Monday, 31 December 2018

bonne année

Happy New Year

“We will open the book. Its pages are blank. We are going to put words on them ourselves. The book is called opportunity and its first chapter is New Year’s Day Edith Lovejoy Pierce

Sunday, 30 December 2018

Sorrel: The Ruby-Red Caribbean Christmas Drink Flavored With Black History

Sorrel, a festive drink made by steeping hibiscus flowers, is the taste of the holidays throughout the Caribbean. It is also a close cousin to the African-American red drink, described as "liquid soul."
Andrea Y. Henderson/NPR
In America, the boozy drink of Christmastime is buttery, cream-colored eggnog. But throughout the Caribbean, the sip of the season comes in a holiday-appropriate shade of ruby red: sorrel.
This sweet, cinnamon-spiced drink gets its festive deep-red shade from the flowers of roselle, a species of tropical hibiscus plant used to make it. "It has notes of family, warmth, Christmas and of being around people that you love," says Jamaican chef Suzanne Rousseau, who with her sister, Michelle Rousseau, co-authored the vegetarian cookbook Provisions: The Roots of Caribbean Cooking.
Different islands give sorrel their own spin, varying the spices and other ingredients. Some people add ginger ale to the mix. Wine, rum or other alcohols can be used for the optional buzzy kick. The Rousseau sisters take the crimson hibiscus buds and combine them in a saucepan with spices like cinnamon, cloves and ginger, boil the mixture for a few minutes, then steep it for two to three days. Once the mixture is steeped, they add sugar, wine and rum to taste, and chill the blend until the holiday drink is ready to be served. "It's not really a cocktail, it's more like a punch," Michelle Rousseau says. The sisters say they like to keep sorrel in their fridge year round — the longer it sits, the richer and sweeter it gets.
But this beloved island drink isn't just a local tradition. It actually has deep roots in the history of the African diaspora, and is a close cousin of another beverage — one with a special place among African-Americans: red drink.
If you don't know what red drink is, then most likely you have never attended a black American church function, family reunion or barbecue, because these gatherings have red drink readily available — not just at Christmastime but throughout the year. If you walk into a soul food restaurant and red drink isn't on the menu, you might as well walk out.
That's because red drink is "liquid soul," as African-American food historian Adrian Miller has called it.
But what exactly is red drink, you ask? It is more of a phenomenon than a single drink. Most commonly, red drink is served ice cold — and red, of course — a sugary blend of several flavors of Kool-Aid. In the South, red flavored Kool-Aid is available during gatherings, but the most popular red drink often comes in the form of Big Red, a fizzy canned soda.
"Red drink is very popular in African-American culture," says Miller. "It's just essentially a nod to ancestral traditional red drinks that crossed the Atlantic during the Atlantic slave trade."
Red drinks made from Roselle hibiscus have spread far and wide. A version of the drink is "known as bissap to many African countries," Miller says. "Then it became sorrel in Jamaica. It's even being embraced by the Latinx culture, called agua de Jamaica."
Miller says that while searching historical records, including old periodicals and thousands of narratives from formerly enslaved African-Americans collected as part of the 1930s Federal Writers' Project, he discovered many references to red drinks served as part of celebrations on U.S. plantations during slavery and after Emancipation.
These red concoctions sometimes came in the form of raspberry or strawberry lemonade, or as vinegar shrubs — drinks made of a mix of syrup, vinegar, fruit and sugar. Though these fruit-based drinks were derived from ancestral African traditions, they were often served to white guests of the plantation as hospitality beverages. These drinks were often spiked with liquor — the exact kind depended on the type of corn the plantation harvested. At times the liquor and even the kind of molasses used would produce the reddish color, which enhanced the red shade of the fruit-based drinks.
After President Lincoln issued the Emancipation Proclamation in 1863, freedom celebrations emerged amongst the enslaved. These celebrations continue to this day in the form of Juneteenth, a holiday marking the end of slavery in Texas that's widely observed throughout the U.S. by African-Americans — customarily with free-flowing red drinks in hand.
At the turn of the 20th century and into the 1930s, "You start to see very specialized drinks like Big Red and the emergence of flavored powdered drinks that you can just make by adding your own water and sugar to taste," Miller says.
In the Caribbean, sorrel became a Christmastime tradition in part because the roselle hibiscus plant used to be available only during that time of year, says Michelle Rousseau. These days, however, the plant is cultivated year-round, and sorrel is bottled and sold commercially, she says.
Interestingly, while America has long had its own strong red drink tradition, Miller says the Caribbean Christmastime sorrel has been gaining a foothold in the U.S. since at least the 1930s, when large numbers of Caribbean immigrants began arriving.
"In the newspapers, I saw references — at least in New York City — to sorrel being sold on the street around Christmastime for newly arrived Caribbean immigrants to have something they desire," Miller says.
For the Rousseau sisters, who still live in Jamaica but spoke to NPR while on book tour in the U.S., sorrel remains the taste of Christmastime — and their Caribbean island.
"This year, I cannot wait to get home, because I still have some in my refrigerator from last Christmas," Michelle Rousseau says. "These were the kinds of things we would do when we were young: sitting in front of the tree lights, put on the Christmas carols and pour yourself a glass of sorrel."

Christmas Sorrel

The Rousseau sisters share their recipe for this Caribbean holiday favorite.
Above, a glass of traditional sorrel and the Rousseau sisters' Sorrel Mimosas (Holiday Hibiscus) made with it.
Ellen Silverman
1/2 pound ginger, peeled and mashed or beaten
3 to 5 cinnamon leaves or ½ teaspoon ground cinnamon
3 to 5 whole allspice berries
2 pounds fresh sorrel flowers/buds
1 ½ to 2 pounds brown sugar
1 ½ cups red wine
1 ½ cups white or dark rum
Mix 2 quarts water with the ginger, allspice berries and the cinnamon leaf or ground cinnamon in a large saucepan.
Boil for a few minutes. Add the fresh sorrel buds, then turn off the heat.
Place the cover on the saucepan, refrigerate the mixture and let it steep for two to three days. If you want to partake in the drink on the same day, then prepare the blend in the morning and let it steep for at least six hours.
Once the sorrel has steeped, strain the mixture and discard of any solid pieces.
Sweeten the mixture to taste with sugar. Be sure to mix until the sugar has dissolved.
Lastly, add rum and wine.
Makes 8 cups
Excerpted from Provisions: The Roots of Caribbean Cooking by Suzanne and Michelle Rousseau. Copyright (c) 2018. Excerpted by permission of Da Capo Press, an imprint of Perseus Books, a Hachette Book Group company. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.


We are showered every day with the gifts of the Earth, gifts we have neither earned nor paid for: air to breathe, nurturing rain, black soil, berries and honeybees, the tree that became this page, a bag of rice, and the exuberance of a field of goldenrod and asters at full bloom.

My economics colleagues speak of these everyday miracles as “natural resources,” as if they were our property, just waiting to be transformed. In the ecological sciences we call them “ecosystem services,” as if they were the inevitable outcomes of the ongoing function of the ecological machine. But, to me, simply as a human person filling my basket with berries and my belly with pie, they feel like gifts, bestowed by the other beings whose lives throb around us.
Though we live in a world made of gifts, we find ourselves harnessed to institutions and an economy that relentlessly asks, “What more can we take from the Earth?” This worldview of unbridled exploitation is to my mind the greatest threat to the life that surrounds us. Even our definitions of sustainability revolve around trying to find the formula to ensure that we can keep on taking, far into the future. Isn’t the question we need, “What does the Earth ask of us?”
The premise of Earth asking something of me makes my heart swell. I celebrate the implicit recognition of the animacy of the Earth: that the living planet has the capacity to ask something of us, and that we have the capacity to respond. Can it be that an entity as vast, as whole and generous, as the Earth has need of me? Me? Could it be that we are more than passive recipients of her gifts, but participants in her well-being? We are honored by the request. It lets us know that we belong.
I’ve been told that my Potawatomi ancestors taught that the job of a human person is to learn, “What can I give in return for the gifts of the Earth?” This is a question so fundamental to our being that it holds a central place in the mythic creation story of our people, a story shared by the first peoples of the Great Lakes.
In the beginning, there was the Skyworld, where people lived much as they do on Earth, alongside the great Tree of Life, on whose branches grew seeds and fruits and medicines, all the gifts of the plants on a single tree. One day a great wind felled the tree, and a hole opened where its roots had been. When a beautiful young woman, called in our language Gizhkokwe, or Skywoman, ventured to the edge to look down, she lost her footing. When she reached out to the tree to stop her fall, a branch broke off in her hand.
She fell like a maple seed pirouetting on an autumn breeze. A column of light streamed from a hole in the Skyworld, marking her path where only darkness had been before. But in that emptiness there were many, gazing up at the sudden shaft of light. They saw there a small object, a mere dust mote in the beam. As it grew closer, they could see that it was a woman, arms outstretched, long black hair billowing behind as she spiraled toward them.
The geese nodded at one another and rose as one from the water, in a wave of goose music. She felt the beat of their wings as they flew beneath and broke her fall. Far from the only home she’d ever known, she caught her breath at the warm embrace of soft feathers. And so it began. From the beginning of time, we are told that the very first encounter between humans and other beings of the Earth was marked by care and responsibility, borne on the strong wings of geese . . .
The world at that time was covered entirely by water. The geese could not hold the woman much longer, so they called a council of all the beings to decide what to do. As Turtle floated in the watery gathering, he offered to let her rest upon his back. The others understood that she needed land. The deep divers among them had heard of mud at the bottom of the water and agreed to retrieve some. One by one, the animals offered their help: the otter, the loon, and the beaver. But the depth, the darkness, and the pressures were too great for even these strongest of swimmers, who came up gasping. Only the little muskrat was left, the weakest diver of all. He volunteered to go while the others looked on doubtfully. His small legs flailed as he worked his way downward. He was gone a very long time. They waited and waited, fearing the worst for their relative. A stream of bubbles rose and the small limp body of muskrat floated upward. But the others noticed that his paw was tightly clenched, and when they pried it open, there was a small handful of mud. Turtle said, “Here, spread this mud on my back and I will hold it.”
Skywoman did as Turtle asked and then began to sing her gratitude and then to dance. As her feet caressed the Earth, the land grew and grew from the dab of mud on Turtle’s back. From the branch in her hand, she seeded the earth with green. And so, the Earth was made. Not by one alone, but from the alchemy of two essential elements of gratitude and reciprocity. Together they formed what we know today as Turtle Island. In the beginning of the world, the other species were our life raft. Now, in the spirit of reciprocity, we must be theirs.
The Earth was new then, when it welcomed the first human. It is old now, and some suspect that we have worn out our welcome. The stories of reciprocity have grown dim in the memory. How can we translate from the stories at the world’s beginning to this hour so much closer to its end? Potawatomi philosopher Dr. Kyle White has written that “the intent of indigenous governance is to make the values and relationships in our creation stories manifest.” Can we understand the Skywoman story not as some artifact from the past, but as instructions for the future? In return for this gift of the world on Turtle’s back, what will I give in return?

The Earth Calls Us to Gratitude

For much of humans’ time on the planet, before the great delusion, we lived in cultures that understood the covenant of reciprocity—that for the Earth to stay in balance, for the gifts to continue to flow, we must give back in equal measure for what we are given. Our first responsibility, the most potent offering we possess, is gratitude.
Now, gratitude may seem like weak tea given the desperate challenges that lie before us, but it is powerful medicine, much more than a simple thank you. Giving thanks implies recognition not only of the gift, but of the giver. When I eat an apple, my gratitude is directed to that wide-armed tree whose tart offspring are now in my mouth, whose life has become my own. Gratitude is founded on the deep knowing that our very existence relies on the gifts of other beings. The evolutionary advantage for cultures of gratitude is compelling. This human emotion has adaptive value because it engenders practical outcomes for sustainability. The practice of gratitude can, in a very real way, lead to the practice of self-restraint, of taking only what you need. Naming and appreciation of the gifts that surround us creates a sense of satisfaction, a feeling of “enoughness” that is an antidote to the societal messages that drill into our spirits, telling us we must have more. Practicing contentment is a radical act in a consumption-driven society.

“Gardener Bay”

Indigenous story traditions are full of cautionary tales about the failure of gratitude. When people forget to honor the gift, the consequences are always material as well as spiritual. The spring dries up, the corn doesn’t grow, the animals do not return, and the legions of offended plants and animals and rivers rise up against the ones who neglected gratitude. The Western storytelling tradition is strangely silent on this matter, and so we find ourselves in an era when we are rightly afraid of the climate we have created.
We human people have protocols for gratitude; we apply them formally to one another. We say thank you. We understand that receiving a gift incurs a responsibility to give a gift in return. Gratitude is our first, but not our only gift. We are storytellers, music makers, devisers of ingenious machines, healers, scientists, and lovers of an Earth who asks that we give our gifts on behalf of life. The next step in our cultural evolution, if we are to persist as a species on this beautiful planet, is to expand our protocols for gratitude to the living Earth. Gratitude is most powerful as a response to the Earth because it provides an opening to reciprocity, to the act of giving back, to living in a way that the Earth will be grateful for us.

The Earth Asks That We Pay Attention

What does the Earth ask of us? In response to this question, I’ve heard from some that the Earth asks us nothing—that there is no possible voice in a collection of ecological processes. But I think that just means we’re not listening. How does she ask? She asks by modeling generosity in times of plenty, by reminding us of limits in times of scarcity. She asks us to learn through the consequences of our failures and through the examples of our non-human teachers, helping us imagine how we might live. But we have to listen.
Every one of us is endowed with the singular gift of paying attention—that remarkable focused convergence of our senses, our intellect, and our feeling. It’s so appropriate that we call it paying attention,for it is perhaps a near-universal form of currency—it is exchangeable, it is valuable, and it incurs an expense on the part of the payer, for attention, we all know too well, is a limited resource.
What should be our response to the generosity of the more-than-human world? In a world that gives us maple syrup, spotted salamanders, and sand hill cranes, shouldn’t we at least pay attention? Paying attention is an ongoing act of reciprocity, the gift that keeps on giving, in which attention generates wonder, which generates more attention—and more joy. Paying attention to the more-than-human world doesn’t lead only to amazement; it leads also to acknowledgment of pain. Open and attentive, we see and feel equally the beauty and the wounds, the old growth and the clear-cut, the mountain and the mine. Paying attention to suffering sharpens our ability to respond. To be responsible.
This, too, is a gift, for when we fall in love with the living world, we cannot be bystanders to its destruction. Attention becomes intention, which coalesces itself to action.
Deep attention calls us inevitably into deep relationship, as information and energy are exchanged between the observer and the observed, and neither partner in the exchange can be anonymous. They are known; they have names. There was a time, not so long ago, when to be human meant knowing the names of the beings with whom we cohabit the world. Knowing a name is the way we humans build relationship. It is a sign of respect to call a being by its name, and a sign of disrespect to ignore it.
Ethnobiologists tell us that our great-grandparents spoke fluent natural history. They knew the names and personalities of dozens of birds and hundreds of plants. Today the average American schoolchild can recognize more than a hundred corporate logos. They can give a name to about ten plants, and these include such categories as “Christmas Tree” and “Grass.” We have lost an entire vocabulary, of speech, of experience, and of relationship.Our fundamental currency of relationship, our highly evolved capacity for paying attention to those species who sustain us, has been subverted in a kind of intellectual hijacking. How can we care for them, monitor their well-being, and fight for their existence if we don’t even know their names?
We have enabled a state of nameless anonymity, bringing human people to a condition of isolation and disconnection, that philosophers have called “species loneliness.” Species loneliness—this deep, unnamed sadness—is the cost of estrangement from the rest of creation, from the loss of relationship. Our Potawatomi stories tell that a long time ago, when Turtle Island was young, the people and all the plants and animals spoke the same language and conversed freely with one another. But no more. As our dominance has grown, we have become more isolated, more lonely on the planet, and we can no longer call our neighbors by name. If we are to manifest the values of the Skywoman story, we have to once again call each other by name.
Knowing the beings with whom we share the world is also the pathway to recognition of the world as gift. The world seems less like a shopping bag of commodities and more like a gift when you know the one who gives you the aspirin for your headache. Her name is Willow; she lives up by the pond. She’s a neighbor to Maple, who offers you the gift of syrup on Sunday morning pancakes. Paying attention is a pathway to gratitude.
The Cherokee poet Marilou Awiakta has been listening. In her poem, “When the Earth Becomes an ‘It,’” she reports that Earth asks that we call her by name.
When the people call the Earth “Mother,”
They take with love
And with love give back
So that all may live.
When the people call Earth “it,”
They use her
Consume her strength. Then the people die.
Already the sun is hot
Out of season.
Our Mother’s breast
Is going dry.
She is taking all green
Into her heart
And will not turn back
Until we call her
By her name.
And in the absence of names, it all comes down to pronouns. Grammar is the way we chart relationships in language, and, as it happens, relationships with the living world. In English grammar, a being is either a person or a thing. We refer to our family and our fellow humans with the grammar of gendered personhood: we say “he” or “she.” To refer to a human being as “it” is deeply disrespectful; it robs one of personhood and kinship and reduces one to a thing. Yet in English, we are given no other way to refer to non-human beings. Understanding other beings as objects, as mere “its,” opens the door to exploitation. Linguistics code for our relationships with the world, delineating the boundaries for our circle of respect and compassion. When Maple is an “it,” we can take up the chainsaw. When Maple is a “her,” we have to think twice.
However, in our Potawatomi language and indeed many other indigenous languages, there is no “it” for birds or berries. The language does not divide the world into him and her, but into animate and inanimate. And the grammar of animacy is applied to all that lives: sturgeon, mayflies, blueberries, boulders, and rivers. We refer to other members of the living world with the same language that we use for our family. Because it is our family.
If we are to survive here—and if our neighbors are to survive, too—we need to learn to speak the grammar of animacy.

The Earth Calls Us to Recognize the Personhood of All Beings

The Skywoman story is grounded in the fundamental ethical tenet that the other beings with whom we share the planet—the ones who sustain us—are persons, too: non-human persons with their own ways of being, their own intentions, their own contributions to the world, their own rights to live. Science and spirituality both demonstrate the fundamental nature of our relatedness with all life forms: we are more the same than we are different. We are governed by the same ecological and evolutionary rules.
Reciprocity is rooted in the understanding that we are not alone—that the Earth is populated by non-human persons. How different our world would be if we extended the same respect and compassion and agency to other species as we do to human people. We tolerate governance that grants legal personhood and free speech to corporations, but that denies that respect to voiceless salamanders and sugar maples.
Reserving personhood for a single species, in language and in ways of living, perpetuates the fallacy of human exceptionalism, that we are fundamentally different and somehow better, more deserving of the wealth and services of the Earth than other species. Recognition of the personhood of other beings asks that we relinquish our perceived role as masters of the universe and celebrate our essential role as an equal member in the democracy of all species.

Potawatomi Territory 1650

Paying attention to other beings—recognizing their incredible gifts of photosynthesis, nitrogen fixation, migration, metamorphosis, and communication across miles—is humbling and leads inescapably to the understanding that we are surrounded by intelligences other than our own: beings who evolved here long before we did, and who have adapted innovative, remarkable ways of being that we might emulate, through intellectual biomimicry, for sustainability. We are surrounded by teachers and mentors who come dressed in foliage, fur, and feathers. There is comfort in their presence and guidance in their lessons.
Granting personhood to all beings can be an economic and political construct, as well as an ethical stance. Recognition of personhood for all beings opens the door to ecological justice. Our laws today are all about governing our rights to the land. The shift we need is to include the rights ofthe land: the rights to be whole and healthy; the right to exist. We can follow the lead of indigenous nations around the world: the Maori, who granted personhood to a river; the Ecuadorian constitution, which enshrines the rights of nature herself in the law of the land; and the Bolivians, who brought to the United Nations the Declaration on the Rights of Mother Nature.

The Earth Asks Us to Change

The Earth asks us to change as everything changes and evolves, like the flesh-tearing Allosaurus who became a warbler singing from the treetops when the time for flesh-tearing was over. For if we don’t change, we will, like all that does not change, perish.
The Earth herself is changing, by our hands. The responses from our government leaders to the “clear and present danger” of climate disruption have been wholly inadequate in scale, in urgency, and in imagination. The limited strategies advanced by politicians, economists, scientists, and engineers have a common theme. Most take the approach that to “solve the climate problem,” we must in some way change the environment. They propose wave turbines, ocean fertilization, seawalls, photoelectric paint, plants genetically modified to withstand a traumatic drought, and heaven forbid one more new kind of light bulb. We will no doubt need all the good new ideas we can get. But while we race around asking how we might change technology or tax structures, the change that might save us goes unspoken: what we need to change is ourselves. The danger is that we have been captured by a worldview that no longer serves our world, if it ever did—a worldview whose manifestation is destroying our beloved homelands, our fellow species, and ourselves. But all we can talk about is changing light bulbs.
I don’t think that it is more technology we need, or more money or more data. We need a change in heart, a change in ethics, away from an anthropocentric worldview that considers the Earth our exploitable property to a biocentric, life-centered worldview in which an ethic of respect and reciprocity can grow.
The philosopher Joanna Macy has called this “The Great Turning”—the essential adventure of our time, shifting from the age of industrial growth to the age of life-sustaining civilization. Her work and the work of countless others describe the accelerating momentum of the transition already in progress, in acts large and small, as humans reclaim an ancient way of knowing in which human life is aligned with ecological processes, not against them. The question is, will the circle turn in time to save us? That’s up to us.
We don’t have to invent this; it’s something we already know. From the time of Skywoman, we have lived this way before—and well. I’ve heard the elders say all we must do is “remember to remember.”
Scientists are deep in a debate about whether to recognize the end of the Holocene—the aptly named “Recent Era”—and declare that we live in a wholly new geologic era, the Anthropocene—the Era of Man. The proposed designation would recognize that humans, not “natural” forces, are the dominant force on the planet today—the major influence on the atmosphere, biogeochemical cycles, and even the evolutionary destinies of species. It is, of course, undeniable that the human species has caused great disruption—indeed, of geologic proportion. But to declare the Age of the Anthropocene smacks of the terrible arrogance that got us into this predicament, which is embodied in Stewart Brand’s famous quote, “We are as gods and might as well get good at it.” It is a fatal error to think that we are in charge; the instructive myths of most every culture hold that lesson. If we don’t remember that, I’m sure that the viruses will be happy to remind us.
I don’t believe that we are entering the Anthropocene, but that we are living in a transient period of profoundly painful error and correction on our way to a humbler consideration of ourselves. In the geologic scope of things, the Industrial Revolution that fueled the expansion of the exploitative, mechanistic worldview was only an eye blink ago. For eons before that, there was a long time on this planet when humans lived well, in relative homeostasis with biotic processes, embodying a worldview of reciprocity that was simultaneously material and spiritual. There was a time when we considered ourselves the “younger brothers of creation,” not the masters of the universe. Our current adversarial relationship with the rest of the living world is not necessarily all that we are as a species. We are a species that can learn from the global mistakes we are making. We have stories to help us remember a different past and imaginations to help us find the new path. We are a species who can change.

The Earth Calls Us to Reciprocity

What does the Earth ask of us? To meet our responsibilities and to give our gifts. Naming responsibility is often understood as accepting a burden, but in the teachings of my ancestors, responsibilities and gifts are understood as two sides of the same coin. The possession of a gift is coupled with a duty to use it for the benefit of all. A thrush is given the gift of song, and so has a responsibility to greet the day with music, which is in turn received as a gift to us as we watch the sky grow pink with dawn. Salmon have the gift of travel, so they accept the duty of carrying food upriver. The stars were given the gift of sparkle, coupled with the responsibility of guiding us at night. So when we ask ourselves, what is our responsibility to the Earth, we are also asking “What is our gift?”
As human people, most recently evolved here, we lack the gifts of our companion species: of nitrogen fixation, pollination, and three-thousand-mile migrations under magnetic guidance. We can’t even photosynthesize. But we carry gifts of our own that the Earth urgently needs.
Reciprocity—returning the gift—is not just good manners; it is how the biophysical world works. Balance in ecological systems arises from negative feedback loops, from cycles of giving and taking: living and dying, production and consumption, biogeochemical cycles, water to cloud and back to water again. Reciprocity among parts of the living Earth produces equilibrium in which life as we know it can flourish. Positive feedback loops—in which interactions spur one another away from balance—produce radical change, often to a point of no return. We must understand that we, like every other successful organism, must play by the rules that govern ecosystem function. The laws of thermodynamics have not been suspended on our behalf. Unlimited growth is not possible. In a finite world you cannot relentlessly take without replenishment.
How can we reciprocate the gifts of the Earth? In gratitude, in ceremony, through acts of practical reverence and land stewardship, in fierce defense of the beings and places we love, in art, in science, in song, in gardens, in children, in ballots, in stories of renewal, in creative resistance, in how we spend our money and our precious lives, by refusing to be complicit with the forces of ecological destruction. In healing.
Ecological restoration is an act of reciprocity, and the Earth asks us to turn our gifts to healing the damage we have done. The Earth-shaping prowess that we thoughtlessly use to sicken the land can be used to heal it. It is not just the land that is broken, but our relationship with land. We can be partners in renewal; we can be medicine for the Earth.
If our leaders don’t lead then we have to. If all our leaders ask is that we are quietly complicit with destruction, we say we are a better species than that. All over Turtle Island people are rising up to reclaim their roles as caregivers for the Earth, to be more than consumers, to be givers.
We humans carry gifts of our own; we are scientists and storytellers. We are change-makers; we are Earth-shapers riding on the back of the turtle. We can remember the covenant of reciprocity, seeking what Onondaga Clan Mother Audrey Shenandoah called “Justice not only for ourselves, but justice for all of Creation.”
Robin Wall Kimmerer
Distinguished Teaching Professor of Environmental Biology - SUNY
Dr. Robin Wall Kimmerer is a mother, scientist, writer, and Distinguished Teaching Professor of Environmental Biology at the SUNY College of Environmental Science and Forestry in Syracuse, New York. Kimmerer is an enrolled member of the Citizen Band Potawatomi. She lives on an old farm in upstate New York, tending gardens both cultivated and wild.

Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy

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Contributed equally
BMC Complementary and Alternative Medicine201818:311
  • Received: 10 October 2017
  • Accepted: 5 November 2018
  • Published: 
Open Peer Review reports



Neural Therapy (NT) is a common complementary treatment approach using injections with short-acting local anesthetics to treat pain and chronic diseases. However, little is known about the underlying mechanisms and the domains of treatment response. This study therefore analyzed patient experiences following NT injections with procaine.


Maximum variation sampling was used to collect data from semi-structured interviews conducted with 22 hospital inpatients aged 59.6 ± 14.9 years (81.8% female). Each had multiple (9.4 ± 6.9) diagnoses. They were undergoing two weeks of integrative treatment, which included individualized NT. The interview data were analyzed in MAXQDA using qualitative content analysis.


With injection, patients first described local anesthetic effects including temporary blocking of pain and increased local warmth. Second, patients reported on vegetative reactions frequently leading to turmoil within the body like initial aggravation of existing symptoms or the appearance of new, concealed or phantom symptoms. This often required the need for rest to deal with the treatment stimulus. As a third step, many patients could gain physical and emotional release and relief in symptoms, mood and functioning. Emotional release was often accompanied by weeping and initially overwhelmed affected patients with dissociated memories. However, in cases where patients were able to experience those memories with a new distance, a fourth step of integration was achievable. It included reframing processes as well as a gain in pain perception and body-awareness. As a possible fifth step, patients experienced improved mood, increased pain acceptance and empowerment. Adverse events of NT included pain from the injections, vegetative complaints and emotional turmoil that lasted for minutes or hours, with a maximum of two days.


Patients treated with procaine injections reported different psychophysiological outcomes contributing to the understanding of the mechanisms underlying NT. Further efficacy studies should separate specific NT from non-specific/placebo effects.

Trial registration


  • Neural therapy
  • Procaine
  • Chronic Disease
  • Body Image
  • Emotions
  • Qualitative Research


Neural Therapy (NT) uses injections of short-acting local anesthetics (mainly procaine) for diagnosis and treatment of chronic pain conditions and functional diseases [1]. According to Huneke, NT is classified into three main approaches. Firstly, local treatment techniques administer procaine directly or close to affected structures (e.g. infiltration into myofascial trigger points). Secondly, segmental techniques deliver procaine to structures innervated by the same spinal segment as the symptomatic area (e.g. dermatome quaddels, injections at muscles, joints and ganglia). Finally, interference field techniques infiltrate procaine into areas of subclinical chronic inflammation (often located in scars, fractures, teeth, sinuses and intestines) outside the respective anatomical segment [2345]. The effects of treating interference fields were first described in 1940 in a patient with arthritic scapular pain, which directly decreased after procaine infiltration in an osteomyelitic leg scar, outlasting the duration of any expected pharmacological effect [36]. NT is not only used for its potency in nerve-blocking effects, but also for its anti-inflammatory effects, which are believed to systematically modulate neuroplastic processes of peripheral sensitization, post-synaptic long-term potentiation, and pathological dysfunctions of the autonomic nervous system [78]. Typical indications include chronic pain conditions, gastrointestinal disorders, rheumatoid and inflammatory diseases and functional cardiovascular syndromes. Contraindications are allergies to local anesthetics, coagulopathy, anticoagulation, and dermal infections. NT is widely used in Europe [910], in Central and South America and the United States – sometimes being referred to as “nerve blocks” causing “regional anesthesia” [1].
Research into NT is limited. A 2005 Health Technology Assessment revealed evidence from case series and retrospective cohort data showing symptom improvement in up to 80% of 3812 treated patients, and preliminary data on cost-effectiveness in ambulatory care [11]. Further prospective observational trials showed effects of NT on subacute and chronic pain outcomes [12131415], impaired circulation [16], and safety of the applied injection techniques [1718]. Despite this, little is known about the underlying mechanisms of NT or the domains of treatment responses. In preparation for randomized controlled trials, this study aimed to investigate the effects and side effects of NT as perceived by chronically ill patients treated in the context of an internal and integrative medicine inpatient unit.


This study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [19].

Study design

The study was designed as a single center, qualitative interview study with post-intervention assessment. Prior to patient recruitment, the research protocol was approved by the Ethics Committee of the University of Duisburg-Essen, Germany (12–5208-BO), and registered at the WHO International Clinical Trials Registry Platform/German Clinical Trials Register (DRKS00004567). The study was conducted between November 2012 and November 2014 at the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany.


Maximum variation sampling was used [20] to generate a heterogeneous sample of patients of different ages and sexes who reported varied effects from NT. Sample size was calculated up to 30 patients, with the intent of stopping recruitment when the interview data became saturated. Patients were invited to join the study by their treating physician, if they matched the following eligibility criteria: were aged 18 years or above, were being treated with NT during their inpatient treatment at the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, were German-speaking, and were willing to give their written informed consent for participation and publication of anonymized quotes. Patients were excluded in cases of severe comorbid mental illness or severe neurological disease.


During the two-week inpatient stay, patients received individualized integrative treatment including conventional as well as complementary therapies [21]. If indicated, NT was applied using a combination of local, segmental and interference field techniques with a maximum single dose of 25–30 ml of 1% procaine solution. The procaine injections were administrated in accordance with the patient diagnosis and reported symptoms and repeated as necessary [1]. All study treatments were performed by a male physician (FJS) with 18 years of experiences in the treatment and teaching of NT.

Data assessment

The researchers used semi-structured interviews to collect the study data. The interview guide developed by the research group (HH, FJS, BB, KEC) was piloted with three patients receiving the described study treatment. The guide’s final version included both general and more detailed questions about the patients’ treatment expectations, their physical and psychological responses to the NT, the effects on quality of life, and treatment safety (Additional file 1). Further open-ended questions on each of the above topics could be used if necessary. The study interviews were conducted face-to-face by two female psychologists (HH, KEC), both of whom had advanced training in qualitative research methods. Neither of the interviewers were involved in delivering the study treatments. Each interview started by introducing the interviewer and outlining their reasons for engaging in the research explaining the study’s aims. The interviews lasted on average 19.5 min, generating a total of 7.13 h of data. All interviews were audio-recorded, professionally transcribed verbatim and pseudonymized. The interviewers’ field notes and patient diagnoses were then added to the pseudonymized transcripts.

Data analysis

The interviews with the original German language text were coded independently by two pairs of coders (AK, BE and HH, KEC) using MAXQDA software (Version 11.0.9, VERBI). The resulting codes were summarized to minor and major themes and paraphrased by an interdisciplinary group consisting of a physician (FJS), two medical students (AK, BE), two psychologists (HH, KEC), and a cultural scientist (BB) using inductive qualitative content analysis techniques [22]. Respective patient quotes were identified using the patient study number and the number of the paragraph within each transcript. For publication purposes, selected quotes were professionally translated into English.


Sample characteristics

The final study sample consisted of 22 inpatients (81.8% female) aged 59.6 ± 14.9 years. No patient refused to participate or withdrew consent for any reason. Most patients had multiple morbidities, with an average of 9.4 ± 6.9 diagnoses each. The main conditions for which they were receiving treatment included polyarthritis, osteoarthritis, spondylosis, radiculitis, fibromyalgia, chronic neck pain, tension headaches and migraine, irritable bowel syndrome, sinusitis, fatigue, recurrent depressive episodes and pain after surgery for metastatic breast cancer. During their inpatient stay, patients received on average 1.32 ± 0.95 NT treatments. Individual treatment characteristics can be found in the Additional file 2.

Qualitative content analysis

The qualitative data analysis process, described above, generated 278 codes, grouped hierarchically under 5 major and 19 minor themes (Table 1):
Table 1
Major and minor themes derived from the qualitative content analysis
Major themes
Minor themes
1. Expectations and premises
Hopes and fears
Safe and trustworthy setting
2. Local and systemic bodily responses
Immediate anesthetic effects
Vegetative responses
Need for rest
Initial symptom aggravation
Pain and symptom alleviation
Reintegrated body image and increased awareness
Improvement in daily functioning
3. Emotional release and contentment
Emotional release reactions
Integration of dissociated memories
Cognitive reframing
Bodily responses
Improved mood and enjoyment of life
Retrieving personal agency
4. Adverse events
Pain from the injection
Vegetative complaints
Emotional turmoil
5. Patients’ conclusions
Significance of the treatment effects

Theme 1: Expectations and premises

Hopes and fears

Patients reported hope of improvement as well as attitudes of ‘wait and see’ and ‘nothing to lose’. Several patients also emphasize fears about injections and possible treatment side effects.
- “I considered this as a chance. I thought: What do I have to lose? I have nothing to lose.” (13|58)
- “I was really worried. I don’t want to leave this hospital in a wheelchair, I told the doctor. But he reassured me and I’m very thankful that I could ask all of my questions.” (10|62)

Safe and trustworthy setting

Patients stated a trustful relation to the doctor as most important to feel safe and engage in the invasive NT treatment.
- “You need trust. I would not allow anyone to use such long needles on such sensitive body parts.” (20|93)
- “The safe environment here, which I did not have outside, to allow yourself to fall.” (05|110)

Theme 2: Local and systemic bodily responses

Immediate anesthetic effects

Following the injections, patients described a number of local anesthetic effects, including the disappearance of pain, sensations of diffuse pressure and improved circulation adjacent the treated vessels.
- “Well, you feel a little prick and later on a diffuse feeling of pressure.” (10|44)
- “My pain was suddenly blown away. […] And it became warm, right up to the knee. And the next time, right up to the foot.” (16|43–46)

Vegetative responses

Patients frequently reported a range of vagotonic/sympathicolytic reactions following their NT. These included nausea and dizziness, as well as more pleasant feelings of relaxation, ease, inner peace and emptiness. Some patients noted that the latter reminded them of the altered states of consciousness that they have experienced during meditation. On a physical level, patients also described sensations of body warmth and surprising changes to their nasal secretion, urination and menstruation.
- “I got a little dizzy at first, but only for a short while, then I felt warmth spreading out into my feet. A very comfortable feeling.” (14|42)
- “This was such an exhilarating feeling. There was nothing: you felt nothing, you thought nothing, nothing at all.” (13|30)
- “As if I was on a beautiful cloud. Such a calm, content and decelerated feeling. [...] I was very close to myself, very focused. The view goes deeply inwards. Similar to what happens when I practice Yoga.” (20|41,45)
- “During the injection, I noticed that my eyes were welling up and that my nose was running. That did not happen for the last 20 years! I was so happy at having a runny nose.” (07|47)
- “I had to go to the toilet about five times that night, passing water.” (17|56)
- “My periods started, which shouldn’t actually be possible, because I haven’t had any periods since I got my coil put in, two years ago.” (21|66)

Need for rest

Some patients found their NT treatments exhausting, both physically and mentally, at times requesting additional time to deal with the treatment stimulus.
- “Afterwards, I felt so tired but in a good mood because something was moving.”(03|55)
- “I wanted to be alone. Walking through the park. That made me feel good.” (22|65)

Initial symptom aggravation

In addition to the above, some patients found that the NT treatment led to a temporary aggravation of their existing symptoms or the appearance of new, concealed or phantom symptoms; the latter were usually seen as harmless systemic responses.
- “My upper back has improved but the pain of my lower back has increased.” (19|91)
- “And then, the teeth that I had had taken out started to hurt. [...] Isn’t that a sign that my whole body responded?!” (14|42,52)

Pain and symptom alleviation

Patients cited pain relief as the main effect of NT, alongside a softening of their scar tissue and a decrease in their muscle tension. Patients reported that most of their other conditions also improved post-treatment although, for some, this relief was brief.
- “At times, I had pain everywhere in my body. Every step hurt. And all of a sudden I can walk without any pain in my legs. So far, the pain has not returned. I am totally excited.” (21|64)
- “I have had more solid bowel movements for two days now. This is a very rapid success, considering that I’ve had severe, debilitating diarrhea for nearly nine months.” (20|73)
- “The next morning I thought: My hands - nothing hurts! I wasn’t sure; was that a dream? Was it real? How long would it last? Would it be gone by tomorrow? But it lasted until today. […] I still have pain in my back, although I’ve had two injections right here, but the tingling in my legs, the electrical ‘prickling’, is gone.” (13|34–38)

Reintegrated body image and increased bodily awareness

Patients reported that their treatments had led them to regain sensitivity in parts of their bodies that had previously been impaired, describing the treated areas as generally more ‘vivid’. Their treatment also helped them to reintegrate parts of their bodies from which they had formerly felt alienated so that they felt more ‘whole’ again. These outcomes enhanced the patients’ bodily awareness, increasing their confidence in their personal feelings and intuitions.
- “My foot was limp. You gave a try, you tried to move the foot, but nothing happened. And, at the moment that I had the injection, it felt as if life re-entered my foot.” (18|99)
- “When the arthritis worsened, and got more painful, I felt as if my leg didn’t belong to me. Like a foreign object, a peg leg. And after the injection, my leg felt more vivid. It was mine. […] It’s great, growing back together again.” (16|45,97)
- “That supports me in listening even more to my gut feelings. [...] And I believe that I might be able to get much closer to my inner self, and trust more in what I really feel.” (20|67)

Improvement in daily functioning

Improving symptoms made patients feel notably younger. Many voiced excitement that their horizons have now broadened, in terms of their mobility and daily functioning; this occurred often after a long history of illness and suffering.
- “When you’ve got so many different places that hurt, you feel like you’re in a vice. As if my body was eighty years old. [...]. Now, I feel considerably younger!” (18|137)
- “Afterwards, I felt as if I’d been in the fountain of youth [...]. And all the others said: Wow! You’re looking really great!” (03|63)
- “Joy! Joy! […] I didn’t need my crutches anymore! I can’t believe it, after three and a half years!” (04|83)
- “I’ve been discharged from medical rehabilitation, due to pain, and unable to work. Now, I have the courage to say, okay, I can imagine working for eight hours.” (13|50)

Theme 3: Emotional release and contentment

Emotional release reactions

Seven patients found that their injections triggered memories, overwhelming them with suppressed emotions. They reported recalling images at a high frame rate, experiencing them as uncontrollable and/or initially confusing; at times this was accompanied by shivering or nausea. All of these patients did not evaluate the release of emotions as frightening, but rather as a relief.
- “Images flashed through my head, from right to left. I felt pretty confused.” (06|50)
- “The injection made me think ‘I have to surrender’. I’ve had such a lump in my throat. […] And then, like a tornado, like a volcano, ‘I have to cry’. I’ve only ever seen pictures of my father. He died 49 years ago. I never said goodbye to him.” (02|40,56)
- “When I got the injection, it all spouted out of me. Suddenly, I saw images, memories resurfaced, I started to cry bitterly, I shivered. [...] I couldn’t control it at all. All those emotions came up to the surface again. I’m glad that it happened, because now it’s gone. It wasn’t threatening; in fact it was a relief.” (21|24,65)

Integration of dissociated memories

Allowing post-treatment emotional release enabled many patients to see their personal memories from an increased distance, helping them to reevaluate and reintegrate their memories into new emotional contexts. This led patients to better acceptance and reconciliation of their personal history.
- “And then I could allow that, tick, tick, tick, images from my memory popped up, like in a movie. I went through my entire tonsillectomy again. But this time, I saw the scene more as if from above. At the end, I felt that it was okay. […] That’s the way it happened. It wasn’t as frightening as the real surgery.” (01|52–54)
- “Well, it was like a film running backwards. Like watching your life in reverse. [...] It was very realistic, or maybe not realistic, but like a critical view of something that you can’t change, anyway.” (03|135–137)

Cognitive reframing

The new associations that patients made between their memories and emotions led them to understand the context and function of their illnesses in greater depth.
- “I only knew that I had this deep sadness inside, which I couldn’t identify. I thought that I would’ve processed the miscarriage; that I could deal with it, but that wasn’t true. That wasn’t obvious to me. Not at all.” (21|34)

Bodily responses

Some patients linked their emotional release directly to improvements in their physical symptoms and body perception.
- “When I got the injection, suddenly, the images came back, everything that happened that day. All the feelings came back. […] And I cried, bitterly, until it stopped. And the next day, I felt such a release, as if a belt around my heart has split. […] I feel like I can breathe again, that the sadness is gone. With one treatment! And the pain in my hands has decreased. And the pain in my shoulders as well.” (21|28)

Improved mood and enjoyment of life

Other patients did not report emotional release during their NT treatment, but found themselves feeling surprisingly happy and lighthearted, when it had finished. Reductions in their pain levels also led to a growing confidence and a new enjoyment of life after the lengthy periods that many had spent fighting against illness.
- “The next morning I woke up and thought that something is different. Although the weather was actually cloudy, to me all the world seemed bright.” (11|27)
- “I feel physically and mentally relieved. It’s really depressing having pain all the time, but you don’t want give up. You tackle the problem, but it’s always a struggle, a fight. And now, there’s less fighting and that’s great.” (06|120)

Retrieving personal agency

Some patients also reported on increased feelings of personal control over their everyday lives, increased engagement in active decision-making and greater feelings of empowerment and autonomy.
- “Before the therapy, I cried a lot, because nothing seemed to work anymore. Now, I feel stronger, because the load is gone, this burdensome situation.” (19|77)
- “I looked back carefully, once again, and decided to finish the whole thing off. It was so many years ago. This might be a new beginning for me.” (03|105)

Theme 4: Adverse events

Pain from the injection

The main adverse event that patients experienced was pain at the time of their injections. They generally tolerated this because they expected the injections to improve their symptoms.
- “The initial prick hurts and it continues to hurt until the needle has found its position. Then, the injection of the procaine causes a feeling of pressure. Sometimes I need to say ‘Stop - slower, please’, until the anesthesia occurs. Then it’s okay. That’s always a challenge.” (20|31)

Vegetative complaints

Other adverse events included vertigo, hot flashes, tiredness, headaches and exhaustion. Most of these outcomes were gone within minutes or hours, although some lasted for up to two days.
- “And then I just felt sick. I thought I have to throw up. I felt dizzy.” (02|38)
- “During the injection, I had hot flashes, which disappeared quickly. [...] Afterwards, I did feel quite exhausted, and sometimes a bit dazed, the closer the injections got to my head.”(19|35,27)

Emotional turmoil

Some patients reported nightmares, the need to cry and/or the relive of previously traumatic events. These events unexpectedly faded away as quickly as they came.
- “I had nightmares, really bad nightmares. But they stopped as suddenly as they appeared.” (06|104)
- “These memories appeared more frequently over the course of the next day and the next afternoon. They were quite intense.” (05|67)

Theme 5: Patients’ conclusions

Significance of the treatment effects

Most patients reported a temporary or sustained reduction in their symptoms, with many experiencing emotional relief and improved well-being. Three of the study patients said that NT had no effect on their pain intensity and two others that it did not affect their mood.
Patients attributed a range of local and systemic effects directly to their NT treatment. The integrative inpatient treatment setting also was perceived as supportive. Most patients reported that, based on their current experiences of NT, they would use it again.
- “Quality of life. Absolutely! Before the Neural Therapy, I managed my life alongside the pain. You took more pills, you took part, also laughed with other people, but you were strained all the time. Now my pain has got less, I’ve realized how relieved I am and how great it is.” (06|118)
- “When the pain in my knee cartilage reappeared, I was very disappointed.” (16|107)
- “[There was] no mood brightening, or anything like that. It was all quite normal.” (10|65)
- “Here, Neural Therapy is embedded in a larger concept. This has led to more stability. Together with other tools that I use, I think, this has led to a more long-lasting effect.” (16|62)
- “If I feel worse again, I would consider using Neural Therapy again.” (13|66)


Summary of evidence

Patients treated with NT reported local anesthetic effects and systemic bodily responses resulting in the reduction of their pain and other symptoms, feelings of emotional release/relief and improvements in their general well-being in most cases. They perceived the treated areas generally as more vivid and better reintegrated into their body image. Improvements in daily functioning made patients feeling younger and enhanced their quality of life. NT injections also triggered states of altered consciousness, sometimes accompanied by the emergence of memories and the release of emotions. These processes of recall and release enabled patients to view their memories more from a perspective of a distant observer, helping them to reevaluate and reintegrate their memories into a new emotional context. This outcome led to emotional relief, cognitive reframing, pain reduction and a sense of empowerment. Other patients did not report distinct emotional events, but were surprised by post-treatment feelings of happiness, confidence and regained enjoyment of life. Adverse events included pain due to the injections, vegetative complaints and emotional turmoil that generally lasted for minutes or hours with a maximum of two days. In relation to the desired treatment effects, patients assessed these side effects as negligible.

A theory of action

The above findings contribute to a deeper understanding of the mechanisms underpinning NT. They suggest that health improvement may be theorized as a process consisting of the following steps:
  1. (1)
    Temporary Block: Local anesthetics temporarily block pain transmission that patients perceive as the immediate disappearance of their pain [7]; this often induce euphoric states that patients describe variously as eased, spaced-out or dazed.
  2. (2)
    Turmoil: Besides interrupting the pain, NT appears to stimulate responses of the autonomic nervous system, frequently leading to turmoil within the body. Study patients described sensations of dizziness at this stage, and the need to rest in order to deal with the treatment stimulus. Their existing symptoms could be temporarily aggravated and new or phantom symptoms could occur. NT theory generally views such sensations as positive treatment responses. Reverse/reaction phenomena, for example, are defined as the worsening of treated symptoms shortly after segmental injection [23]. Other complementary therapies have also been found to worsen patient symptoms initially [242526]. Retrograde phenomena flowing segmental treatment, on the other hand, are defined as the development of pain in a related interference field that had previously been clinically silent [1]. This may explain the report of new symptoms not apparently linked to their primary pain. Turmoil of emotions, moreover, was reported by several patients, seemingly associated with injections into scar tissue. Such reactions are also known from the application of manual treatments like massage or Craniosacral Therapy [2427]. Emotions were partly linked to former stressful life events, in which patients had to fight or freeze and were unable to express their emotions. Such experiences can lead to a chronically increased sympathetic tone and muscle tension whilst the emotional load subsides [28]. Later relaxation of the tissue tension, in reverse, can lead the suppressed emotions to resurface, triggered by the somatic markers with which they are still associated [2829].
  3. (3)
    Release and Relief: Subsequent to the experience of turmoil, which seemed to be a sufficient but not a necessary condition, patients could perceive physical and emotional release as well as relief in symptoms, mood and improved daily functioning. On a bio-physiological level, this link is explainable by the pharmacology of local anesthetics. Beside the reversible block of voltage-gated Na+-channels, procaine is known to modulate the inflammatory response and sympathetic nervous system activity by reducing the secretion of proinflammatory cytokines, inhibiting the signal transduction via G-protein coupled receptors and muscarinic m1/m3 receptors [303132], and enhancing local endocannabinoid levels by inhibiting fatty acid amide hydrolase expression [33]. This increases local perfusion and relieves tension within the fascial and muscle tissue. The benefits of emotional release might be explained by Porges’ Polyvagal Theory. In addition to fighting and freezing reactions, which are mediated by the sympathetic and parasympathetic (unmyelinated dorsal vagus) nervous system, Porges hypothesizes that a second parasympathetic mode (myelinated ventral vagus) fosters oxytocin secretion, social communication, self-soothing/calming, and inhibits sympathetic-adrenal arousal in safe environments [34]. Research findings for manual therapies [3536] and acupuncture [37] may also apply to NT that may similarly increase vagal activity and activate the amygdala, hypothalamus and anterior cingulate cortex, which are regions known to regulate stress and emotion. Generating a safe therapeutic environment also seems to make a difference between emotional reorganization and retraumatization [38].
  4. (4)
    Integration: Symptom relief can lead to consolidation and integration mechanisms, which may include improvements in pain perception and body/self-awareness [39] as well as the reintegration and reevaluation of dissociated memories and disease beliefs [40]. Both basic [41] and clinical research [42] agree that patients often have to revisit the emotionally distressing memory trace, allow the physiological arousal and following relaxation, before they can reevaluate and reintegrate their memories.
  5. (5)
    Empowerment: As a result of their NT treatments, the study patients reported that they felt empowered and better prepared to engage in a more active life.


This study has a number of potential limitations. Firstly, the inpatient setting might limit the generalizability of the findings. Although only quotes that referred clearly to NT were entered into the qualitative content analysis, it remains possible that study outcomes are not solely due to NT treatment but are due to combination with other inpatient treatments. Secondly, the study data were collected from participants during their inpatient stay. Thus, the data only reflect experiences and perceptions immediately after or a few days after their NT treatments. Questions about the possible persistence of any of the observed changes must therefore remain unanswered. Finally, it should be noted that conclusions drawn from qualitative data, even if maximum variation sampling was used, are neither representative nor reveal causal relations, as we could not control for placebo and non-specific treatment effects.

Implications for further research

Further studies should address the link between emotional release and physical relief phenomena. In addition, it should be investigated whether the observed effects are specific to NT in contrast to sham (efficacy research) or similar to other complementary or psychological treatment techniques (comparative effectiveness) [43]. Qualitative designs as well as rigorous randomized controlled trials with adequate sample sizes and standardized outcome measures are necessary; these should not be limited to a physical symptom level but include tools to quantify effects of release, integration and empowerment as well.


Patients treated with procaine injections reported different psychophysiological outcomes ranging from improvements in pain and chronic symptoms to enhanced daily functioning and mental quality of life. In cases where usual or local treatment approaches are not effective, expanded segmental and interference field techniques might offer a promising treatment option. Further quantitative trials should answer the question whether the observed effects are specific to NT or a consequence of unspecific mechanisms associated with the patients’ expectations, therapist attention, or other setting conditions.




The authors would like to thank the members of the doctoral qualitative research group of the University Witten/Herdecke, under the direction of Dr. Bettina Berger, who also has contributed substantially to the study’s qualitative data analysis.


The study was supported by a research grant from the German Society of Acupuncture and Neural Therapy (DGfAN), Germany. The funding source had no influence on the design of the study; the collection, analysis, or interpretation of the study data; or the preparation or approval of this manuscript.

Availability of data and materials

The datasets analyzed during the current study are not publicly available due including personal information but are available from the corresponding author on reasonable request.

Authors’ contributions

HH was responsible for the conception and design of the study, the collection and analysis of the study data and for drafting the manuscript. FJS was responsible for the performance of the study intervention, participated in the conception and design of the study and the analysis of the study data, and critically revised the manuscript. AK, BE and DA participated in the analysis of the study data and critically revised the manuscript. GD participated in the conception and design of the study, and critically revised the manuscript. BB participated in the conception and design of the study, the analysis of the data, and critically revised the manuscript. KEC was responsible for conception and design of the study, and participated in the collection and analysis of the data, and drafting of the study manuscript. All authors approved the final manuscript.

Ethics approval and consent to participate

The study protocol was developed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University of Duisburg-Essen, Germany (Approval number: 12–5208-BO). All participants gave their written informed consent before they were included in the study.

Consent for publication

All participants gave their consent for the publication of the anonymized quotes.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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