It’s all in your head
To illustrate what it is like to be trapped in a particular system of knowledge, Michel Foucault referred his readers to the movement of celestial beings. Medieval thinkers, he argued,...
To illustrate what it is like to be trapped in a particular system of knowledge, Michel Foucault referred his readers to the movement of celestial beings. Medieval thinkers, he argued, not only believed in the existence of angels, but also thought that these winged messengers could descend from the heavens in circular motions only. It was unthinkable that angels might move in any other way than by gentle downward spiralling. Today, the majority of Westerners no longer believe in angels. Instead, they tend to believe in the infallibility of science, and in the tenets of evidence-based medicine. Entrenched as many are within the materialist paradigm, believing in phenomena that cannot fully be explained with recourse to the principles of modern science is almost unthinkable today.
Practices that are based on the belief that the mind has the power to influence our physical body, its ability to heal and its capacity to guard itself more effectively against disease, have for a long time been dismissed as pseudo-science. Until recently, claims that ancient traditions such as meditation may offer powerful physical and psychological benefits, have been disdained as esoteric nonsense, and shown to be based on false physiological assumptions.
Partly, this dismissal as charlatanry of mind–body relations can be put down to the still powerful Cartesian legacy: in the seventeenth century, Descartes established the mind and the body as radically separate entities, and a dualistic view of matter and spirit has dominated Western philosophy and medicine ever since. Yet it is also a logical consequence of the advance of modern medicine, which replaced ancient holistic models that placed the emphasis above all on subjective patient experience. Since the nineteenth century, the focus has shifted ever more towards measurability and the analysis of structural, visible changes in the physical body.
Recently, however, as Jo Marchant shows in her thought-provoking book Cure: A journey into the science of mind over body, a considerable number of medical researchers have begun to investigate the efficacy of a range of mind–body-based cures, drawing on the traditional tools of evidence-based medicine. These include randomized control-group trials and various ways of measuring physiological changes, such as brain scanning, DNA analysis, blood tests and the evaluation of complex epidemiological data. This new generation of evidence-based mind–body researchers has produced some remarkable findings, which Marchant analyses with elegance and lucidity. Interviewing researchers and patients, and explaining the set-up and outcomes of numerous recent studies, she covers phenomena such as the placebo effect, hypnosis, conditioning and biofeedback. The bulk of what she finds calls, she argues, for nothing less than a revolution in patient care, health policies and the way in which research is funded.
Nobody would deny the existence of the following mind–body interactions: thinking of something we fear, such as spiders, heights, or public speaking, can accelerate our heartbeat and our breathing, make us dizzy, or cause us to sweat. Imagining certain foods we like can prompt us to salivate, while thinking of foods we detest might make us feel nauseous. Stress can make our hair turn grey. Fantasizing about someone we desire can easily result in a physical reaction. But what about more complicated mind–dynamics?
The placebo effect is a much-discussed phenomenon. The very belief that forms of treatment can help us to get better, as well as the fact that placebos are often administered by those with medical authority or by healers, can in its own right have the power to heal. What is more striking, however, is that recent studies have shown that placebos have a measurable biological effect on the brains of trial participants. Researchers have suggested that the placebo effect is operative even in the case of drugs with active ingredients: taking drugs triggers an expectation that our pain will ease, and this expectation releases natural endorphins. The placebo effect is most significant in psychiatric disorders, such as depression and anxiety: in most cases, antidepressants such as Prozac are only marginally more effective than placebos, if at all. Which does not mean, of course, that they do not work: the point is precisely that placebos do indeed have the power measurably to affect our bodies and sense of wellbeing.
It is now commonly accepted that chronic stress can significantly damage our long-term health. Under duress, our body releases hormones including adrenaline and cortisol into the bloodstream. The original function of this “fight-or-flight response” was to enable us to escape predators: all essential energies are made available, glucose and fat are pumped into the bloodstream, and blood is diverted from areas such as the stomach and sexual organs to the limbs and the brain. But stress can be triggered by psychological factors, too, and in these cases can become chronic. It is not fanciful to say that chronic stress can kill: when cortisol is released continuously into the body, this suppresses the immune system, making us more susceptible to infections and inflammation. In a state of chronic stress, we are more vulnerable to colds and our wounds heal more slowly. Our cardiovascular system is strained and the likelihood of death from heart failure increases. Chronic psychological tension can even increase the risk of certain forms of cancer: laboratory experiments on animals have shown that stress inhibits DNA repair mechanisms, “and that it suppresses parts of the immune response, such as natural killer cells, that normally fight tumors”.
Marchant’s account of the research on the effects of poverty on health is particularly disturbing. People at the lower end of the socioeconomic scale – who constantly have to battle with financial worries, social alienation and hopelessness – are more likely to be ill and to die from strokes, heart disease, obesity, chronic lung disease and cancer. Exposure to chronic stress also affects reward circuits in our brain, leading to a prioritization of immediate pleasure over future gains. Even after having taken into account that living in poverty usually goes hand in hand with unhealthier lifestyles (eating less healthily, drinking and smoking more, and exercising less), researchers have concluded that chronic stress materially influences our brains, and that “the stress and alienation of being poor cause chronic inflammation that damages health throughout people’s lives”.
Hypnotherapy, by reaching beyond the conscious mind and affecting more deep-seated thought patterns and beliefs, has been shown to lower our stress levels significantly and influence immune responses associated with stress, as well as to reduce inflammation and patients’ perception of pain. It has also proven to be very effective in the treatment of Irritable Bowel Syndrome: a recent study showed that hypnotherapy helps 70 to 80 per cent of patients for whom all other treatments have failed.
Unsurprisingly, both the quality and the quantity of care that patients receive makes a difference. A study from 2012 involving over 15,000 women in sixteen countries found that those who have one-to-one continuous support through labour are significantly less likely to need a Caesarean or instrumental birth, or to use strong painkillers, thus allowing their body’s natural hormones to do their work. The study concluded that “emotional support from a single, trusted person” significantly reduced birth complications and the need for medical interventions. Other trials have shown that mere comforting talk before and after medical interventions has a measurable impact on patients’ pain and anxiety levels, significantly lowering their need for drugs: in a randomized controlled trial of 241 people undergoing renal and vascular procedures in Boston, for example, “pain scores in the intervention group peaked at 2.5 out of 10 compared to 7.5 for the controls”.
Mindfulness-based Cognitive Therapy cuts by 50 per cent the relapse rate in patients with recurrent major depression. These patients have fewer symptoms, a better quality of life and a 24 per cent lower relapse rate than those treated only with drugs. Other studies have established that meditation not only alters mood and reduces signs of physiological stress, while also lowering the markers of inflammation in the body, but can in fact change the very physical structure of our brains in beneficial ways.
Loneliness, too, increases mortality rates as seriously as smoking. A study from 1982, in which a group of epidemiologists analysed the health patterns of residents in Tecumseh, Michigan, found that adults who report fewer social relationships and activities are twice as likely to die over the next decade. The same team conducted further research in other cities, each time taking into account age and other risk factors, and concluded that “social isolation is as dangerous for health as obesity, inactivity and smoking”. In 2013, scientists at Harvard who studied 734,000 cancer patients established that those who are married are 20 per cent less likely to die from their illnesses. One explanation for these phenomena is that loneliness and the experience of social exclusion “activate exactly the same regions of the brain as when we are in physical pain”. Moreover, lonely people tend to experience social interactions more frequently as threatening scenarios, and consequently have higher basic stress and inflammation levels than their better-connected peers.
Marchant concludes that many forms of alternative medicine do not work in the way that their practitioners claim they do work, but rather in other, rationally explicable ways. The “true active ingredients” of these treatments appear to be empathy, feeling safe and cared for, social support, the placebo effect and hope. The human brain possesses some important means of self-healing, such as the release of hormones and natural painkillers, as well as the control over the efficacy of the immune system, and can thus indeed help to ease symptoms and fight disease.
The principal health threats facing us in the twenty-first century are not acute infections (for which, of course, old-fashioned drugs work better than mindfulness and its various siblings), but chronic stress- and lifestyle- related conditions for which drugs are likely to be less effective. Marchant’s hope is that in the near future the human aspects of care will no longer be seen as an “add-on luxury, but as a central, guiding principle towards improving patient outcomes”. However, a major obstacle to translating the findings of the new mind–body research into policies and practices lies in the way in which medical research is funded: the vast majority of clinical trials in the UK and the US “are funded by drug companies, who understandably have no interest in proving the benefit of any approach to care that might reduce the need for their products”.
Ultimately, Marchant turns the mind–body medicine debate on its head by suggesting that “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”. While alternative medicine and holistic traditions are still often viewed as unsound practices, it is in fact the Cartesian idea of the mind as radically distinct from the body, “an ephemeral entity that floats somewhere in the skull like a spirit or a soul, that makes no scientific sense”. Many of our illnesses are not either exclusively physiological or psychological, but in fact both at the same time.
The cause espoused by Jo Marchant does have a downside, however. In many cases, it is precisely a discontent with the cold, rational, scientific approach to medicine that drives patients to seek holistic treatments. Re-rationalizing these treatments, robbing them of their aura and their spiritual dimension, making them fit neatly within a materialist world view, might well lead to a further process of disenchantment. Is not the exotic otherness of some of these treatments at the very heart of their appeal, and possibly even their main “active ingredient”? Should it be as unthinkable for the twenty-first century as the idea of zigzagging angels was in the Middle Ages to accept that we may quite simply find solace in ancient practices precisely because they remain resistant to the sober dictates of scientistic measurability?