Four
EXHALE
Every morning at 9:00, after Olsson and I have finished our testing and split off for solo time, I roll out a mat on my living room floor and work on becoming a little more immortal.
The path to everlasting life involves a lot of stretching: back bends, neck bends, and twirling, each one a holy and ancient practice that had been passed down in secrecy from one Buddhist monk to another for 2,500 years. Olsson and I need this stretching; even if we breathe through the nose twenty-four hours a day, it won’t help much unless we’ve got the lung capacity to hold in that air. Just a few minutes of daily bending and breathing can expand lung capacity. With that extra capacity we can expand our lives.
The stretches, called the Five Tibetan Rites, came to the Western world, and to me, by way of writer Peter Kelder, who was known as a lover of “books and libraries, words and poetry.”
In the 1930s, Kelder was sitting on a park bench in southern California when an elderly stranger struck up a conversation. The man, whom he called Colonel Bradford, had spent decades in India with the British Army. The Colonel was old—all sloping shoulders, gray hair, and wobbly legs—but he believed there was a cure for aging and that it was locked up in a monastery in the Himalayas. The usual mystical stuff occurred up there: the sick became healthy, poor became rich, old became young. Kelder and the Colonel stayed in touch and shared many conversations. Then, one day, the old man hobbled away, desperate to find this Shangri-La before he drew his last breath.
Four years passed until Kelder received a call from his building’s doorman. The Colonel was waiting downstairs. He looked 20 years younger. He was standing straight, his face vibrant and alive, and his once-balding head was covered in thick, dark hair. He’d found the monastery, studied the ancient manuscripts, and learned restorative practices from the monks. He’d reversed aging through nothing more than stretching and breathing.
Kelder described these techniques in a slim booklet titled The Eye of Revelation, published in 1939. Few people bothered to read it; fewer believed it. Kelder’s yarn was likely fabricated, or at minimum grossly exaggerated. However, the lung-expanding stretches he described are rooted in actual exercises that date back to 500 BCE. Tibetans had used these methods for millennia to improve physical fitness, mental health, cardiovascular function, and, of course, extend life.
More recently, science has begun measuring what the ancient Tibetans understood intuitively. In the 1980s, researchers with the Framingham Study, a 70-year longitudinal research program focused on heart disease, attempted to find out if lung size really did correlate to longevity. They gathered two decades of data from 5,200 subjects, crunched the numbers, and discovered that the greatest indicator of life span wasn’t genetics, diet, or the amount of daily exercise, as many had suspected. It was lung capacity.
The smaller and less efficient lungs became, the quicker subjects got sick and died. The cause of deterioration didn’t matter. Smaller meant shorter. But larger lungs equaled longer lives.
Our ability to breathe full breaths was, according to the researchers, “literally a measure of living capacity.” In 2000, University of Buffalo researchers ran a similar study, comparing lung capacity in a group of more than a thousand subjects over three decades. The results were the same.
What neither of these landmark studies addressed, however, was how a person with deteriorated lungs might heal and strengthen them. There were surgeries to remove diseased tissue and drugs to stem infections, but no advice on how to keep lungs large and healthy throughout life. All the way up to the 1980s, the common belief in Western medicine was that the lungs, like every other internal organ, were immutable. That is, whatever lungs we were born with, we were stuck with. As these organs degraded with age, the only thing we could do was sigh and bear it.
Aging was supposed to go like this: Starting around 30, we should expect to lose a little more memory, mobility, and muscle with every passing year. We would also lose the ability to breathe properly. Bones in the chest would become thinner and change shape, causing rib cages to collapse inward. Muscle fibers surrounding the lungs would weaken and prevent air from entering and exiting. All these things reduce lung capacity.
The lungs themselves will lose about 12 percent of capacity from the age of 30 to 50, and will continue declining even faster as we get older, with women faring worse than men. If we make it to 80, we’ll be able to take in 30 percent less air than we did in our 20s. We’re forced to breathe faster and harder. This breathing habit leads to chronic problems like high blood pressure, immune disorders, and anxiety.
But what the Tibetans have long known and what Western science is now discovering is that aging doesn’t have to be a one-way path of decline. The internal organs are malleable, and we can change them at nearly any time.
Freedivers know this better than anyone. I’d learned it from them years ago, when I met several people who had increased their lung capacity by an astounding 30 to 40 percent. Herbert Nitsch, a multiple world record holder, reportedly has a lung capacity of 14 liters—more than double that of the average male. Neither Nitsch nor any of the other freedivers started out like this; they made their lungs larger by force of will. They taught themselves how to breathe in ways that dramatically changed the internal organs of their bodies.
Fortunately, diving down hundreds of feet is not required. Any regular practice that stretches the lungs and keeps them flexible can retain or increase lung capacity. Moderate exercise like walking or cycling has been shown to boost lung size by up to 15 percent.
These discoveries would have been welcome news to Katharina Schroth, a teenager who lived in Dresden, Germany, in the early 1900s. Schroth had been diagnosed with scoliosis, a sideways curvature of the spine. The condition had no cure, and most children who suffered from extreme cases like Schroth’s could expect to spend a life in bed or rolling around in a wheelchair.
Schroth had other thoughts about the human body’s potential. She’d watched how balloons collapsed or expanded, pushing or pulling in whatever was around them. The lungs, she felt, were no different. If she could expand her lungs, maybe she could also expand her skeletal structure. Maybe she could straighten her spine and improve the quality and quantity of her life.
At age 16, Schroth began training herself in something called “orthopedic breathing.” She would stand in front of a mirror, twist her body, and inhale into one lung while limiting air intake to the other. Then she’d hobble over to a table, sling her body on its side, and arch her chest back and forth to loosen her rib cage while breathing into the empty space. Schroth spent five years doing this. At the end, she’d effectively cured herself of “incurable” scoliosis; she’d breathed her spine straight again.
Schroth began teaching the power of breathing to other scoliosis patients, and by the 1940s she was running a bustling institute in rural western Germany. It had no hospital rooms or other standard medical equipment; just a few run-down buildings, a yard, a picket fence, and patio tables. One hundred fifty scoliosis patients would gather there at a time. They suffered from the most severe form of the disease, with spines curved more than 80 degrees. Many were so hunched over, their backs so twisted and turned, that they couldn’t walk or even look upward. Their disfigured ribs and chests made it hard for them to take a breath, and they likely suffered from respiratory problems, fatigue, and heart conditions because of it. Hospitals had given up on trying to heal these patients. They came to live with Schroth for six weeks.
The German medical community derided Schroth, claiming that she was neither a professional trainer nor a physician and was not qualified to treat patients. She ignored them all; she kept doing things her way, having the women strip down bare-chested in a dirt lot beneath a copse of beech trees, stretching and breathing themselves back to health. Within a few weeks, hunched backs straightened and many students gained inches in height. Women who had been bedridden and hopeless finally began to walk again. They could take full breaths again.
Schroth spent the next 60 years bringing her techniques to hospitals throughout Germany and beyond. Toward the end of her life, the medical community had changed its tune and the German government awarded Schroth the Federal Cross of Merit for her contributions to medicine.
“What the bodily form depends on is breath (chi) and what breath relies upon is form,” states a Chinese adage from 700 AD. “When the breath is perfect, the form is perfect (too).”
Schroth continued to expand her lungs and improve her own breathing and form throughout her life. This former scoliosis patient, who as a teenager had been left to wither in bed, would die in 1985, just three days shy of her 91st birthday.
Midway through my research for this book, I took a trip to New York City to meet a more contemporary breathing expert who offered a different approach to expanding the lungs and longevity. Her apartment workspace was located a few blocks from the United Nations in a brown brick building with an awning covered in pink-eyed pigeons. I walked past a drowsy doorman, rode up an elevator, and a minute later I was knocking at room 418.
Lynn Martin welcomed me in. She was beanpole thin and dressed in a black jumpsuit with an oversize brass-buckled belt. “I told you it was small!” she said of the studio apartment. Surrounding us were manila folders, human anatomy books, and a few plastic models of human lungs. On a wall beside a bookshelf were black-and-white photos of Martin in the early 1970s. In one, she was wearing a black leotard in mid-glide on the wood floor of a dance studio, her blond hair pulled back in a lazy ponytail, her face bearing an uncanny resemblance to Rosemary’s Baby–era Mia Farrow.
After a few pleasantries, Martin sat me down and started telling me what I came to hear. “He was very verbal, but when you asked what exactly he was doing, he could never explain it,” she said. “Nobody since has ever been able to do what he did.”
The subject of intrigue was Carl Stough, a choir conductor and medical anomaly who got his start in the 1940s. Of all the pulmonauts I’d come across over the past several years, Stough was the most elusive. He published one book in 1970, which quickly flopped and went out of print. Twenty years later, a CBS producer put together a one-hour program about his groundbreaking work, but it never aired. Stough himself didn’t advertise his techniques. He never went on speaking tours. Even so, professional opera singers, Grammy-winning saxophonists, paraplegics, and dying emphysemics—thousands of them—managed to find him. Stough broke all the rules; he expanded lungs and extended life spans. And yet, most people today have never heard of him.
Martin had worked with Stough for more than two decades. She was a living link to this mysterious man and his research in the lost art of breathing. What Stough had discovered, and what Martin had learned, was that the most important aspect of breathing wasn’t just to take in air through the nose. Inhaling was the easy part. The key to breathing, lung expansion, and the long life that came with it was on the other end of respiration. It was in the transformative power of a full exhalation.
Photographs of Stough from the 1940s show an upright man who bore a passing resemblance to Thurston Howell III, the millionaire from Gilligan’s Island. Stough liked to sing and teach singing. He noticed how his fellow singers would belt out a few measures, stop to take a breath, and then belt out a few more. Each seemed to be gasping for air, holding it high in the chest, and releasing it too soon. Singing, talking, yawning, sighing—any vocalization we make occurs during the exhalation. Stough’s students had thin and weak voices because, he believed, they had thin and weak exhalations.
While directing choirs at Westminster Choir College in New Jersey, Stough began training his singers to exhale properly, to build up their respiratory muscles and enlarge their lungs. Within a few sessions, the students were singing clearer, more robustly, and with added nuance. He moved to North Carolina to conduct church choirs that went on to win national competitions, and his choir appeared on a weekly program broadcast nationally by Liberty Radio Network. Stough became so renowned that he moved to New York to retrain singers at the Metropolitan Opera.
In 1958, the administration of the East Orange Veterans Affairs Hospital in New Jersey called. “You must know something about breathing that we don’t,” said Dr. Maurice J. Small, the chief of tuberculosis management. Small was wondering if Stough might be interested in training a new group of students. None of them could sing, and a few couldn’t walk or talk. They were emphysema patients, and they were in desperate need of help.
When Stough arrived at the East Orange hospital weeks later, he was horrified. Dozens of patients were laid out on gurneys, each one jaundiced and pale, their mouths craned open like fish, oxygen tubes pumping to no avail. The hospital staff didn’t know what to do, so they just wheeled the men across the waxed terrazzo floors and into a room hung with faded-yellow tissue dispensers and American flag clocks, one patient beside the other, waiting to die. It had gone this way for 50 years.
“I foolishly had assumed that everyone had at least a rudimentary knowledge of physiology,” Stough wrote in his autobiography, Dr. Breath. “Even more foolishly I had assumed that a universal awareness of the importance of breathing existed. Nothing could have been farther from the truth.”
Emphysema is a gradual deterioration of lung tissue marked by chronic bronchitis and coughing. The lungs become so damaged that people with the disease can no longer absorb oxygen effectively. They’re forced to take several short breaths very fast, often breathing in far more air than they need, but still feel out of breath. Emphysema had no known cure.
The nurses, meaning well, had placed cushions under patients’ backs so that their chests were arched up. The idea was to create elevation to ease inhalations. Stough instantly saw that this was making the condition worse.
Emphysema, he realized, was a disease of exhalation. The patients were suffering not because they couldn’t get fresh air into their lungs, but because they couldn’t get enough stale air out.
Normally, the blood coursing through our arteries and veins at any one time does a full circuit once a minute, an average of 2,000 gallons of blood a day. This regular and consistent blood flow is essential to delivering fresh oxygenated blood to cells and removing waste.
What influences much of the speed and strength of this circulation is the thoracic pump, the name for the pressure that builds inside the chest when we breathe. As we inhale, negative pressure draws blood into the heart; as we exhale, blood shoots back out into the body and lungs, where it recirculates. It’s similar to the way the ocean floods into shore, then ebbs out.
And what powers the thoracic pump is the diaphragm, the muscle that sits beneath the lungs in the shape of an umbrella. The diaphragm lifts during exhalations, which shrinks the lungs, then it drops back down to expand them during inhalations. This up-and-down movement occurs within us some 50,000 times a day.
A typical adult engages as little as 10 percent of the range of the diaphragm when breathing, which overburdens the heart, elevates blood pressure, and causes a rash of circulatory problems. Extending those breaths to 50 to 70 percent of the diaphragm’s capacity will ease cardiovascular stress and allow the body to work more efficiently. For this reason, the diaphragm is sometimes referred to as “the second heart,” because it not only beats to its own rhythm but also affects the rate and strength of the heartbeat.
Stough discovered that the diaphragms in all of the East Orange emphysema patients had broken down. X-rays showed that they were extending their diaphragms by only a fraction of what was healthy, taking only a sip of air with each breath. The patients had been sick so long that many of the muscles and joints around their chests had atrophied and stiffened; they had no muscle memory of breathing deep. Over the next two months, Stough reminded them how.
“My activities looked silly when observed from a distance, and they seemed silly at the outset to the person with whom I worked,” wrote Stough.
He’d begin the treatments by putting patients flat on their backs, running his hands across their torsos, and gently tapping on rigid muscles and distended chests. He’d have them hold their breath and count from one to five as many times in a row as they could. Next, he massaged their necks and throats and lightly coaxed their ribs as he told them to inhale and exhale very slowly, trying to wake the diaphragm from its long slumber. Each of these exercises allowed the patients to let out a little more air so that a little more air could get in.
After several sessions, some patients learned to speak a full sentence in a single breath for the first time in years. Others began walking.
“One elderly man who had not been able to walk across the room not only could walk but could walk up the hospital stairs, a remarkable feat for an advanced emphysema patient,” Stough wrote. Another man, who hadn’t been able to breathe for more than 15 minutes without supplemental oxygen, was lasting eight hours. A 55-year-old man who had suffered advanced emphysema for eight years was able to leave the hospital and captain a boat down to Florida.
Before-and-after X-rays showed that Stough’s patients were vastly expanding their lung capacity in only a few weeks. Even more stunning, they were training an involuntary muscle—the diaphragm—to lift higher and drop lower. Administrators told Stough that this was medically impossible; internal organs and muscles cannot be developed, they said. At one point, several doctors petitioned to ban Stough from treating patients and kick him out of the hospital system. Stough was a choral teacher, not a doctor, after all. But the X-rays didn’t lie. To confirm his results, Stough began recording the first footage of a moving diaphragm, using a new X-ray film technology called cinefluorography. Everyone was floored.
“I told Carl in no uncertain words that he was mildly demented to say that he could effect a rise in the diaphragm and a descent in the ribs, but then in one patient we got rather spectacular results showing that he did do this,” said Dr. Robert Nims, the chief of pulmonary medicine at the West Haven VA Hospital in Connecticut. “We have shown that he’s able to decrease the volume of the lungs [via deep exhalations] more than any pulmonary man would say it was possible.”
Stough hadn’t found a way to reverse emphysema. Lung damage from the disease is permanent. What he’d done is find a way to access the rest of the lungs, the areas that were still functioning, and engage them on a larger level. The “cure” Stough professed was de facto, but it worked.
Over the next decade, Stough would take his treatment to a half-dozen of the largest VA hospitals on the East Coast, sometimes working on patients seven days a week. He’d go on to treat not only emphysema, but asthma, bronchitis, pneumonia, and more.
The benefits of breathing, of harnessing the art of exhalation, Stough found, extended not just to the chronically sick or to singers, but to everyone.
Back in Lynn Martin’s apartment, I was reawakening my own slumbering diaphragm on the living room futon. “This is not a massage,” Martin said, making her point as she pressed a hand against my ribs. I drew soft and long breaths deep into my abdomen while Martin helped loosen my rib cage, trying to coax at least 50 percent of my maximum diaphragm movement with each inhale and exhale.
Breathing this way wasn’t necessary, Martin told me. Our bodies can survive on short and clipped breaths for decades, and many of us do. That doesn’t mean it’s good for us. Over time, shallow breathing will limit the range of our diaphragms and lung capacity and can lead to the high-shouldered, chest-out, neck-extended posture common in those with emphysema, asthma, and other respiratory problems. Fixing this breathing and this posture, she told me, was relatively easy.
After several rounds of deep breaths to open my rib cage, Martin asked me to start counting from one to ten over and over with every exhale. “1, 2, 3, 4, 5, 6, 7, 8, 9, 10; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10—then keep repeating it,” she said. At the end of the exhale, when I was so out of breath I couldn’t vocalize anymore, I was to keep counting, but to do so silently, letting my voice trail down into a “sub-whisper.”
I ran through a few rounds, counting quickly and loudly, then silently mouthing the numbers. At the end of each breath, it felt like my chest had been plastic-wrapped and my abs had just gone through a brutal workout. “Keep going!” Martin said.
The strain of the counting exercise is equivalent to the strain on the lungs during physical exertion. This was what made the exercise so effective for Stough’s bedridden patients. The point was to get the diaphragm accustomed to this wider range so that deep and easy breathing became unconscious. “Keep moving your lips!” Martin egged me on. “Get out the last little molecule of air!”
After a few more minutes of counting, silent and otherwise, I stopped and took a break and felt my diaphragm chugging away like a piston in slow motion, radiating fresh blood from the center of my body. This is the feeling of what Stough called “Breathing Coordination,” when the respiratory and circulatory systems enter a state of equilibrium, when the amount of air that enters us equals the amount that leaves, and our bodies are able perform all their essential functions with the least exertion.
In 1968, Stough left the VA system and his thriving private practice in New York to train yet another group of students. These people could talk, and they could walk, and they could run very fast. They were the runners on the Yale track and field team, among the best in the nation at the time. When Stough arrived at the track fieldhouse, the athletes were so excited that they hung a poster on the bulletin board outside: Dr. Breath Is Here Today!
Stough had expected these elite athletes to have exemplary breathing habits. Instead, he found that they suffered from the same “respiratory weakness” as everyone else: they got the same colds and flus and lung infections. Most of them breathed way too often, high in their chests. Sprinters were the worst off. The short and violent breaths they took during runs put too much pressure on delicate tissues and bronchial tubes. As a result, they suffered from asthma and other respiratory ailments. At the finish line, they coughed and sometimes vomited and collapsed, wheezing in pain.
“I had observed that in recovering from performance, athletes tended to adopt the same breathing characteristics as those the emphysema patients exhibited,” Stough wrote. These runners had been trained to push through the pain, and they did. They won competitions, but they were harming their bodies.
Stough laid out a table at the Yale indoor track, sat the runners on it, and began running his hands up and around their chests in front of a crowd of onlookers. He warned them to never hold their breath when positioned at the starting line at the beginning of a race, but to breathe deeply and calmly and always exhale at the sound of the starter pistol. This way, the first breath they’d take in would be rich and full and provide them with energy to run faster and longer.
After only a few sessions, all the runners reported feeling better and breathing better. “I never felt so relaxed in my life,” one sprinter said. They took half the time to recover between races and were soon breaking personal bests and edging toward world records.
On the heels of the Yale success, Stough moved to South Lake Tahoe to train Olympic runners preparing for the 1968 Summer Olympics in Mexico City. Same therapy, same success. A decathlete went out to the track and broke his previous record. Another broke his lifetime record. A runner named Rick Sloan broke his two life records for three events.
“Through my work with Dr. Stough, I knew I had to exhale,” said Lee Evans, an Olympic sprinter. “You know, I exhale, which kept my energy up. I didn’t get tired. . . . But after the game, I found that this was for my life.”
You might recognize Evans. He’s the man in the famous photograph standing on the center podium at the Olympics awards ceremony, wearing a Black Panther beret and jutting a fist in the air. He won gold in the 400 meters and another in the 400-meter relay. The rest of the 1968 U.S. men’s team under Stough’s training went on to win a total of 12 Olympic medals, most gold, and set five world records. It was one of the greatest performances in an Olympics. The Americans were the only runners to not use oxygen before or after a race, which was unheard of at the time.
They didn’t need to. Stough had taught them the art of breathing coordination, and the power of harnessing a full exhalation.
“He was doing so many things at once,” Lynn Martin says as we moved from the futon back to the dining room table at the center of her studio apartment. “The sensitivity of his hands, perfect pitch of his ears, the natural knack for instruction—all of it.” For the past few minutes, Martin has been telling me about her time working with Stough, how she’d gone to see him in 1975 on the recommendation of another dancer and had come out feeling transformed. She returned weeks later and took a job at the clinic. Even though Martin would spend more than two decades working with Stough as one of his closest associates, he never told her his secrets. “He thought it was too difficult to put into words,” she said.
I could relate. I’d seen a video recording of Stough at the 1992 Aspen Music Festival—the only existing footage that demonstrates what he did and how he did it. It opened with a frame that read: An Introduction to Respiratory Science: The Preventative Medicine of the Twenty-First Century. Stough was at the center of a conference room, a massage table in front of him. An open window looked out over a thicket of pine trees glowing white in the summer sun. Stough was deeply tanned and dressed in a black blazer with brass buttons and a pocket kerchief, as if he’d just flown in on a Concorde from Monte Carlo.
He started off by inviting a tenor named Timothy Jones to lie on the table and proceeded to jiggle Jones’s jaw, dig his hands into his waist, and rock him back and forth. “You see, I have to keep tapping right on the chest,” said Stough, his yellow polka-dot tie dangling in Jones’s hair. This went on for several minutes, until Stough leaned three inches from Jones’s face and began to count from one to ten with him in a gibberishy harmony. “Everything’s loosening very fast!” Stough announced. He wiggled Jones’s hips and neck so violently that the singer almost fell off the table.
It was a bizarre spectacle, and the grabbing and pushing and deep stroking looked at times like borderline molestation. After my own experience in Martin’s studio for an hour, babbling numbers and having my chest poked and ribs squeezed, it became more clear to me why Stough’s work never caught on. It didn’t matter that saxophonist David Sanborn and asthmatic opera singers, Olympic runners, and hundreds of emphysema survivors praised his treatments as a lifesaver. Stough wasn’t a doctor; he was a self-made pulmonaut, a choir conductor. He was just too far out there. His therapy was just too weird.
“Although the process of breathing involves both anatomy and physiology, neither branch of science has claimed it for thorough exploration,” wrote Stough. “It was a little-known territory waiting to be mapped and charted.”
Stough made his map over a half century of constant work. But when he died, that map was lost. As soon as he left the VA wards, so did his therapy.
At the end of my two-hour Breathing Coordination session, I left Martin’s apartment and hopped on the train back to Newark Liberty International Airport. As we rumbled across the marshlands and over the Passaic River, I searched through the current treatments for the nearly 4 million Americans now suffering from emphysema. There were bronchodilators, steroids, and antibiotics. There was supplemental oxygen and surgery and something called pulmonary rehabilitation, which included assistance to quit smoking, exercise planning, nutrition counseling, and some pursed-lip breathing techniques.
But there was no mention of Stough, or the “second heart” of the diaphragm, or the importance of a full exhalation. No mention of how expanding the lungs and breathing properly had effectively reversed the disease or lengthened lives. Emphysema was still listed as an incurable condition.