Imagination is more important than knowledge. Knowledge is limited while imagination embraces the entire world----Albert Einstein.

Introduction to Mental Imagery

Mental imagery, sometimes called visualization, guided imagery, and often used interchangeably with the practice of meditation and hypnosis, is the language used by the mind to communicate and make sense about the inner and outer worlds (Shafer & Greenfield, 2000).

Imagery, refers to the awareness of sensory (physical), and perceptual (cognitive), experiences which have been used in a variety of health and healing practices in the Western world for over three decades (Heinschel, 2002). Meditation, mindfulness, hypnosis, and yoga are also techniques commonly used in Behavioral Health Programs today to assist in high-level awareness health education sessions (Kabot-Zinn,1990). While there is something unique and peculiar about thinking in mental images, or understanding the meaning of "pictures in the head" as it applies to health and well being, this uniqueness is to receiving attention in the theoretical and research literature (Pslyshyn, 2002). Given the diverse role of the imagination appears to have in healing, the difficulty in studying the invisible world scientifically, religious groups who oppose such practices, and the differences in preconceptions held by practitioners, it is no surprise that there are many distinct views on the practice and value of mental imagery (Pinker & Kosslyn, 1983, Snaith, 1998).

Role of Imagination in Healing

In the last decade, interest in the practice of mental imagery, and the role of the imagination in health and well being, has dramatically increased as a popular approach for treating a wide variety of psychiatric, medical concerns, and enhancing sports performance (Shafer & Greenfield, 2002; Bloom, 1998; Epstein, 1989).

In fact, ten million North Americans of all ages admit openly to practicing some form of imagery or meditation, to reduce stress, boost the immune system, and cope with life threatening illnesses. This number has doubled compared to admitted devotees a decade ago (Stein, 2003; O’Donnell, Maurice, & Beattie, 2002). While the principles of mental imagery have been utilized in healing since the beginning of medical history, recent pioneers embracing the scientific merit of mental imagery are transforming the healing practices in Western medicine (Ader, 1981; LeShan, 1989; Selye, 1956; Simonton & Henson, 1992; Borysenko, 1988; Benson, 1975; Brigham, 1994).

Mental States and Physical Health Are Intimately Connected

The era of health care reform has placed a great emphasis on brief therapies, behaviorial health, and alternative practices involving the cooperative relationship of the therapist, and the active participation of the client (Elliott, 2003). As a result, doctors, health care providers, therapists, and patients acknowledge that mental states and physical health are intimately connected (Lemonick, 2003). Advances and shifts in health care practice have stimulated education, training, and the clinical application of imagery for the treatment of mental health, substance abuse, and medical problems. Mainstream Americans no longer have to search for gurus in the mountains or the Far East to inquire about the practice of mental imagery. Information is now offered and training provided in schools, hospitals, law firms, government buildings, corporate offices, and prisons (Gruzelier, 2002; Stein, 2003).

The central theme that emerges from empirical research is the impact of the client's sensory experience during the imaginal process (Heinschel, 2002). Clients do not have something "done" to them, they live an actual experience during the imagery exercise using the practitioner (clinician, health care worker, as the guide). While the eyes are either open (focused on a point in front of them) or closed, the client is guided through the exercise in the clinical setting (office, hospital, home, etc.), to be practiced as "prescribed" (i.e. x times daily) on their own between sessions (one time only, daily for seven days, or for twenty one days) depending on the presenting problem and the individual (Shafer & Greenfield, 2002).

Case Studies

The following case examples illustrate how mental imagery can be utilized in a variety of health concerns:

Case Example #1

Sandra, a 43-year-old attorney, has been asthmatic since childhood. Despite using a variety of approaches, she has always felt enslaved to her disease. She has tried both ignoring her condition and catering to it. Though everything seems to help for a time, nothing gives her the release she seeks. She is tired of searching for a solution which constantly evades her. Feeling drained and confused, she seeks out a clinician trained in the use of mental imagery as a treatment of last resort.

The therapist asks Sandra to close her eyes, turns her senses inward, and does some reverse breathing (exhaling first though her mouth, then inhaling through her nose). With this simple preparation, Sandra enters the world of her imagination where anything is possible – for here there are no rules, no diagnoses or prognoses, in fact, no limitations of any kind. Using an imagery exercise called “Liberation From Slavery,” Sandra sees and feels herself chained to her illness which appears to her as a large beast pressing her down, its foot planted firmly on her chest. Uncomfortable as this image may be, once she sees it she has the opportunity to acknowledge it (in effect to experience it), and to make a change. Using her imagination, she finds a key that unlocks the chains, breaks free of the beast, and releases herself from its power. Suddenly, the beast begins shrinking, while Sandra grows taller. As the chains fall away, the restriction and heaviness in her chest diminish. She feels lighter, her breathing becomes easier, and the sense of fear and powerlessness she had been feeling is replaced by hope and clarity.

When the imagery exercise is completed, the clinician as the guide, instructs her to breathe out and open her eyes. At this time, the therapist asks Sandra how she feels, and asks Sandra to describe her experience from the exercise in the present tense. She is encouraged to try this exercise (the prescribed dose), every day for at least seven days, up to 21 days, and to record her experiences (including night dreams) until her next appointment.

The benefits Sandra derives from doing this exercise are far reaching and immediate. Her imagery acts as a mirror that reveals her from the inside out. Instantaneously, from the imagery exercise she has learned truths about herself that until now she has overlooked, even denied. Indeed, she is stronger, “taller,” more powerful than she ever suspected. By freeing herself from the chains (which she sensed were her beliefs and fears about her illness), she becomes bigger than this disease, something she had always felt was all powerful, too much for her to handle. In changing the image, which she does by using the key to release herself, she has affected her beliefs, thoughts, and feelings in a positive, and liberating way. In doing this, she has gone beyond ordinary thinking where such things are “impossible,” and has become her own authority, the one who is ultimately in control of her choices in life (Shafer & Greenfield, 2002).

Case Example # 2

] Dee is a 55 year old nurse who works many hours and is the sole supporter of her family. She presents at the office with her arms scarred and scabbed severely from her digging and scatching. After discussing the various issues in her life that are “making her itch”, she is guided through a mental imagery exercise (Epstein, 1989) for general relaxation. Several days later, Dee emails the clinician the following (personal communication, with Shafer, 2003) exercise she developed on her own, evolving from the general relaxation exercise she was given in session. Her intention is to stop the itching and heal the wounds on her arms:

I sit in a quiet place (if at all possible). I close my eyes gently and take a few deep breaths. During this time, my mind travels to the spleen and watches as red blood cells (rbcs) come out to travel around the body. They travel to the heart and to the lungs and I watch as they pick up oxygen and return to the heart to be sent to all parts of the body. At this time, the rbc’s have also picked up glucose and there are white blood cells and antibodies traveling with them. I view them as they descend through the network of arteries, arterioles, and capillaries and then, they are at the sites that need healing. I like to visualize the right and left sides separately, but if I am tired and start fighting sleep, then I pull my perspective back and watch both sides at the same time. I see the rbc’s leaving oxygen and glucose at the base of the lesions. I see the antibodies surrounding the areas to prevent infection and I see the wbc’s backing up the antibodies.

I then pull my perspective back and gently stroke each arm separately and visualize more blood going to the areas to help them heal. The last thing I do is to take several deep breaths and tell my body that I do not want it to show me evidence of my anger, frustration, or stress. I tell it that there is no need for my body to hurt itself. Then I take three long breaths out and with each exhale I say (imaginally): “With this breath, I breathe out all of my anger, with this breath, I breathe out all of my stress, with this breath I breath out all my frustration.”

Like Sandra, the impact for Dee was immediate. She stopped itching within the week, created her own imagery exercise making her the authority over her healing, and the scabs were healed (without scarring) within one month. The confidence and esteem Dee gained from the creation of her own exercise and the results she achieved from doing the work herself drastically improved her sense of self. Clients gain a sense of mastery and call recall such achievements when future health challenges present senses of doubt, and helplessness.

Summary

As with the beginning of all habits, start with simple relaxation exercises first, perhaps with yourself and other colleagues to gain comfort and familiarity with engaging the imagination and each of the five senses. The mind and the body can interact in many ways to bring about health and illness as is introduced throughout this chapter. At first these interactions may be difficult to understand or see, however practice observing and reading the images provided in the exercises with a deeper appreciation. Experiment with all the possible ways to gain access to the sensory world of the client. For example start listening in a more active way such as listening to music. Or, if the client has trouble imaging, involve the sense of smell or taste or touch, integrate aromatherapy in the practice. Clients may like to write impressions from the work in a journal, record dreams, and utilize the therapist as the teacher or guide in their journey.

What may be discovered as the work of mental imagery continues, is that this not only attunes the therapist’s ability to image, but how to expand in this work with clients. While research is a challenge and is highly debated in this work, the evidence based research must continue to further the credibility of this mind-body practice.