Chapter 4
Boundary Similarities and Differences

Chronic Fatigue, Fibromyalgia, Irritable Bowel, and PTSD

Here are some words to the wise: “When we ignore what matters most to us, it will become the matter within us.” This observation, from psychotherapist Paula Reeves, is perfectly in sync with our understanding that our mind and our body effectively are one bodymind.

“What matters most” is the aspect of our life in which we have the most emotional investment, whether or not we consciously realize it. Feelings are a form of energy that is at the core of our selves; if we ignore those feelings or tell them to go away, they won’t simply leave without a trace. On the contrary, because they relate to what’s highly meaningful, they will hang around. They will bide their time. And they will find a way to become known. As Reeves puts it, they will become the “matter within”--and a potentially unhealthful matter at that.

Through the concept of bodymind, we understand that no complete and utter secrets exist within us. “Gut feelings” have an inner reality, and an inner legitimacy, even though they emanate from our “second brain” down below rather than the upstairs brain with which we’re more familiar. A blush, a rash, a migraine, a bout of chronic pain or fatigue--these are all ways that “what matters” within is made manifest. So, too, are such conditions as asthma, depression, hypertension, phantom pain, rheumatoid arthritis, and post-traumatic stress disorder (PTSD).

Feelings (as we gathered in chapter 2) flow like water. In people whose boundaries are thinner, this flow is quicker and more direct. In people who have thicker boundaries, the flow is slower and less direct. Given the differences inherent in boundary type, we can imagine that the stream of feeling will meander different places and cause different effects from person to person. In one person it may pool in a particular locale or ripple over into a tributary. In another person it may cascade freely. In a third person, the flow may be slowed--dammed up, even.

The characteristic way that someone literally feels is bound to influence his or her bodymind symptoms. In many cases a chronic condition comes to reflect the state of things. If we look closely at these conditions we will see not only the force of emotion at work but also that boundary type can be linked with the given ailment. Thus, knowing your boundary type is a key to the types of chronic illness for which you’re at risk, a key just as important, if not more so, than your much-discussed genotype. When we look at chronic health conditions through the lens of emotion, the ways that they take root (causes) and the ways that they can be resolved (treatments) are illuminated.

PTSD: A New View

Let’s contrast the person afflicted with CFS (chronic fatigue syndrome) with the case of someone affected by PTSD (post-traumatic stress disorder). At first glance they seem to be opposites: a mysterious malaise that portends who-knows-what (CFS) versus a highly immediate, riveting “replay” of a terrifying event that’s all too clear (PTSD). Furthermore, whereas the person with CFS may have a tough time getting to sleep, the person with PTSD may be awoken by nightmares. And while the CFS sufferer is likely to ignore her needs while carrying out a project or serving others, the person with PTSD is prone to feeling irritable, to being overtaken by sudden bouts of anger, and to displaying hyper-vigilance and hyperarousal.

The fascinating thing about PTSD (though obviously distressing to the person burdened by it) is how he essentially relives the traumatic event as though it’s a clear and present danger. The sights, sounds, smells and--especially--feelings are brought into visceral reality. What could cause this re-experiencing to be so vivid when, for someone suffering under the weight of CFS, it’s unclear what, if anything, lurks behind the fog?

The concept of boundaries allows us to evaluate PTSD in an entirely new way. Let’s start by assuming it is a thin boundary condition. The biological evidence supports this proposition. The level of serotonin in PTSD sufferers is low compared to individuals with CFS. Serotonin can be seen as a rough indicator of the state of activation of the hypothalamic-pituitary-adrenal axis, or HPA axis. The key thing to realize is that, while nature may predispose some of us to be especially low reacting or especially high reacting, genetics are not the whole story. The functioning of the HPA axis--which represents our stress activation system--changes based on environmental influences. A lesser amount of serotonin indicates a stress reactivity threshold that is fairly low, reflecting the thin boundary personality. A higher amount of serotonin points to the higher threshold, thick boundary personality.

The reactive nature of the thin boundary person with PTSD is captured by the following remark from a combat veteran. The smell of gunpowder, he said, not only makes him feel hot, “It’s as if my whole metabolism changes.” What he experiences is intense as well as instantaneous.

Here is what we surmise is taking place in cases of PTSD. When a thin boundary person is physically assaulted, the stirred up feelings don’t just recede into the bodymind, as they do with someone who has a thick boundary. They form a tight knot, a kind of stone in the energetic stream. (Contrast this by picturing CFS as a condition where the feelings are walled off or dammed up.) When the person is reminded of the original event, the feeling “current” pushes the stone to the surface, where it evokes a frightening replay of the trauma in the here and now.

Ultimately, boundaries make the entire difference. Chronic fatigue syndrome gathers force out-of-awareness of a thick boundary person. But with PTSD, the person’s thinner boundaries allow for a much more immediate retrieval of the dissociated energy, so much so that the replayed experience feels almost identical to the original trauma.