On 14th August 2020, I read an article by Edward C. Godnig published in the Journal of Behavioral Optometry in 2003: "Tunnel Vision - Its Causes and Treatment Strategies". This followed my discovery on 3rd August of a video by Emma McAdam, "Soften the gaze", as part of her series of "anxiety skills". They were eye openers (no pun intended!): they gave me an insight into possible causes and therapeutic paths for Body Dysmorphic Disorder which are not mentioned to this day in the internet pages of the organisations devoted to sufferers of this condition in several countries. They are also absent from the Wikipedia pages on BDD in english, french, german, italian and spanish. When the term "tunnel vision" is used in those pages, it is figurative and not related to the physiological processes which I am going to explain in this post.
BDD is caracterised by the excessive attention a person gives to bodily flaws that appear minor to other people, magnifying them to the extent that normal life can be impaired and unhappiness takes over. This is a serious mental condition that can lead to suicide. You can read more about it here.
The eye opener for me was learning how much our capacity to focus on one visual element, to the exclusion of everything else, has a strong physiological background. When we are anxious, we experience stress reactions, our sympathetic nervous system (schematically, "fight or flight") takes over, and one of the consequences is that our central vision becomes predominant, to the detriment of our peripheral vision.
Although I have been working on the balance of the autonomic nervous system for some years now, as the predominance of the parasympathetic nervous system ("rest and digest") is essential to good singing (several nerves of the vocal apparatus are branches of the vagus nerve), this was new to me. I had never looked into the influence of the sympathetic and parasympathetic nervous systems on vision.
I now quote Edward Godnig: "Tunnel vision, or visual perceptual narrowing, is most commonly associated with the perceptual changes accompanying an intense and sudden assault on an individual. It results in an extensive neurological reaction. These perceptual changes often are reported during combat situation where the body alarm reaction is activated. This reaction can be defined as the neurological, biochemical, hormonal and behavioral changes that occur when the body and mind face "flight or fight encounters". Godnig then quotes Elliott B. Forrest: "Tension increases anxiety and is increased by anxiety. It induces a more narrowed focal, discrete, central processing style and is increased by the exclusion of peripheral stimuli. Tension also fosters selective rigidity in body function and in mental action". And back to Godnig: "This tunneling effect has also showed shape distortions".
Neither Edward Godnig nor Emma McAdam draw conclusions about BDD in their respective article and video, but the implications of a strong link between stress and vision will be evident to any person suffering from this condition.
What I had just learnt made me reflect on the therapy sessions for BDD that I have been following since December 2019. They have helped me in many ways, I am very grateful to my therapist. Among other elements, they led me to recognise how much the vision of my appearance and of other people's is dominated by an intense fear of the features not conforming to an imagined beauty ideal, in particular signs of ageing. But no linking of this intense fear to the "fight or flight" reaction had been established by my therapist. The therapy is, curiously enough in a situation where the body is so prominent, an essentially intellectual process.
For me, starting to consider my BDD through the angle of the sympathetic reaction of the autonomic nervous system was a revelation. It explained in particular the troubling changes in my condition: there were days where the flaws did not bother me, I accepted them or even did not see them, I was feeling great and felt no impairment in my daily life and interactions with others, apart from when confronted with being photographed or filmed. This could be easily explained, I now recognized, by changes in the balance of my autonomic nervous system. If I was in the "rest and digest" mode, which I practiced very often for my singing, I was deeply calm, not fearful, and my vision reflected this by giving me the large and somewhat benevolent picture of myself and others which people without BDD experience.
In my "bad days", when I dislike my appearance, I am now consciously working to enhance the parasympathetic response in relation to my vision as it has become clear to me that the anxiety caused by the flaws that the focussing is magnifying aggravates in turn the focussing: a typical vicious circle.
If I look in the mirror or at a photograph and get affected by flaws, I practice exercises to restore the balance of my autonomic nervous system until I attain a central-peripheral continuum in my vision. In particular, if I am practicing the habituation that my therapist taught me while looking at my entire body in a mirror, I interrupt it at regular intervals with exercises on the peripheral vision which develop the parasympathetic state, being very aware of the changes in my sensations, my posture and my breathing. In this sense, I am now integrating into the therapy the bodily components which I felt were missing from it. I have already had the amazing experience of a flaw receding into the background. It was incredible and quick, it happened in a few minutes!
Basically, anything that helps a person relax will favour peripheral vision. But there are some specific exercises. Edward Godnig indicates some techniques for the enhancement of peripheral awareness. Emma McAdam also gives some exercises in her video, as does Chrissy Zwijewski in her article aimed at practitioners of body building.
Here is a description of my own present practice: I hold my hands at different points at the limits of my peripheral vision and move my fingers, while looking at a point in the middle distance and being aware of the movements of my hands through the corners of the eyes. After a short while, I feel my face relax, a light smile starts to spread, my saliva becomes more fluid, my eyes start moistening, a deep and free breath comes of its own, and I feel a strong relaxation in the pelvic floor, as well as down into the legs. All these feelings are sure signs of parasympathetic activity which I have experienced often, but never until now in relation to vision. I feel at the same time deeply calm and full of energy. The process takes from thirty seconds to two minutes. I try to practice this as much as I can every day. I can also just close my eyes and start smiling: I feel an instant relaxation of the upper face and it brings me to the same happy state as the preceding exercise. And I also try to be aware of peripheral vision as often as possible in whatever activity I engage in. A train trip, with the landscape streaming past on both sides, is a wonderful opportunity.
I also practice regularly the following exercise which I use in the frame of my activities as a vocal coach and which brings me to the state of calm associated with the predominance of parasympathetic activity:
- Place your hands together at the small of the back and thrust your chest out 5 or 6 times
In this way I hope to be able to counteract my years of thorough (!) practice of tunnel vision and maybe cure my BDD for good. And I am now aware that any source of anxiety could have an effect on my vision and therefore aggravate my condition.
A short bibliography:
Forrest, E.B., Stress and vision, Santa Ana, CA, Optometric Extension Program Foundation, Inc., 1988.
Godnig, E.C. (2003). Tunnel vision: Its causes and treatment strategies. Journal of Behavioral Optometry, 14(4), 95-99.
Rogers, T. J., & Landers, D. M. (2005). Mediating effects of peripheral vision in the life event stress/athletic injury relationship. Journal of Sport and Exercise Psychology, 27(3), 271-288.
Chu, C., Rosenfield, M., Portello, J.K., et al. (2011). A comparison of symptoms after viewing text on a computer screen and hard copy. Ophthalmic Physiology, 31(1),29-32.
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