Of Mind and Bodyby Linda Wasmer Smith
As the world gets smaller and cross-cultural sharing becomes more prevalent, holistic healing techniques are gaining a foothold among people looking for alternatives traditional Western therapies. In the West we have long depended on doctors and medicine to care for our health, but we are now learning age-old ways to turn to our own inner resources for help. Through meditation, positive visualization, hypnosis, mental healing, and relaxation, we are beginning to reap restorative benefits achieved through a renewed belief in our own mental control over our bodies.
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Of Mind and Body
By Linda Wasmer Smith
Henry Holt and CompanyCopyright © 1997 Linda Wasmer Smith
All rights reserved.
Glenda is walking her dog among the dusty bear grass and prickly cactus at the base of the Sandia Mountains on the east side of Albuquerque, but her mind's eye is looking inward. As her West Highland terrier tugs at its leash, the special education teacher imagines that the small white dog is a white blood cell poised to attack the cancer in her body. It's a technique she learned from a best-selling book and honed at a well-known cancer center. Perhaps, she thinks, such healing images combined with chemotherapy treatments can give her that critical edge in the life-and-death struggle against non-Hodgkin's lymphoma.
Perhaps. Certainly this is the kind of feel-good story that is repeatedly seen in popular books and magazine articles and heard on talk shows. As it happens, a year after her initial diagnosis, Glenda's cancer is now in remission. However, no one can predict what the future may hold — or what role this kind of imagery exercise may play in the final outcome. Yet Glenda, like a growing number of Americans today, is convinced that the link between mind and body is a powerful one that can be exploited to treat and prevent illness and enhance wellness.
The recent upsurge in public interest in what has come to be known as mind-body medicine has been swift and strong. A landmark 1993 study, published in the esteemed New England Journal of Medicine, was led by internist David Eisenberg, M.D., of Harvard Medical School. Eisenberg and his fellow researchers found that a third of a national sample of 1,539 adults said they had used at least one unconventional medical therapy within the past year. Most popular were relaxation techniques, which had been used in the last 12 months by 13 percent of those interviewed. Among other therapies tried by at least 1 percent of the respondents were imagery, spiritual healing, self-help groups, biofeedback, and hypnosis.
Mind-body medicine is an approach that sees mental phenomena such as thoughts and emotions as being central to the body's physical health. Treatments based on the interconnectedness of body and mind include, in addition to those cited above, meditation, psychotherapeutic techniques, music therapy, and humor therapy. An older, and still often-used, term for this field is psychosomatic medicine.
One ground-breaking study that assessed the effectiveness of some such treatments was directed by Stanford psychiatrist David Spiegel, M.D. Back in 1976, 86 women with advanced breast cancer were randomly assigned to either an experimental group or a control (comparison) group. For a year afterward, both groups received standard medical care, but only those in the experimental group also got weekly supportive group therapy with self-hypnosis training for pain control. A decade later, the researchers tracked down what had become of these patients. They found that the women who had taken part in support groups had lived an average of 18 months longer than their counterparts who had not — a finding that is especially striking since Spiegel's original goal was actually to disprove the idea that psychological factors could influence the course of cancer. (This study is discussed in greater detail in Chapter Six.)
Taken together, the various mind-body interventions are one aspect of alternative medicine, an umbrella term for practices that fall outside conventional Western medicine. In addition to mind-body therapies, these include such things as acupuncture, herbal medicine, homeopathy, massage therapy, and alternative diets.
To more fully explore these kinds of practices, Congress established an Office of Alternative Medicine within the National Institutes of Health in 1992. Of the first 30 grants awarded by that office, 10 went to researchers investigating mind-body control. Among the wide-ranging projects that received this funding were a study of biofeedback and relaxation for diabetes at the Medical College of Ohio, a study of guided imagery for asthma at Lenox Hill Hospital in New York City, and a study of hypnosis for chronic low back pain at the Virginia Polytechnic Institute and State University.
Rather than calling mind-body approaches alternative, some people prefer the term complementary medicine. This highlights the fact that such therapies are best used as an adjunct to mainstream medical care instead of a replacement for it.
How Conventional Wisdom Became Unconventional
Approaches deemed alternative in the present-day United States might well be the norm in another time or place, notes Marc Micozzi, M.D., Ph.D., a scientist trained as both a physician and an anthropologist who is director of the National Museum of Health and Medicine in Washington, D.C. "Even though we Westerners have been thinking of the mind and body as separate for several generations now, that's really an artificial separation," he says. "In many cultures, the whole concept of mind-body medicine would be meaningless, since you can't put the mind and body back together if you never split them."
Historians trace this intellectual rift to René Descartes, an influential seventeenth-century French philosopher. Descartes was a dualist who thought the universe consisted of two basic elements: matter and mind. In this view, our minds belong to the spiritual sphere, while our bodies are part of the physical world of science.
Initially, this separation gave medical scientists the freedom to experiment on the human body, while preserving for the church the realm of the mind. It eventually gave rise to biomedicine, the style of medicine now practiced by doctors with M.D. degrees, which has been the dominant medical system in the United States since the mid-1800s. Biomedical scientists came to believe that, given almost any affliction, they could eventually find a physical cause such as a bacterium, virus, or chemical imbalance. The problem could then be corrected with the appropriate vaccine or drug.
In the age of AIDS and cancer, however, this view can seem oversimplified. Many physicians and patients alike are embracing a broader view of healing as the restoration of balance in the natural forces within the body. Health systems based on this concept sprang up in ancient times in Greece, China, and India. While the Greek system was later overwhelmed by the Western scientific revolution, those in China and India have survived to modern times. "Today Asian medicine makes no distinction between body and mind in its approach to health and healing," says Micozzi. "The concept of a mind-body split just doesn't exist there. They don't know what we're talking about."
The Body Has a Mind of Its Own
By the 1930s, cracks in the foundations of strict biomedicine were already starting to appear. American psychiatrist Franz Alexander, M.D., built a framework for psychosomatic medicine with his astute observation that certain physical conditions seem to be strongly associated with emotional upset. As Alexander wrote in 1939, "many chronic disturbances are not caused by external, mechanical, chemical factors or by microorganisms, but by the continuous functional stress arising during the everyday life of the organism in its struggle for existence."
The traumatic events of World War II brought this connection to the forefront, as military doctors began reporting cases of what were called organ neuroses — conditions of the heart or digestive organs that were apparently caused by emotional disturbances. By the 1950s, the list of suspected psychosomatic diseases — conditions believed to be worsened by psychological stress — included asthma, high blood pressure, rheumatoid arthritis, peptic ulcers (ulcers of the stomach or upper small intestine), ulcerative colitis (ulcerating inflammation of the colon), neurodermatitis (skin inflammation associated with emotional disturbance), and hyperthyroidism (overactivity of the thyroid gland).
In the 1990s, we're still learning the hard way how chronic severe stress affects the human mind and body. This is shown by the emergence of a so-called Sarajevo syndrome, a cluster of stress-related psychological and physical symptoms that seem to be on the rise among residents of that beleaguered city. And researchers are still working to establish which diseases really are caused or worsened by stress. Any cause-and-effect relationship has not proved to be as straightforward as once assumed. For example, despite the long-standing reputation of peptic ulcers as a stress-induced disease, doctors now recognize that the Helicobacter pylori bacterium plays a major role in their development. Nevertheless, the impact of stress is pervasive. In fact, many popular mind-body therapies can actually be grouped under the heading of relaxation techniques — a broad term for therapeutic approaches used to counteract the body's stress response.
Holistic Healing and Hospitable Hospitals
However you categorize mind-body treatments, they tend to have certain basic characteristics in common. These fundamental principles include:
Holistic approach.Holism is a philosophy which states that all aspects of a human being — physical, mental, emotional, and spiritual — are interrelated. Therefore, holistic health care providers focus not just on a specific symptom or disease, but on the person as a whole. Advocates point out that the words "whole," "heal," and "holy" share the same linguistic root.
Emphasis on healing. Because of this focus on the total person, mind-body practitioners tend to stress bringing all sides of a person into better balance rather than just curing a particular disease or disorder. Therefore, the word "healing" is often used instead of "curing." Proponents claim it is possible for a person to be healed without the condition being cured.
Patient-centered care. Given the multifaceted nature of each individual's needs, patient-centered health care recognizes that only a fraction of these can be met by medical professionals. People are encouraged to be active participants in their own health care rather than passive recipients. Of course, all mind-body therapies require a person's active involvement.
Consumers are starting to demand more sensitive and personalized treatment, and health care centers around the country are scrambling to respond. At St. Charles Medical Center in Bend, Oregon, for example, many rooms boast scenic mountain or desert views. Roving minstrels and rotating art shows help humanize the environment, while a "humor cart" helps relieve stress. There's even a wheelchair-accessible fishing pond designed for use by patients recovering from strokes or brain injuries.
In fact, there is some solid evidence that more hospitable hospitals really may promote faster healing. One classic 1984 study published in Science analyzed the records of 46 patients who had undergone gall bladder surgery at a suburban Pennsylvania hospital. Half had stayed in rooms with windows that looked out onto trees, while the other half had been in identical rooms that afforded only views of a brick wall. The patients with the trees view had shorter postoperative hospital stays, received fewer negative evaluative comments in the nurses' notes, and required fewer potent painkilling medications in the days just after surgery.
The Planetree Alliance: Quality Care for Patients and Families
At the forefront of the movement toward more humanistic medicine is the Planetree Health Care Alliance. Since its founding in 1978, this nonprofit organization has helped establish patient-centered programs at more than 20 hospitals across the United States and in Europe.
"Before coming to Planetree, I got written up once for not emptying a dirty linen cart out of an isolation room," says nurse Laura Gilpin, R.N., now director of hospital development for the San Francisco-based organization. "I never got written up for not spending time with a woman whose breast was going to be taken off the next morning. Clearly, in subtle and not-so-subtle ways, the hospital was communicating the message that caring and compassion were not valued. Planetree gave me permission to be the sort of caregiver I wanted to be."
The various Planetree units offer a number of features, big and small, aimed at creating a more nurturing environment. Patients wear their own pajamas and sleep on flowered sheets. Visitors are allowed at all times, and friends and family can even cook for their loved ones in a specially provided kitchen. Interested family members are trained to serve as care partners, who learn how to perform such nursing tasks as changing dressings. Patients are also encouraged to educate themselves. To this end, the alliance operates several health resource centers around the country that are sources of health and medical information. In addition, an open-chart policy lets patients read their own records and even add their own comments.
People are free to pick and choose the services that seem most beneficial to them. Says Gilpin, "To me, what's important is to really personalize the care and make whatever is right for a given patient possible."
Bedside Manner 101 and Beyond
Of course, to make the most of holistic hospitals, you need more holistically oriented doctors to staff them. At medical schools nationwide, the push is on to provide training in mind-body and related approaches. For instance, in 1995, Harvard Medical School offered a continuing-education course for health professionals on alternative medicine that was billed as the first of its kind. Among the topics addressed were unconventional therapies for cancer and human immunodeficiency virus (HIV) infection.
While some mind-body classes concentrate on teaching specific techniques, such as hypnosis or biofeedback, others are essentially updated versions of Bedside Manner 101. Preliminary data presented by Michigan State University researchers at the 1995 meeting of the American Psychosomatic Society suggest that, not surprisingly, people may be happier with doctors who have learned to be more patient-centered. The researchers provided intensive training in psychosocial and humanistic aspects of medicine for 26 internal medicine and family practice residents. Instruction focused on such skills as giving top priority to patient needs, informing patients fully, and exhibiting warmth and confidence. Afterward, the patients of these residents expressed more satisfaction with their treatment than did the patients of other doctors.
Happier patients are one thing, but are they healthier, too? In fact, there's good evidence that expanding people's involvement in their own medical care can actually improve their prognosis. In one influential study, published in the Annals of Internal Medicine in 1985, researchers coached people with peptic ulcers in how to ask questions and negotiate decisions with their physicians. They also helped the patients read their own medical records. These patients were then compared to controls who had received only standard information about their condition. Audiotapes showed that the trained patients were twice as effective as the controls at getting information from their doctors. More importantly, patients in this group also reported fewer physical limitations six to eight weeks later.
Teaching New Docs Old Tricks
One of the most comprehensive programs in mind-body medical studies has been launched at the Georgetown University School of Medicine. The driving force behind this innovative curriculum is James Gordon, M.D., who is also founder and director of the Center for Mind-Body Medicine in Washington, D.C.
"Each year, I offer an elective for first-year medical students called the Healing Partnership," says Gordon. "Everyone in the class has to keep a journal, because self-awareness should be the foundation of any approach to health care. ... The students all meditate daily, and everybody engages in regular physical exercise."
Gordon also presents annual lectures on Illness as Personal Transformation and the Cultural and Social Context of Health and Illness. For second-year students, he offers a course called Introduction to Mind-Body Studies, which covers such topics as relaxation, meditation, self-hypnosis, biofeedback, and visual imagery. For fourth-year students in psychiatry, he supervises sessions in which such techniques are used with actual patients. Gordon also serves as a mentor to selected students who spend a month with him in his medical practice. In addition, he offers an extracurricular support group to help students cope with the stress of medical school.
The Georgetown program is regarded as a model for other medical schools across the nation. "There's a great deal of interest," says Gordon. "But most schools are just beginning something that has been evolving here since 1984. In many cases, they're starting out with a single elective course. Ultimately, they'll develop their own programs based on the talents and views of the faculty there."
Excerpted from Of Mind and Body by Linda Wasmer Smith. Copyright © 1997 Linda Wasmer Smith. Excerpted by permission of Henry Holt and Company.
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