The Banal Greeting: Fine, Thanks, How Are You?

“How are you?” is the question we use, rather than ask, as a banal greeting, rarely expecting a precisely truthful response in lieu of the usual “Fine, thanks, how are you?” We may be “fine” in that we and our loved ones are in good enough health, and that no crisis has occurred here and now to disrupt our family, our work, and our usual sense of who we are.

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But in fact, “fine” doesn’t describe much. Even when our health is broadly good, even at the best of times when outer circumstances are calm, how we are is never that simple to define. Our moods and feelings fluctuate. Most of us know what it is like to feel the fine gradations of an ill-defined unease, persistent anxiety, an undercurrent of blues or mild depression, or even an overarching feeling of despair. The pandemic - an outer crisis of gigantic proportions - has certainly increased these feelings, just as war, geopolitical and political tensions, and the growing threat to planetary sustainability are creating a state of collective anxiety that (for those who don’t deny this reality) somehow remains the inescapable backdrop of whatever “I am fine” responses one can muster.

There is no clear-cutting point that indicates when common ill feelings of the psyche become pathologies, when such unease becomes disease. The definitions of pathologies characteristic of what one calls “mental illness” fluctuate along with assumptions and knowledge about how the mind works. There are times when psychological support is welcome however well we are otherwise functioning. And then, there are times when such help becomes actually necessary to function at all, when unease does become debilitating disease – when our ordinary inner order becomes a disorder, one that one hopes can be named, tamed, and treated.

What is actually going wrong when we feel lousy is an aspect of what goes right when we truthfully say “I’m fine”. At any given moment, we consciously and unconsciously keep tabs on and update our inner state, which is made up of signals from within the body and all its systems – visceral, cardiovascular, reproductive, and so on. This sense of the organism’s inner states is called interoception, defined by a group of scientists researching it as “the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels”. And it is an output of the constant, so-called homeostatic and allostatic adjustments that ensure the optimal stability of our organism within a constantly changing environment. Physiological processes of great complexity are at work in the background of how we feel. These processes become manifest in the form of felt emotions, but they themselves are not transparent. We may feel our heartbeat before giving a talk, our stomachs churn upon hearing bad news, and our mouths dry up when put on the spot. But our awareness does not extend further, nor could it, since awareness itself is, in a crucial sense, an output of these very processes. Then there are those longer-term states - anxiety, depression and various mood disorders, PTSD, states of depersonalization and derealization, eating and body image disorders, chronic pain, and many more. They too are outputs of processes we do not see whose dysfunctions can wreak havoc on daily life.

Over the past two decades or so, research on interoception has grown tremendously. It takes as a starting point an assumption about the mind that was not always, and indeed is not everywhere a given. That one cannot understand the mind without looking at the body. That the mind isn’t reducible to the brain because neurological processes are in constant interaction with the body’s other processes and the brain itself with its other organs, notably the heart and gut. And that the felt emotions that are constantly at work under and upon our skin are the dynamic output of this embodied mind determining, in turn, our very sense of self. “How I am”, as well as “who I am”, depend on these loops, which are not centered on the self so much as played out within the environment and in constant interaction with other people. The ability to understand others depends on the ability to sense ourselves. The self on its own is a chimera. After all, we start off within the body of our mother, we are raised by carers, and brought into a world of shared languages and cultures. By dint of our very existence, we need others to live, love, and thrive. And it is to others that we transmit parts of ourselves once we are dead: in many ways, we all live inside each other.

When the processes that sustain our inner coherence go awry, what is also going wrong is the ability to live, love, and thrive. At the heart of these difficulties, there may lie a dysfunction of the processes by which we feel our body to be ours – the sense of body ownership – and by which we feel this embodied self to be well ensconced within the environment, as an agent in relation to other agents. A depressed person wants to hide away, duck, and sever connections with others. The foundations of the self feel upturned – and when its coherence is in jeopardy, as it is then, there is a strange dislocation from the temporality we share with others at the times when we truly feel fine. At all times, the brain serves the body by predicting its states and correcting its prediction errors - to use the model of predictive processing according to which perceptual and sensorial experience is constituted of the brain’s predictions of inputs derived from previous somatosensory experience: the mismatches between prediction and actual input is called a “prediction error”, which must then be corrected by the organism’s homeostatic mechanism of allostatic, that is, predictive adjustment to allow for its optimal thriving within the changing world. When the adjustments don’t happen, then there is ill-health. Chronic pain, for one, can be understood as a dysfunction of the interpretation and integration of the sensory and somatosensory signals that usually sustain our body representations, all of which are entwined with emotional states.

It is clinically hard to find access to these complex knots, precisely because they pertain to intertwined somatic and affective processes. But because it is the very mechanisms at work in ensuring our temporal and self-coherence that are centrally (though not exclusively) involved in so many ailments, techniques that target these mechanisms are a line of possible treatment for them. Interoception training can help alleviate anxiety, as has been shown by neuroscientist Sarah Garfinkel, or chronic pain, as has shown by a team in Milan. Affective touch has been shown, notably by Katerina Fotopoulou and her team, to play a crucial role in the stabilisation of affect by directly regulating interoceptive inference about the world. There are attempts at developing sound feedback to help develop interoceptive awareness.

Such tools are not yet central within the clinical community of psychiatrists and neurologists. A lot of work indeed needs to be done for the notion of the brain-body unity to become mainstream, even though millions of people seek it via yoga in various forms – and yoga, which focuses on interoceptive awareness, can have real effects on the embodied psyche. It would be enriching to bring insights from the mat to experimental psychology, whose rich findings are all the more needed in a world where collective anxiety is rife. There are always reasons to not feel so fine. But there are ways of making do, and of finding serenity.