Notes from Space, Time and Medicine

Space, Time and Medicine, Larry Dossey, M.D., Shambhala, Boston & London, 1982.

From one of Dr. Dossey's physician patients who learned biofeedback therapy to deal with headaches: "I watch the River of Time flow gently for a while . . . . The river slowly starts to curve so much that it begins to flow back on itself, gradually forming a complete circle. . . . the circular River of Time . . . starts to flood its banks inwardly . . . . and as it continues a giant lake is formed. . . . The surface becomes calm and still, reflective as a mirror. . . . time itself, has ceased to flow. . . . This timeless Lake of Time is indescribably serene, like a high alpine lake you encounter unexpectedly and never want to leave. It fills me with a sense of peace and I stay there feeling the stillness of the Lake of Time for as long as I wish. . . . This patient had himself learned how to manipulate his sense of time to his clinical advantage. He had learned to experientially slow time and to stop it . . . . His headaches continued to diminish. . . . Events did indeed enter his awareness sequentially, yet this process was entirely divorced from any sensation of a linearly flowing time." p. 20

I began to realize that I was witnessing patients becoming healthier through acquiring a new experiential meaning of what time was all about.
My patients were learning a strategy that held serious consequences for the improvement of their health. My own curiosity about this phenomenon evolved into a serious concern. If, I thought, patients can eradicate certain illnesses through adopting a nonlinear view of time wherein past, present, and future merge into a timeless stillness, the obvious question was: do we make ourselves sick by conforming to an idea of a strict linear time composed of a rigid succession of future, past, and present?
I have come to have little doubt that this is the case. Many illnesses--perhaps most--may be caused either wholly or in part by our misperception of time. Just as the patient in the above example created bodily health through his vivid perception of a nonflowing time, I am convinced that we can destroy ourselves through the creation of illness by perceiving time in a linear, one-way flow.
One of the goals of this book is to examine the evidence for this assertion. We shall see that the emergence of both human health and disease is coupled to our perception of time.
Without a clear idea of the concept of time we cannot understand its impact on our health, nor can we appreciate how the sense of time can be manipulated in ways to make us healthier. p. 21

We wander through varied sorts of time each day, giving little thought to the matter. We discard one concept of time in favor of another whenever it is convenient to do so. Yet we ordinarily maintain the illusion that time is a single concept, an entity that needs no explanation.
Here we are concerned with the time of experience, the kinds of time we actually feel. Where does our time experience come from? p. 23

We visualize heaven as an eternal timeless state, and our religious traditions assert that it is the child who is its natural citizen. It is the child who is at home in a nonlinear time, and who fits the beatific visions of antiquity. In a way that goes unnoticed we conjoin the spiritual sense and the experience of time. Perhaps it is not surprising that most great religions have always prescribed methods such as prayer and meditation through which one can become as a child; for in practicing these disciplines one quickly discovers that the experience of time changes. It ceases to flow; and experientially one feels enveloped by the stillness of which all the great mystics have spoken. p. 30

In total immersion in a task, whether listening to lungs or weeding vegetable gardens, time is abolished. It stands still. p. 34

There are, then, many ways in which we abolish time in our daily rounds, some of which we never think about. It is natural to denigrate in our thinking many of these ways of annulling time--daydreaming, reverie, fantasizing--relegating these moments to "wasted" time. The premium is on linear time--the time of history, the time of getting things done, the time of goals and accomplishments and rewards. In linear time we produce. caught in a culture in which the only sin exceeding that of allowing capital to lie idle is that of allowing time to go unused. p. 35

How do we experience time? We often speak of a "sense of time," but this implies a special organ with which we actually sense time, as the eye senses light. No such organ has ever been identified. . . .
If we indeed had an organ with which we perceived time, this would imply that there is an external or "real" time that is being perceived. We almost intuitively take some type of clock time as this "real" time--either hours, minutes, or seconds. p. 36

What, then, is Time? The most useful approach, as Ornstein suggests, is to discard the notion of an "inner clock" or a "real time" and to adopt a purely cognitive and experiential definition of time. p. 39

. . . we cling to the idea of a real time--a time that flows and is divisible into past, present, and future. Our belief in a linear real time underlies our basic assumptions of health and disease, of living and dying. But this kind of thinking is tied to an older science, which depended on an external reality, a reality independent of our senses. This view of the world has been discarded by modern physics. If we revise our idea of time in order to be consistent with the modern physical views, we must say of it what we have been forced to say of the external world: time is bound to our senses--it is part of us, it is not "out there." And our concepts of health and disease consequently must be revised, dependent as they are on our view of time. p. 43

What is an expanded sense of time? It is something we are all familiar with. It is a state in which we "lose track" of time. The passage of time slips away from our awareness. Time stands still. It enlarges, it expands. For many of us these moments come unexpectedly, as when we become preoccupied with a certain task or when we participate in a pleasant diversion. In meditation, for instance, this sense of time can be entered routinely, by choice.
In contrast, we experience a contracted sense of time when our awareness of time passage is enhanced. In doing something unpleasant, moments may seem like hours. Time drags. The fear of having a tooth pulled or the anticipation of an uncertain outcome such as passing or failing an examination will constrict our sense of time.
The relativity of the sense of time was expressed by Einstein when he observed, "If you sit with a beautiful girl, two hours seem like two minutes. If you sit on a hot stove, two minutes seem like two hours. That's relativity."
Persons who experience pain ordinarily live in a contracted or constricted time sense. Minutes seem like hours when one is hurting. Because the time sense is constricted, pain is magnified-sometimes far beyond what seems appropriate. Are there ways to intervene in painful situations, ways to manipulate the sense of time by expanding it? Can we lessen pain by "stretching" the time sense? p. 46

Without realizing it we do it all the time as physicians. Almost all substances that we use to treat severe pain modify the patient's sense of time. Patients who receive these medications do not say, of course, that their time sense was altered, but they respond with statements such as "that medicine made me float!" or "I became really drowsy," or "I forgot where I was."
There simply is no good vocabulary to use in describing these events which occur hourly in every major hospital. What does a patient mean when, after receiving pain medication, he says, "I really lost track of things for a while," or "That medicine really 'zonked' me," or "That stuff 'bombed' me out?" Undoubtedly altered time perception is one of the hidden meanings in such statements.
Not only drugs but other techniques as well do much to alter the time sense and have become valuable adjuncts to controlling pain. Hypnosis is one such example, and is of incalculable value for some patients in pain control. Biofeedback, which relies heavily on imagery and visualization in achieving physiologic self-control, has a marked effect on modifying time perception. Meditation, autogenic therapy, and progressive relaxation have similar effects. In fact, any device or technique that expands one's sense of time can be used as an analgesic!
It is important to realize that when we experience a technique that diminishes pain through expanding our time sense, we are not merely exercising self-deception. We are not fooling ourselves into thinking the pain is not there. Evidence is solid that mental states can evoke actual changes in brain physiology, changes that alter pain perception. p. 47

Just as Pavlov's dogs learned to salivate inappropriately we have learned to hurry inappropriately. Our sense of urgency is set off not by a real need to act quickly, but through learned cues. Our "bells" have become the watch, the alarm clock, the morning coffee, and the hundreds of self-inflicted expectations that we build into our daily routine. The subliminal message from the watch and the clock is: time is running out; life is winding down; please hurry. . . . Our sense of urgency results in a speeding of some of our body's rhythmical functions, such as the heart rate and respiratory rate. Exaggerated rises in the blood pressure may follow, along with increases in blood levels of specific hormones that are involved in the body's response to stress. Thus, our perceptions of speeding clocks and vanishing time cause our own biological clocks to speed. As we saw earlier, the end result is frequently some form of "hurry sickness--expressed as heart disease, high blood pressure, or depression of our immune function, leading to an increased susceptibility to infection and cancer. p. 49

We determine our own reality by mirroring our perceptions of a fleeting time in our body's function. Having convinced ourselves through the aid of clocks, watches, beeps, ticks, and a myriad of other cultural props that linear time is escaping, we generate maladies in our bodies that assure us of the same thing--for the ensuing heart disease, ulcers, and high blood pressure reinforce the message of the clock: we are running down, eventually to be swept away in the linear current of the river of time. For us, our perceptions have become our reality.

CARDIOVASCULAR DISEASE

Our sense of time is not only a major determinant in our awareness of pain, it affects our health by influencing the development and course of specific diseases. This is nowhere more obvious that in persons who have been called Type A individuals by Friedman and Rosenman. Type A persons have "hurry sickness." Their lives are oriented around goals, deadlines, and objectives, which they seem to react to in a driven fashion. They are unable to approach a task in a healthy, balanced way, but in extreme cases seem almost consumed by a need to accomplish and achieve.
Not only do they have an inward sense of urgency, their outward behavior suggests the same quality. When sitting they may be in constant motion, not only with thoughts, but with body parts--hands, fingers, legs, feet. They are usually vocal, verbally expressing the products of a mind that cannot rest. This behavior frequently gener-ates discomfort and tension in those around them.
It is as if Type A persons are "time sick." They resemble patients who are in chronic pain in that they have an acute sense of time. Only in this case, unlike the person experiencing pain, there is never enough of it.
Type A persons are usually ambitious and frequently are highly successful, having succeeded in harnessing their high motivation and sense of purpose. Yet for all the qualities for which they are (p. 50)
admired--their vision, energy, and dedication-they possess, as a group--a characteristic that nobody envies: they have a high mortality rate from heart disease.
Time sickness is not merely a colorful appellation, it is an actual illness possessed by the group as a whole. It is not just that Type A persons may experience excessive anxiety, that they may be more nervous and discomfited than their Type B counterparts, in which case their hurry sickness might be counted only as a nuisance or a bother. The problem is worse than a nuisance: Type A individuals, as a group, die earlier. Their behavior puts them at risk for the most frequent cause of death in our society, coronary artery disease.
The importance of the exaggerated response to time, the sense ot urgency displayed by Type A individuals, is that it is translated into physiologic effects. These effects are pervasive and are seen long before heart disease supervenes. These physiological events are so characteristic of time-sick persons, they could be called the time
syndrome. Among them are increased heart rate and blood pressure at rest; elevation of certain blood hormones such as adrenalin, norepinephrine, insulin, growth hormone, and hydrocortisone, all of which are ordinarily secreted in an exaggerated way during times of urgency or stress; increased gastric acid secretion; increased blood cholesterol; an increased respiratory rate; increased secretory activity of sweat glands; and increased muscle tension throughout the body. The time syndrome is a body-mind process with effects on all major systems. It is not simply a conscious experience of unpleasant feelings.
The awareness that the time sense is awry in certain clinical disorders is enormously important, because this understanding can give us clues in treating these problems. We noted, for example, that the cholesterol level is frequently elevated in Type A persons. We can ask, therefore, if manipulating the sense of time in humans has any effect on the blood cholesterol level. The answer, interestingly, is yes. Cooper and Aygen have shown that if subjects are taught to meditate, which is an easily available method of "adjusting" the time sense toward the other end of the experiential spectrum than that which is felt by Type A persons, blood cholesterol levels fall by an average of twenty percent.2 Moreover, other aspects of the time syndrome respond: blood pressure, heart and respiratory rate, as well as the blood levels of insulin, hydrocortisone, adrenalin, and norepinephrine are modified to more desirable levels.
The significance of these observations is inestimable: by taking thought in ways which "elongate" the time sense, time-sick individuals (p. 51)
can alter many of the devastating effects of the time syndrome. The method involved is not critical, for as we have seen, many methods are effective, such as meditative disciplines, biofeedback, progressive relaxation, and autogenic therapy.
. . .
As we learn to meditate, or when we become familiar with the states of consciousness that are peculiar to biofeedback, autogenic therapy, or to other techniques employing deep relaxation, we develop a familiarity with a new sense of time. We begin to experience time in new ways. We begin to feel at home with time as it expands. Phrases such as "the ever-present now" and "the eternal moment" become full with meaning. Above all, we develop a friendliness with time.
As this new regard for time evolves to deeper levels, new understanding unfolds. It becomes apparent that one of the motivating forces behind our old way of reacting toward the passage of time (p. 52)
was fear--an indisputable feeling that took the form of busying ourselves in needless motion. This frenetic behavior begins to appear as a defense against time, a resistance that assumes its final form in our individual, silent protest against death itself.
All time-riven events such as illness and demise begin to appear less menacing. Events in our daily lives such as tragic happenings, which used to stir us reflexively to remorse, now evoke less painful responses. We see the world differently through a new time. And as we learn to see a friendlier face of time, the mask of death itself becomes transformed--if not into a smile, perhaps at least without a frown. (p. 53)

. . . we persist in focusing on body problems almost exclusively. Is the patient maintaining his diet? Has the white blood cell count fallen too low to permit further treatment? Is the clotting mechanism intact, or should we defer chemotherapy for now? Body problems are real, and should be dealt with; but they are only part of the larger view, which includes the "time strategy being used by the seriously and terminally ill.
How can we intervene in the time strategy being utilized by seriously ill patients? A great therapeutic reservoir of techniques exists for this purpose, most of which make use of the purposeful use of visualization, imagery, and relaxation. Entirely new disci-plines such as biofeedback have arisen in the past two decades, which are known to be highly effective in modifying the time sense in sick patients.
The importance of these techniques should not be underestimated, for evidence suggests that they are potent factors in extending life in seriously ill patients. (p. 55)

Since no demarcations in time exist in a nonflowing, nonlinear time, past, present, and future become arbitrary divisions. The ordinary way of marking life at its poles by birth and death becomes suspect. We can begin to see birth and death as events occurring at either end of the asymmetric unfolding of happenings that we call life, but that carry no absolute status as an ultimate beginning or an ultimate end. Death, in the new view of health, becomes effete. The ordinary goal of health care, that of forestalling the moment of death, fails as a rational effort on the part of both physicians and patients, for there is no ultimate end to be saved from. Because the flow of time is seen as a psychological event not representing a true feature of the physical world, the ordinary sense of urgency that we feel is reduced. Along with this lack of respect for a pernicious (p. 143)
flowing time, the epidemic of various forms of "hurry sickness" begins to abate. We cease to destroy ourselves out of a sense that time is running out, that there isn't enough of it, that we are approaching our final end. (p. 144)

The notion that time flows in a one-way fashion is a property of our consciousness. It is a subjective phenomenon and is a property that simply cannot be demonstrated in the natural world. This is an incontrovertible lesson from modern science, a lesson that has been enormously difficult for modern man to comprehend. A flowing time belongs to our mind, not to nature. We serially perceive events that simply "are," and the serial perception of many such events eventuates in what we interpret to be an indisputable fact of nature, the flow of time. (p. 151)

There is a curious quality of this process which has to do with our time sense. The sense of time that we ordinarily have, that of a flowing, linear process comprised of a past, present, and future, seems suspended in moments of imagination. These pictures in the mind change as events unfold, yet they do not convey to us the sense of time flow. In the imagery process there is no sense of time (p. 164)
urgency. Time seems suspended, although events clearly "happen" in the image itself.
We ordinarily think this is impossible. Anything that "happens" must involve a linear experience of time. How can things happen outside of time?
This quality of time that we experience in the imaging process is strongly similar to the modern description of time given by the British mathematician-physicist P.C.W. Davies, which we have already examined. Davies contends that a flowing time is not a quality of the world itself, but is a psychological illusion, albeit a mysterious and persistent one. Nowhere in modern physics, Davies contends, must one postulate a flowing time of past, present, and future to account for the findings of modern physical science. (p. 165)

Time and Illness
We are coming to the understanding in medicine that some diseases are the result of a disorder of time perception. As we have observed several times in this book, the sense of time urgency is associated with a sobering variety of physical problems. For example, anxiety, stress, and tension figure into the development of atherosclerotic heart disease and hypertension, the two most com-mon causes of death in our society.
The chronic misjudgment of the nature of time should be seen for what it really is: chronic disease itself. It is a silent process, but for many of us an inexorable one leading to disease which can be fatal. We do not ordinarily judge it in these terms, of course, and too frequently ascribe our sense of time urgency to "nerves." Having misjudged the cause of our distress, we misjudge the solutions-- tranquilizers and alcohol are too often the most commonly trusted antidotes.

Time and Therapy
Time urgency has been recognized by an increasing number of persons in medicine, however, for the disease it is. Promising treatments are evolving. It is interesting to observe that most of these newer methods of treating "hurry sickness" and time urgency--biofeedback, relaxation, and meditative techniques--lure the subject in very subtle ways into a new way of perceiving time. They ask the (p. 166)
patient to step out of a chronic, habitual way of sensing time as an inexorable flowing proces into an alternative mode of time perception. They ask the patient to "stop" time. They invite him into the realm of spacetime, although this invitation is never explicit.
. . .
Most persons learn these skills easily and they come to enjoy the imagery process. Why? The new mode of time perception feels good. To be forever bogged down in a sense of time urgency is defeating. Stress and anxiety for most of us are unbearable without periodic alleviation. Thus, to involve oneself in a new mode of time perception is to experience good feelings.
We have seen earlier that participation in the states of consciousness that we typify as being serene, calm, and relaxed generate physiological changes that can be measured. The changes that occur are as real as those produced by any drug. Changes in hormonal levels in the blood, variations in heart rate and blood pressure, and changes in levels of muscle tension and blood flow to certain regions of the body accompany a subject's imagery efforts. Thus, since the processes of imagery and visualization are involved in these states, we can begin to see these processes as potent therapeutic agents. They are "medicine" in the truest sense, as real as drugs and surgical procedures. (p. 167)

How is this possible? Regardless of the image that is made, the subjects do at least one thing similarly: they are exchanging their usual sense of time perception for one in which time ceases to flow. . . . Even though the events are sequentially changing, they are not happening in the usual linear sense; they simply are. (p. 168)

Many pastimes, hobbies, and diversions share this capacity to "kill time," and frequently those who engage in them are said to be "killing time." This is an accurate description of the felt changes in time flow. In doing something repetitive--for example, needlepoint, where repetitive stitches follow one on the other--one can step out of time into a complete absorption in the project. Although the stitches form a sequence, each stitch can have its own "is-ness." It can escape its position in sequence, and experientially seems to bear no strong temporal association to the stitch that came before it or that comes after it. Each stitch stands on its own. The preoccupied needlepointer indeed "kills time," having stepped into the nonflowing realm of spacetime through total absorption in his/her work. (p. 169)

BRODIE: Often, in the heat and excitement of a game, a player's perception and coordination will improve dramatically. At times, and with increasing frequency now, I experience a kind of clarity that I've never seen adequately described in a football story. Sometimes, for example, time seems to slow way down, in an uncanny way, as if everyone were moving in slow motion. It seems as if I have all the time in the world to watch the receivers run their patterns and yet I know the defensive line is coming at me just as fast as ever. I know perfectly well how hard and fast those guys are coming and yet the whole thing seems like a movie or dance in slow motion. It's beautiful. [Emphasis added.] (p. 170)

It is well known that most children have a highly developed capacity for total absorption in a task. In certain situations children can use this ability therapeutically. To illustrate, I shall share the story of Mark, a six-year-old boy who was referred to my biofeedback laboratory for treatment of hyperactivity. Hyperactive children
are a literal embodiment of "hurry sickness." They cannot be still for very long. Their constant activity is disconcerting for their parents and peers. Because they are constantly in motion they cannot focus their attention. Although they are usually intelligent they may be judged to be slow intellectually, for it is only with great difficulty that they can stay "on track" long enough to complete a task. (p. 172)

There are a variety of images that can be used effectively in manipulating the sensation of pain. The technique which Monica used to abort her discomfort was to visualize the location of her pain as a small glowing red ball. She would focus as intensely as possible on this image, and when it was extremely vivid she would cause the ball to begin to move, ever so slowly, outside her body. She would center the ball about six feet in front of her. Then this small red ball of pain, glowing intensely, would begin to grow. It would enlarge to the size of a basketball, hovering in space. Moreover, it was suspended in time. Monica's description of this state was that time "stood still." Although events were "still going on," such as the red ball continuing to shimmer, time had ceased to flow. This was the time of spacetime.
. . .
Clinical experience suggests that a key to manipulating pain perception--as Monica's descriptions suggest--is in stopping time. (p. 173)

The physician, nurse, or therapist who aids the patient in pain is more than a dispenser of analgesics. He can be a guide. He can be one who shows the sufferer the way through the corridors of time to the still point where time ceases to flow, and where pain abates. And the patient, the suffering patient--how can we avoid the conclusion?--becomes a time traveler.
The new physical description of time is grist for everyman's mill, as the above clinical cases illustrate. The relevance of the new definition of time goes beyond the physics laboratory to impact on the lives of anyone who suffers from a time-dependent disorder, or hurry sickness--which, unfortunately, includes almost all of us. (p. 174)

In spite of the fact that the sense of linear, flowing time may have survived as part of our biological nature because of its survival value, this is surely not the whole story. I believe there is survival value also in perceiving time in a static, nonflowing, nonlinear way. We have observed that a sense of urgency is associated with the perception of time as a linear process of past, present, and future. Our modern sense of this urgency is expressed by our feeling that there is not enough time. We are running out of it. For each of us the flowing river of time will run dry. This moving river translates for most of us into a moving treadmill on which we attempt to do more and more in Iess and less time. The price we pay is stress, tension, and anxiety.
There is considerable evidence, as we have seen in Part II, that the psychological effects of urgency--stress, anxiety, tension--do not stay in the psyche. They are translated into the body where they eventuate in physical ailments. The sense of urgency generates infirmity, disease, and death. So although this sense may have enabled us to behave in ways which facilitated survival at earlier stages in our evolutionary history, it surely is a two-edged sword which haunts us in modern times.
In contrast, the psychological sense that accompanies the perception of time as static and nonflowing is one of tranquility, serenity and peace. This is the time perception so well described in mystical and poetic literature. It is the sense of oneness, of unity with all there is, the feeling of calm and release. It is the opposite of urgency. (p. 179)

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