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A Journey into the Science of Mind over Body
by Jo Marchant
Church attendance increases your life expectancy by 7-14 years. Fake drugs (placebos) work even if you know they are fake. Hypnosis cures IBS (irritable bowel syndrome). Mindfulness slows the progress of multiple sclerosis. Meditation thickens your prefrontal cortex. Psychiatric drugs kill half a million people in the West annually.
That, roughly, is the territory covered by this book: the landscape between the strong evidence that the state of your mind affects the state of your body and the hard truth that current medicine, in choosing to ignore this evidence, might be harming us. It is, of course, a landscape littered with as many hucksters as healers. We must tread carefully.
Jo Marchant is a sceptically inclined science journalist. "I believe passionately in the scientific method," she writes. But science might have been misled by its own history. In the 17th century, Descartes's division of the world into the physical and the God-supported mental created a dualism that continues to haunt science. When God dropped out of the picture, scientists were seduced into discounting the mental as an irrelevant add-on, only of interest to the superstitious. Now even neuroscientists, who claim to be studying the mind, like to say the human self is a delusion.
In medicine, hard physicalists tended to ignore the patient entirely as anything other than a control system for the body machine. This was comprehensively disproved by the effectiveness of placebos, which seemed to work as well as, or better than, the real thing. The physicalists were contemptuous. Placebos, said an article in The Lancet in 1954, only work for 'unintelligent or inadequate patients'.
But it was the writer in The Lancet, not the patients, who had succumbed to superstition. The story of placebos, with which Marchant begins her book, provides incontrovertible evidence that the body can be profoundly affected by the mind. This does not simply mean that placebos lull the patient into feeling less pain, actual physical changes occur. Placebos, for example, can trigger the release of endorphins, natural painkillers. Or there is the astounding story of acutely autistic children being cured by the hormone secretin, which double-blind trials seemed to show had no effect. Then there was the antidepressant Prozac that worked for millions, even though tests showed it shouldn't.
The point is, as one doctor puts it, that 'the active ingredient is meaning'. If a treatment signifies care and hope to the patient, then it may work. Extraordinarily, this works even when the patient knows a treatment is a placebo - Marchant even claims to have cured her own headache with a fake drug. Now there are companies selling placebos online, capsules whose only ingredient is air. Clearly the subconscious can still be activated in spite of the doubts of the conscious.
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Placebos indicate that patients' minds can be conscripted in almost any treatment regime. This insight can be extended far beyond fake drugs. Chronic fatigue syndrome (CFS), for example, can be relieved by cognitive behavioural therapy. Oddly, some CFS sufferers don't want to hear this because it implies their affliction is all in the mind. Perhaps they should realise that 'all in the mind' is rapidly becoming an obsolete or even meaningless diagnosis. In this context, hypnosis (which appears to be effective in treating IBS) should, perhaps, be seen as a much more commonplace treatment.
So should a high quality of care. A startling study in 2012 showed that pain and complications in childbirth could be reduced if the mother had a single caregiver throughout labour. It can even reduce the likelihood of caesarian sections, which are now far too common in Britain and America, apparently because they are convenient. The long-term effects of all these c-sections have yet to be assessed.
Good care also helps in dying. Contemporary squeamishness about death means that we tend to ignore the dying, wishing them away before their time is due. Care becomes rudimentary, dominated by futile or, in some high-profile cases, cruel treatments. A mind-body view should change all this. Marchant reports a study that showed that well-cared-for patients survived 11.6 months as opposed to 8.9 months for a control group.
The point was human contact. This, above all else, gives people, even in extremis, a reason to live. Social ties save lives and their absence is toxic. Why do Costa Ricans live longer than their much wealthier American neighbours? Because they have much richer and broader social networks. Their supreme sociability can, it seems, be detected at the level of their chromosomes.
In spite of all this, Marchant's conclusion is bleak. A mind-body revolution in medicine will be held back by the way research is funded: in America, 75% of the money comes from drug companies whose only interest is in selling us chemical compounds. Only 0.2% of America's National Institutes of Health's $30bn budget goes on mind-body research. This is really bad news for us; the NHS could save a fortune if mind-body procedures were implemented.
Marchant's book is amiably badly written. She suffers the common science writer's tic of adding, without integrating, reportage. So when I am suddenly told that one of her interviewees 'is dipping a strip of pitta bread into her hummus' as she speaks, I die a little inside and, more important, take her less seriously.
It is, nevertheless, a diligent and useful work that makes the case for 'holistic' medicine while warning against the snake-oil salesmen who have annexed that word for profit.
In the end, Wittgenstein was right when he said that the best picture of the human soul is the human body. We are indivisible entities whose most serious afflictions are neither real nor imagined, but both. This can be hard to understand, but it is the price we pay for being human.
From multiple sclerosis to chronic pain to HIV, science is increasingly showing us that what's in a patient's head affects how the body heals.
I met Tunde Balogh at the Catholic pilgrimage site of Lourdes, France. The 37-year-old, originally from Hungary, had been diagnosed with breast cancer a year earlier but refused conventional treatment. 'They'd cut off my breast, I didn't want to do that,' she told me. Instead, she felt the answer was inside her. She tried reiki, reflexology, and eventually German New Medicine, which teaches that cancer is caused by emotional conflict. But none of it worked; the cancer soon spread to her bones. By the time she made it to Lourdes, her only hope was a miracle cure.
Let's be clear: Claims that the mind can heal aren't harmless. When made in the absence of evidence they raise false hope, and if people reject conventional treatment they need, they can die. That includes cancer patients, but less dramatic cases risk lives, too. Homeopaths regularly caution parents not to vaccinate their children against potentially fatal childhood infections, for example, and advise travelers against conventional drugs to protect against malaria.
Perhaps it's not surprising, then, that skeptics react to any suggestion of healing thoughts as an evil threat to be stamped out, branding everything from placebo research to integrative medicine as 'quackery.' But when researching my book, Cure: A Journey Into the Science of Mind Over Body, I came to the conclusion that this position isn't supported by the science either. Although the mind isn't a miracle cure - we will always need physical drugs and treatments - there is now overwhelming evidence that it drives biological changes that are crucial for physical health, influencing everything from pain to the immune system.
Our mental state has particularly dramatic effects when it comes to the symptoms we experience: things like pain, nausea, fatigue and depression. Playing a virtual-reality game eases pain in burn patients by as much as 50 percent (PDF) more than drugs alone, while research on placebos - fake treatments - tells us that psychological factors such as expectation and social interaction ease symptoms via biological changes very similar to those caused by drugs. Placebo painkillers trigger the release of natural pain-relieving chemicals called endorphins. Parkinson's patients respond to placebos with a flood of needed dopamine. Breathing fake oxygen can reduce the levels of neurotransmitters called prostaglandins, which cause many of the symptoms of altitude sickness.
It might sound crazy that thoughts and expectations should have similar effects to drugs, but underlying many placebo responses is the simple principle that the symptoms we feel aren't a direct, inevitable consequence of physical damage to the body. Such damage is important, of course, but ultimately our experience of it is created and controlled by the brain. If we feel stressed and alone, warning signals such as pain, fatigue, and nausea are amplified. If we feel safe and cared for (whether that means being surrounded by friends or receiving what we believe to be an effective medical treatment), our symptoms are eased.
This means that for many medical conditions, pouring ever more resources into physical drugs and interventions, while squeezing appointment times and cutting medical staff, may be counterproductive. One trial found that patients with irritable bowel syndrome (IBS) had much greater relief from their symptoms if the practitioner was warm and empathic rather then cold but polite - regardless of the treatment they received. Similarly, patients with acid reflux disease did dramatically better after an extended (42-minute) consultation with a physician, compared with a standard (18-minute) visit. In situations from back pain (PDF) to childbirth, patient outcomes depend not just on what drugs are prescribed but on how that care is delivered.
But this isn't all. Because the brain controls physiological functions from digestion to the immune system, the mind doesn't simply determine our subjective experience; it can be relevant for the physical progression of disease, too. These processes aren't generally under voluntary control; we can't 'wish' ourselves better. But we can influence them, particularly by modulating our response to stress.
When you're anxious your heart beats faster, for example, putting a greater strain on your cardiovascular system. This isn't usually a problem, but in some circumstances it can be dangerous or even fatal. Natural disasters such as earthquakes sometimes kill as many people from heart attacks as from falling rubble. Trials show that during invasive medical procedures such as breast biopsies or destruction of tumors, people who feel negative or anxious beforehand suffer more complications (things like prolonged lack of oxygen, low or high blood pressure, post-operative bleeding or an abnormally slow heart rate). Relaxation techniques such as visualizing a safe place vastly reduce pain and anxiety during these procedures - as well as the rate of adverse events.
Feeling stressed can also have physical consequences on the gut. If we're unhappy with toilet arrangements we might not go for days, whereas facing a challenge such as an exam or competition can cause us to empty our bowels. These processes exacerbate conditions such as IBS, and trials show that gut-focused hypnotherapy, which teaches patients to tackle stress and calm their digestive system - is a highly effective treatment. A course of such hypnotherapy reduces the sensitivity of the gut to pain, and while hypnotized, patients can alter their rate of gut contractions, something that we can't normally do at will.
Third, stress triggers a branch of the immune system called inflammation: the body's first line of defense against infection or injury. This is useful in an emergency but if triggered long-term by chronic stress, it disrupts healthy immune responses and eats away at the body's tissues, making us more susceptible to infections, allergies, and auto-immune disease. And that doesn't just mean eczema flareups or a few extra colds. Through its effects on the immune system, stress has also been shown to accelerate the progression of life-threatening conditions such as multiple sclerosis and HIV. Research into whether interventions that reduce stress can reverse these changes is only just beginning, but there's some preliminary evidence that stress-management therapy can stall progression in MS, and that mindfulness meditation may slow HIV.
There's even evidence that the mind plays a role in cancer. Inflammation clears damaged cells and promotes the growth of new blood vessels, which is useful for wound healing but also gives tumors the space and food supply they need to grow. In animal studies, stress hormones make a range of cancers spread faster, while patient trials suggest that stress-management interventions reduce inflammation, although the jury is still out on whether this feeds through into improved survival times.
Even if reducing stress doesn't directly affect survival in cancer, however, there are other ways in which psychological approaches can improve physical prognosis. If easing the fatigue and nausea caused by chemotherapy helps someone stick to their treatment regime, it can improve survival. Meanwhile, social support helps patients to make better decisions. In one study, terminal cancer patients offered early palliative care chose to receive less aggressive treatment. They were less depressed, had a better quality of life - and they lived longer.
The mind can't heal everything, and to reject physical treatments for life-threatening conditions is dangerous and misguided. But it's clear that our mental state does have wide-ranging physiological effects that can affect health in many different ways, and which are relevant even to the most serious conditions such as cancer, multiple sclerosis, and HIV.
Skeptics are right to warn of exaggerated claims in mind-body medicine. But denying the role of the mind has its own risks. It pushes people - particularly those with direct experience of how it can help - away from science and toward the crackpot explanations of alternative therapists. And it blinds us to insights that could be hugely important for medicine. In Cure, I argue that we need to combine both approaches: to care for patients' bodies and their minds.
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BANG! You're startled by a loud noise. Instantly you're fully alert and looking round for danger, heart racing. Or you see something erotic, and your body optimistically readies itself for intercourse. These simple observations are incontrovertible proof that our state of mind has a powerful effect on our bodies - a basic truth that we have ignored for too long, says science writer Jo Marchant.
Her book on this began as an article that appeared in New Scientist in August 2011. Marchant, a former colleague, had emailed me a few months earlier. Would I be interested in running a story about how our minds influence our health, and how we can harness these effects to help ourselves. 'These areas have always been seen as a bit too close to pseudoscience,' she wrote, 'but studies are now starting to show clear physical effects and pin down mechanisms.' It was one of those rare proposals that pretty much had me at hello.
Even if you read that piece, you will find Cure: A journey into the science of mind over body fascinating and thought-provoking. Marchant has travelled extensively around Europe and the US, talking to health workers and ordinary folk, to produce this meticulously researched book. Her bold aim: to rescue the idea that our minds influence our health from the clutches of pseudoscience and restore it to its proper place at the heart of conventional medicine.
The first section covers how doctors can exploit the power of our minds to make us feel better, lower drug doses and in a few cases, such as irritable bowel syndrome and chronic fatigue syndrome, actually make us better. The evidence that methods such as hypnosis and virtual reality can greatly reduce pain and provide an alternative to addictive drugs is particularly compelling. There's a very clear message for doctors: how patients feel really matters.
The second part of the book looks at things we can do ourselves, such as mindfulness, biofeedback and even - gasp - spirituality. These techniques cannot magically cure serious disorders and diseases, but there is evidence that they can help us feel better and reduce our chances of developing stress-related ills such as heart disorders.
What's missing for me are the negative studies. A lot of 'feel-good' alternative therapies have failed to show any benefit in scientific trials and some can be harmful, even deadly. There are also hordes of quacks out to exploit sick people. Marchant does touch on this briefly in the final pages, but she's far too polite, and perhaps too reluctant to introduce any discord into this positive book.
That said, Cure is a much-needed counter to a reductionist medical culture that ignores anything that doesn't show up in a scan. 'Taking account of the mind in health is actually a more scientific and evidence-based approach than relying ever more heavily on physical interventions and drugs,' Marchant concludes.
Cure should be compulsory reading for all young doctors. And reading it might just turn out to be good for your body as well as for your mind.
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