons struggling for recuperation. This area, which may take up variable brain space, is the one in need of focused attention.

In the case of a stroke involving sensory and motor loss, the distribution of lack of function can be precisely mapped. In sensory loss, for example, the patient may have no awareness of areas below the elbow; yet begin to report increasing feelings higher up in the arm. The approach here is to center meditative focus on the body areas beyond the frontiers of numbness and into the feeling zones. Amplify them mentally via sustained attentiveness will stimulate those parts of the homunculus that are attempting to recuperate. A case description can be found, (“Hypnosis in the Hospital Setting,” in DeBetz, Sunnen, A Primer of Clinical Hypnosis, 1985).

Summary and conclusion

Well established is that sustained attention, whether expressed through dedicated concentration, focusing, contemplation, yogic techniques and various styles of meditative practice, can beneficially change mind’s functions. Documented are measures of increased emotional harmony, stress resistance and well being.

Surprisingly but well documented as well, is that with dedicated practice, sustained attention can also beneficially alter the very physicality of the brain, as evidenced by increases in blood perfusion (Newberg 2010, Wang 2014), modulate regional brain metabolism as expressed in EEG activity (Benson 1990, Lee 2018, Goleman 2018), and stimulate the anatomical expansion and integration of brain areas connected to higher functions (Lazar 2005, van Luterveld 2017, Vestergaard-Poulsen 2009, Hölzel 2011, Fox 2014, Luders 2015, Gotink 2016).

In the meditative approach to the prevention of stroke, the brain circuitries most vulnerable to stroke are bolstered by enhancing their circulatory capacities. In so doing, vascular netting is given more branching to nourish neurons, thus making for resilient vascular and tissue support in case of need.

In this meditative approach to rehabilitation from stroke, techniques center on stimulating the brain areas questing for recovery, namely those adjacent to the areas of injury. Posited is that neuronal convalescence will have greater success with the impetus of dedicated sustained attention.

The special adaptation of meditative techniques aiming for stroke prevention and stroke rehabilitation may be called ”Sustained Attention Neuronal Therapy” (SANT), encompassing not only stroke therapeutics, but also a panoply of physical disorders that implicate brain dynamics and the mind-body interface.

Bolstered by the ever-expanding wealth of research supportive of these concepts, it is hoped that these techniques will soon be applied to their validation and clinical needs.

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• (Ret.) Associate Clinical Professor of Psychiatry, Bellevue-NYU Medical Center, NY. Board Certified in Psychiatry and Neurology. In May 2017, the State University of New York (SUNY) awarded Dr. Sunnen the William A. Console, MD, Alumni Achievement Award, "In Recognition of Significant Achievement in Psychiatry."