Reconnecting with Your Secret Sense
- Dr Em Wong
- Jul 2
- 8 min read
It’s often surprisingly difficult to get patients to communicate about the discomfort they’re feeling. The human brain experiences pain and discomfort sensations internally, where they can’t be objectively measured or quantified. So, a broken leg can be diagnosed on X-ray and assessed on the basis of whether the leg can be used to bear weight. But we have to rely on a patient’s words and actions to tell us about their pain.
Most people aren’t so good at describing their own pain. This may be, because most of us aren’t in the habit of noticing such details, or it’s just not that easy to translate our sensations into words. That’s why medical students are taught on day 1 to ask a series of multiple choice questions:
Is the pain sharp or dull?
Is it constant, or does it come and go?
What makes your pain better or worse?
Despite this kind of prompting, many people still struggle to speak, holding their eyes tightly shut and bodies stiff. Others can only moan and writhe, too caught up or overwhelmed to do anything else.
The body is in constant communication with the brain, all day, every day.
The brain is believed to receive trillions of internal sensory signals every minute—only a tiny fraction of which make it through the filter of consciousness to our interoceptive (or body awareness) sense. Our ability to perceive these signals and to translate them into words and numbers, gives us a secret superpower that I like to call feelings fluency. Building our proficiency in feelings fluency strengthens our stress resilience and boosts brain health in countless ways.
Your secret sense
The interoceptive sense is what connects us to the body’s inner intelligence, telling us what is happening inside the body.
We’ve all heard of our body’s five external senses—sight, smell, touch, hearing and taste, but we also have at least three internal senses: the vestibular, proprioceptive, and interoceptive senses (see Fig 1). The vestibular sense provides input on balance, and proprioception tells us about the position of our limbs (like, how you know if your leg is straight or bent in bed without having to look).
Interoception is sometimes called the secret sense or intuition because it operates below the level of our consciousness. Research has shown that the body senses danger far more quickly and takes instinctive protective action long before the logical part of our brain consciously knows what’s happening.
Because our “gut sense” is inherently risk averse, its predictions can often be wrong or seem like an overreaction. Like, when you instinctively jump away from something coiled near your foot. It can be a bit embarrassing to realize that it’s just some rope and not actually a snake. But before we dismiss our intuition out of hand, it’s only fair to acknowledge that the logical part of the brain gets things wrong all the time too. Imagine when we’re overreacting with anxiety and dread about being stuck in traffic, and it turns out not to be the end of the world to be running a little late.
Sensory input signals from the body feed into the sophisticated machinery of the brain’s autonomic nervous system, which dynamically maintains optimal internal conditions for critical body functions through a process known as homeostasis. The brain and body’s innate intelligence acts invisibly and autonomously to keep parameters such as oxygen, glucose, fluid, electrolytes, pH and body temperature in balance. The body’s intelligence is also responsible for basic survival and defensive responses, mobilizing the immune system to heal and protect, while also seeking safety and social connection.
Interoception operates below the level of our consciousness
For example, the body’s temperature, hydration, and salt levels are continuously monitored through a complex array of receptors in the brain, arteries, kidneys, and skin. On hot days, the body automatically produces sweat and dilates capillaries in the skin, to cool us down. In the green zone of homeostatic reactions, physiological reactions occur unconsciously and involuntarily, which is why we’re often sweaty and flushed before we know it.
When our core temperature rises to the amber zone, homeostatic mechanisms rise to the level of consciousness, activating our body to get involved by prompting us to seek shade, change into lighter clothing, or turn on the fan. We may also feel the urge to get a cold drink, which cools us by replenishing fluids lost through sweating. Being more sensitive to early warning signals, allows us to take pre-emptive action before becoming overheated.
Interoceptive signals begin as subtle whispers in the amber zone, repeating with increasing urgency and distress. The homeostatic red zone is when we need others to help us get back to the safe zone. Marathon runners can sometimes risk collapse and injury, ignoring symptoms of heat exhaustion such as fatigue, thirst, and dizziness, because they become so focused on finishing their event.
Mind body disconnection
All human babies are completely reliant on their primitive instincts when they are born. They can only communicate discomfort from their interoceptive signals through crying. Cries are non-specific messages of distress (as parents can only guess at whether their baby feels hungry, cold, scared, or wet). As the baby grows into a child, she develops the ability to take care of her own bodily needs by feeding and eventually even toileting by herself.
She also learns how to control and manage her bodily signals and urges. Rather than crying when she’s hungry and peeing whenever she needs to, she learns to eat at mealtimes and to use her words to ask permission for going to the bathroom. She’s learned to avoid the risk of shaming, by delaying or resisting the urge to act on interoceptive signals by following these established social rules.
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And by the time we are adults, we will each have internalized different rules and habits for responding to “calls of nature” in different situations (see Fig 2). We may feel free to complain about being hungry at home, while we’d never dream of doing so in the work setting. In some Western cultures, it’s considered rude to belch loudly in public, so we resist the urge to do so. In Hong Kong, there’s no such rule.
There are times when mind-body disconnection helps us survive unthinkable horror. I once had a patient whose whole body was criss-crossed with deep scars from a series of surgeries she’d had to remove shrapnel. She’d been on a family vacation at a hotel resort in Indonesia, when a terrorist bomb suddenly went off in her bathroom. She never spoke of the incident, but her husband shared the story of how he struggled to care for their two boys, while also calling desperately for help during those critical hours when she was bleeding out and public services were in chaos.
My patient’s survival and subsequent return to normal work and life were nothing short of miraculous. She believed that she’d only been able to survive because she dissociated from her body and her memories of that incident. It’s important to be respectful of the body and mind’s intrinsic ability to heal through their own innate intelligence. Compartmentalizing physical and mental trauma has helped generations to survive war, famine, and countless tragedies.
Research shows that while repressing feelings and memories can be helpful over the shorter term, such strategies can take a toll on our physical and mental health.
Studies suggest that chronic disconnection between body and mind stresses the physiology in ways that are measurable, in terms of biomarkers like blood pressure, cortisol levels, and inflammatory markers. Thus over the longer term, it may be worth considering what approaches feel safe or helpful in reconnecting the mind and body. Ageing wisely requires us to build resilience, which in turn depends on being able to read and trust our body’s signals, while also understanding how best to respond.
The myth of stoicism
Over the years as a primary care doctor, I’ve noticed tremendous variability in how much awareness people have over bodily functions. Some seem to pay exquisite attention to every symptom (real or imagined). While others are strangely unaware of major changes in the body (like when a teenager was brought into the emergency room with abdominal discomfort that turned out to be labor pains signalling the impending delivery of her baby).
Ageing wisely means trusting and understanding how to respond to our body
We know from the science that intrinsic body awareness ranges widely, depending on multiple factors including genetics, culture, and mental state. Many cultures glorify stoicism (when someone endures pain or hardship without showing their feelings or complaint). And yet it’s unclear if stoics truly have more mental discipline or if they simply possess intrinsically higher pain thresholds.
For as long as I could remember, my grandma Nai Nai was always troubled by minor aches and pains and poor sleep. Such complaints were seen by the family as weakness, especially since they’d been going on for decades with “nothing serious” going on. Her total body pains were considered to be “all in her head” and variously attributed to hypochondriasis (hypochondria), wear and tear from having had too many children, and high levels of anxiety and restlessness.
Nai Nai was constantly trying this or that new remedy. I found the breadth and range of different practitioners she saw most fascinating. Sometimes a pristine clinic shiny with antiseptic cleanser; other times, a sweaty hole-in-the-wall redolent with aijiu 艾灸 smoke and herbal decoctions. By the time I finished my internal medicine residency, I was fairly certain that Nai Nai was suffering from fibromyalgia, a condition involving muscle pains and poor sleep. There is neither a specific cause nor treatment that is universally beneficial, but I encouraged her to keep up with the gentle liu tong quan 六通拳 martial arts exercise form that seemed helpful to her.
My grandpa Gung Gung represented the opposite end of the spectrum, projecting robust health and disdaining health complaints. He was diagnosed with stage IV cancer at the age of 93, found incidentally on a routine screening check up. He had always enjoyed excellent health, so even minor side effects from targeted anti-cancer drugs proved difficult for him to tolerate. He rarely complained out loud, but was visibly impatient and frustrated that his body wasn’t responding as expected to treatment.
Interoceptive skills can be honed through the simple practice of paying attention
I’ve often wondered if Gung Gung’s cancer could have been detected earlier if he’d been more sensitive to his body’s signals. But it was unlikely to have made much difference to prognosis, at his advanced age. I’ve come to see that it’s just not helpful to judge ourselves as being stoics or hypochondriacs. Strength can manifest in different ways. We are all gloriously unique individuals with our own beliefs, body processes, and communication styles.
Nai Nai’s approach was to be open and vulnerable in sharing her suffering and getting help. And in the end, she lived to be 106 years old, despite having birthed eight (yes, 8) children. Her aches and pains mysteriously disappeared as her memory faded in those final years. I believe she was finally able to achieve a level of comfort by laying down her burden of worries and silencing her inner critic.
The mind-body connection facilitates brain health, because it helps us tune in to signals from the body that inform our progress in building our brain-healthy lifestyles. Feelings fluency can also help us identify and respond to early warning signals from the body and to get unstuck from the won’t-power inertia of unhelpful habits.
Whatever your innate capacity for interoception may be, it will most definitely improve through the simple practice of paying attention.
Dr Em’s Coaching Tips
Check the score: What’s your energy level right now (on a scale of 1–10? (0 is “I need to lie down” and 10 is “Dance party time!”) And what was it when you first woke up this morning?
The simple act of checking this score is you practicing your interoceptive skills, simply paying attention to how you are feeling. And you are practicing feelings fluency when you translate those feelings into numbers on a scale.
Energy audit: Consider tracking your energy score over the next week, to act as a baseline. It could be as simple as starting a personal note on your phone. Because energy is a key parameter of brain health, these data points represent opportunities for learning more about which habits are (and aren’t) working for you.
For example, if you feel exhausted instead of refreshed when you wake up in the morning, you may want to tweak some sleep parameters. If you crash after lunchtime, it may be worth tweaking what’s on your plate (or in your cup) that could be messing with blood sugar levels.
Learn more about Managing Your Energy.
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