A matter of the mind
CAN the mind repair and revive a body in the terminal stages of entropy, flying in the face of just about every medical precedent?
Peter Hettel was dying irrevocably of cancer of the sinus. He chose to take the road, so far, least taken: he chose to follow the almost uncharted pathways of the mind over the medical simplicities of invasive surgery or radiation therapy.
An American software engineer steeped in the impeccable and unerring logic of the binary, Hettel gave up smoking and coffee, gorged on carrot juice and vitamin supplements, and took up yoga and meditation. To add a little colour to this peaceful exorcism, he crawled around and wiggled his eyes to create harmony between the hemispheres of his brain. The end was true to fantasy: a few months after beginning his bizarre regimen, Hettel was performing a yogic yawn when his nose veins suddenly burst and he spat out a mass of rubbery tissue. When the bleeding stopped, the tumour had gone. Only a hole remained.
Although so rare as to invoke disbelief, Hettel"s mind-over-matter triumph, reported in Newsweek"s March 13, 1995, issue, is not a one-off event. There have always been patients who do not follow the normal course of healing. Many cures that share mysterious origins--faith healing, spontaneous remissions and the effective use of placebos, or dummy drugs--point toward the mind"s role in the body"s business.
Healing episodes like Hettel"s defy medical wisdom and pose a basic question: was the healing in the patient"s mind, in his body, or both? To find out, western medicine has recently begun to move away from drugs and surgery toward the amorphous field of mind-body medicine. The move was almost a forced one, because the old reliance on the physical body alone had began to crumble.
The proponents of mind-body medicine believe that the mind and body are inextricably linked, and their unceasing intercourse exerts a profound influence upon health and illness, life and death. Attitudes, beliefs, and emotional states ranging from love and compassion to fear and anger, can trigger chain reactions that affect blood chemistry, heart rate, and the activity of every cell and organ in the body.
In a recent book titled Remarkable Recovery, alternative-healing enthusiasts Caryle Hirshberg and Marc Ian Barasch argue that so-called miraculous cures are natural events whose logic needs to be desperately worked out. The authors relate several mind-boggling recoveries, with the implicit belief that the body is intelligent enough to cure itself without outside intervention.
Far from being a modern phenomenon, the belief that there is a connection between mind and body is actually a modern revival of age-old beliefs. In fact, for most of history, medicine was little more than a bag of mind-altering tricks. In the words of Jane Brody, a British psychologist: "Except for some potent herbs that later became the basis for effective pharmaceuticals, the early healers had little more going for them than their ability to inspire trust and invoke images of recovery."
Old ideas die hard; they just go into hibernation till the winter of habit and orthodoxy thaws into the spring of experiment and glasnost. Over the past 2 decades, a growing band of iconoclast physicians has been challenging the theory that the mind has little to do with the overall behaviour of the body -- essentially how the body becomes sick and how it heals. Their investigations have produced impressive evidence that portends a sea change in the way patients and healthcare professionals are viewing the healing process.
But most doctors are uneasy with what has come to be known as mind-body medicine. For want of an explanation, they dismiss miraculous cures (spontaneous remissions) as flukes. Given a choice between a new idea and a familiar chemical, a doctor will trust the latter. The problem comes when the drug isn"t effective. Recent surveys taken in the UK and US have shown that as many as 80 per cent of patients feel that their underlying complaint was not satisfactorily resolved when they left the doctor"s office. Classic studies going back to World War II showed that patients left the Yale Medical School hospital sicker than the day they arrived. These are paralleled by similar studies that show that psychiatric patients improved more while they were they were on the waiting list to see a psychiatrist than after they actually saw him.
This growing disillusionment with modern medicine is reflected in the increasing number of patients resorting to a wide spectrum of alternative therapies -- from herbs and biofeedback, to tai chi chuan and transcendental meditation. According to a recent survey, 1 out of 3 adult Americans visit alternative therapy clinics, spending US $ 14 billion ($ 4 billion alone on alternative cancer therapies) in the process.
More tellingly, in 1990 Americans had more visits to alternative therapists than they had to primary care physicians. Alarmed by these statistics, the US government opened an Office of Alternative Medicine 2 years ago and dedicated US $ 14 million to research in this field.
The growing popularity of mind-body medicine has persuaded a few medical researchers to rethink the long-standing notions of what constitutes modern medical practice. For instance, these therapies have revived the role of the patient as an active player in the healing game.
As a consequence, the central role of the physician is being increasingly threatened. This explains the attempt by western researchers to forge complementary therapies, by combining elements of conventional and alternative medicine. By putting the stamp of science on mind-body medicine, physicians are apparently trying to co-opt it into their fold and woo back disenchanted patients to their clinic.
Mind-body medicine: The scorecard
Evidence is mounting that mind-body techniques may not only improve the quality of life -- particularly for someone fighting a serious illness -- but actually affect the course of the disease itself.
The evidence is pouring in from 3 directions: Physiological research, which investigates the biological and biochemical connections between the brain and the body"s systems; Epidemiological research, which shows correlations between certain illnesses in the population at large; and Clinical research, which tests the effectiveness of mind-body approaches in preventing, alleviating, or treating specific diseases.
Much of the epidemiological evidence pointing to a mind-body connection is a legacy of the psychiatric research done in the "60s. Although the recurring theme of these studies was how a stressed mind rubs off its sickness on the body, some findings that established this link suggested, by inference, that by manipulating the mind the body could be cured of its afflictions.
Much of the modern understanding of stress and its baleful influence on the body, is due to psychiatrists Thomas Holmes and Richard Rahe, of the University of Washington School of Medicine, who developed the classic method of correlating people"s lives with their illnesses. They showed that the more stress a person had experienced, the more likely it was that he or she would become sick in time.
Events that were linked to illness covered a wide emotional range, including divorce, job loss, and death. In 1988, researcher Kurt Kroenke and his colleagues at San Antonio, Texas, found that chronic fatigue syndrome, hitherto called the Epstein-Barr virus infection after the pathogen that supposedly caused it, appeared to be associated more with depression and anxiety than with any specific physical disease.
Loneliness: Perhaps the stressor (anything that causes stress) with the best-established influence on health. A 1979 study conducted by L F Berkman and S L Symes and published in the New England Journal of Medicine, followed 4,725 adults for 9 years. By the end of the study period, the death rate was 2 to 3 times higher in persons with fewest social ties as compared to those with the most. The study also suggested a link between social intercourse and the 2 major killers, heart disease and cancer.
Emotional state: In 1973, a 15-year US study concluded that an individual"s psychological status contributes heavily to morbidity or longevity. The study found that the personal emotional characteristics that can increase vulnerability to illness include low ego strength, work dissatisfaction, poor mental health, and pervasive pessimism.
Mental state: Even more profound is the effect of the overall attitude on health. A landmark study notable for its long-term perspective tracked 185 men who were college students in 1942-44 into middle age. The study found that men with "good mental health" early in adulthood had much less chronic illness during middle age. Specifically, men with good mental health had only about 1/10th the rate of illness or death as those with poor mental health. Mental health was defined by categories like job satisfaction, marriage, group recreation, taking vacations, amount of sick leave and heavy use of mind-altering drugs, including alcohol.
Personality type: In a similar long-term study, researchers followed the health of more than 1,000 persons who graduated from John Hopkins Medical School between 1948 and 1964. They found that subjects with "irregular and uneven" personalities were predisposed over a 30-year period to such major illnesses as hypertension, coronary heart disease, and cancer. For example, a type A personality, described as being hard driving, aggressive, uncompromising, impatient and highly competitive is 2 to 3 times more at risk of a death-dealing heart attack than a type B personality, described as the opposite of A. The findings of these studies are, however, not accepted by all physicians.
Attitudes: Another important insight into the mind-body connection was provided by a study that examined the effect of pessimism on health. The study looked at what they called "explanatory style". They studied 99 graduates of Harvard University who filled out a questionnaire at age 25 explaining events that they had experienced during World War II. The subjects were then tracked for 35 years. The startling result from this work was that people who explained bad events pessimistically in early adulthood had substantially more physical illness between ages 45 and 60 than those who offered more optimistic explanations.
There are anecdotes, like Hettel"s, that seem to show that emotional states, including a strong will to live, can affect the course of a cancer. These accounts challenge traditional concepts of disease progress and treatment. Results from systematic studies of attitudes and their influence on cancer are not as nearly dramatic as stories about individuals. But they can be more useful and accurate as evidence that human thoughts and feelings can simulate and indeed manipulate their healing system.
In one of the few studies to look at psychology and the onset of cancer, Richard B Shekelle and his colleagues followed 2,020 middle aged men for 17 years. At the start of the study, in 1957-58, the personality profiles of the men were characterised. Seventeen years later, the investigators found statistically significant elevation of cancer incidence in those men who had high scores on the depression scale of the personality test. What is important about this study is that the personality profiles were obtained before subjects became ill. Thus it cannot be argued that the patients were depressed because they contracted cancer.
All of this research combined gives credence to the hypothesis that basic attitudes or ways of reacting emotionally to life stresses can predispose a person to a host of ailments.
Because so many factors can affect a person"s response to stress, it is difficult to determine the precise impact of such stressors. In addition to the social and psychological factors described above, a person"s age, race, sex, and genetic makeup as well as the nature and duration of the stress may all affect the ultimate health outcome.
To make things simpler, recent studies focused on one type of physiological response to stress -- changes in the immune system -- in a limited number of specific situations.
In 1991, the New England Journal of Medicine published a watershed report demonstrating a striking link between levels of mental stress and vulnerability to colds. This marked a turning point in the acceptance of mind-body medicine by the medical community.
But the conceptual wall between the brain and the immune system had started developing cracks way back in the mid-"70s, when psychologist Robert Ader and immunologist Nicholas Cohen performed an experiment involving giving rats an immunosuppressant drug with saccharin-flavoured water. The immune system of the rats became conditioned to the taste of the saccharin; eventually, giving the harmless saccharin water alone led to immune suppression, sickness and death.
By showing that the immune system could learn such associations, Ader and Cohen provided persuasive evidence that the brain could directly influence immunity. It triggered an explosion of research.
Researchers have since found a number of physiological connections between the brain and the immune system. They have shown that antibodies and immune system cells can respond to chemicals called neurotransmitters, once thought to affect only the nervous system, and that nerve cells respond to chemical messengers secreted by the immune system. This provides plausible means by which two systems might communicate with each other.
Neurotransmitters are messengers that run to and fro from the brain, telling every organ inside us of our emotions, desires, memories, intuitions and dreams. None of these events are strictly mental, since they can be coded into chemical messages. "The arrival of these chemicals on the scene makes the interaction of mind and matter far more mobile and flowing than ever before. They also help us fill the gap that apparently separates mind and body," says Deepak Chopra, executive director of the Institute for Human Potential and Mind Body Medicine, San Diego, and the author of the bestseller Quantum Healing.
By the mid-"80s, scientists had dug up as many as 50 of these mind-body surfers, suggesting an incredible flexibility to communicate from cell to cell. As scientists decipher their complex personality, many hitherto hidden contours of mind-body interaction are beginning to emerge.
For instance, now it is known that neurotransmitters are transmitted not just by the central nervous system, as was hitherto believed, but also by the immune system, through special cells called monocytes. Unlike neurons, which are fixed in place along the nervous system, the monocytes of the immune system travel through the bloodstream, giving them free access to every other cell of the body.
When the researchers looked beyond the nervous system and the immune system, they began to discover the same neuropeptides and receptors for them in other organs, such as intestines, kidneys, stomach, and heart. "This means your kidneys can think," says Chopra, in the sense they can produce the same chemicals found in the brain.
This shows that the neat division of the body into nervous system, endocrine system, digestive system, and so on, may soon be outmoded. It has now been proved that the same neurochemicals influence the whole bodymind.
Everything is interconnected at the level of the neuropeptide.
The most compelling study to date, was done at Stanford University by David Spiegel, a psychiatrist who wanted to show that women with breast cancer, if allowed to talk over their day-to-day troubles in a supportive setting, would suffer less emotional distress than women placed in a different situation. The data showed that groups did improve the women"s quality of life.
However, Spiegel"s original intention was to disprove the notion, spread by some popular books in the mid-"80s, that mental and emotional factors could influence the course of cancer. To his surprise, a decade later he found that the women in the support groups had survived twice as long as the others. The extended lease of life of 18 months was more than even cancer medications could have been expected to provide at that point in the women"s disease. When Spiegel published his findings in the journal The Lancet, it inspired many investigators to look more closely at the clinical effects of mind-body treatments.
Another famous landmark in mind-body medicine came from the clinic of O Carl Simonton, a radiologist at the University of Texas. He had met a 61-year-old man with throat cancer. Not only was the prognosis extremely poor --the doctors gave him 5 per cent chance of surviving 5 years after treatment -- but the patient was already so weak that it seemed unlikely he would respond well to radiation, the standard therapy for this condition.
Simonton suggested the man enhance his radiation therapy through the use of visualisation. He was taught to visualise his cancer as vividly as possible. Then, he was asked to visualise his immune system as the white blood cells successfully attacked the cancer cells and flushed them out of his body.
Much to Simonton"s surprise, the tumour seemed to be shrinking. And after 2 months it was gone. Elated at the success of the therapy, the man decided to use it to cure his arthritis too. More surprise. The arthritis too disappeared, and the man remained free of both for a follow-up period of six years.
In India, Dil Navaz Varaiva of the Bombay Natural History Society cured herself of sciatica using the visualisation therapy. Says she, "I got rid of my sciatic pain by just imagining it wasn"t there."
Intrigued by such cures, doctors over the last decade have experimented with mind-body innovations, from biofeedback and hypnotism to visualisation and meditation. The diseases targetted, range from cancer and coronary heart disease to diabetes and skin disorders.
Taken together, these research efforts and clinical experiments suggest that the split between mind and body, long taken for granted in Western philosophy, is illusory. For patients, the mindbody approach has very practical significance. It means that by paying attention to and exerting some control over emotional and mental states--one"s worries, hostility, habitual reactions, pessimism, and depression--one can help oneself stay healthy or recover more rapidly from being sick.
No matter, never mind
Many experts, however, caution that it is important not to overestimate the influence of the mind"s behaviour on disease processes. They say scientific understanding of the relationship between mind and body is in its early stages, and specific applications of this general principle must be regarded with caution at present.
Long-term statistical studies dispute whether such sporadic cures as Hettel"s are any better than those of conventional treatments. At present, conventional therapy has a big edge. Says Deepak Chopra, "If a woman with breast cancer, for example, detects a tumour while it is still very small and localised, the chances of curing her are currently better than 90 per cent. In comparison, the number of spontaneous remissions would be well below 1/10 of 1 per cent." Therefore, until a mental or other alternative therapy outperforms radiation and chemotherapy, it will not become the treatment of choice--for the doctors at any rate.
Furthermore, the findings of mindbody approaches have been nebulous and difficult to interpret. American psychologist Michael Lerner spent 3 years knocking at the doors of clinics offering alternative approaches to cancer, which ranged from herbs and macrobiotics to thinking of happy thoughts. He found that nothing close to a cure for cancer has been found anywhere. Though alternate approaches give a measure of comfort and relief to patients, the remission rates are not radically different from those of standard therapy.
But the mind-body field is plagued by more fundamental problems than just inconsistent results. Its supporters are yet to come up with a rigorous proof of its basic principle, that the mind influences the body toward either health or disease. In 1985, a major study of breast cancer conducted at the University of Pennsylvania failed to find any link between the mental attitude of patients and their chances of surviving their disease beyond 2 years. This provoked many reseachers to denounce the whole concept of emotions affecting cancer.
Furthermore, there is little agreement over what constitutes the "mind". If a patient comes in with cancer, is his mental state judged by how he feels on the day of the diagnosis, long before, or long afterward? For Chopra, an even more basic question is whether "the `mind" that a doctor is interested in is the patient"s overall personality, his subconscious, his attitudes, his deepest beliefs, or something not yet understood and defined by psychology?"
Another thorn in the mind-body issue is the dietary approach to illness. In 1984, Rafiq Waziri, a psychiatrist at the University of Iowa, put forward the idea that schizophrenia is caused by the brain"s inability to metabolise a chemical called serine correctly. To offset the lack of serine, the brain then overproduces a neurotransmitter called dopaminem which causes the condition. So Waziri wondered if schizophrenia could be cured by finetuning the digestive system.
To test his idea, he put a group of schizophrenics on a diet of glycine, a chemical that serine is supposed to build as part of dopamine mechanism. And remarkably, a few schizophrenics responded quite dramatically--they were able to stop their medications without having any psychotic episodes.
So if you can eat your way to sanity, or even a better mood, then the basic issues in mind-body medicine become even more confused. "Can you trust the mind to cure arthritis and at the same time hold that eating chocolate will make you depressed," asks Chopra. " This would imply a self-contradiction, that mind is dominant over matter except when matter is dominant over mind. And in this atmosphere of ambiguous findings, the two positions--treat the body through the mind, treat the mind through the body--are equally up in the air."
For most people however, the question is not whether mind-body medicine is a legitimate field of research, or whether its potential has been fully defind.The immediate practical question, is whether mind-body medicine as it stands now, can be of value to the people dealing with a range of illnesses and healthy people who want to remain that way.
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