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Thinking can alter the way body fights disease,
new research shows
By Ronald Kotulak
Chicago Tribune
(MCT)

CHICAGO - Western medicine separated the mind from the body in the Middle Ages when the famous French philosopher and mathematician Rene Descartes agreed to accept flesh and bone as the province of physicians, while the Catholic Church claimed possession of the mind, insisting it was the creation of the soul.

But Descartes, whose works were placed on the Church's Index of Prohibited Books in 1667, believed the two really interacted in the brain. Using the fledging powers of observation and deductive reasoning that he was then developing, Descartes could conclude that "the mind is so intimately dependent upon the condition and relation of the organs of the body, that if any means can ever be found to render men wiser and more ingenious than hitherto, I believe that it is in medicine they must be sought for."

It's taken a long time, but doctors and psychologists are now bringing the mind and the body back together amid new evidence that the mind can improve the healing process in ways that traditional medicine can't.

Unlike earlier notions about the mind-body connection, which were often based on anecdotal stories or simply "gut" feelings, scientists now can document through powerful imaging technology what Descartes could only deduce, that our thoughts are capable of producing dramatic chemical and physical changes that directly affect our health.

Hospitals, including Northwestern Memorial in the Chicago area, are enlisting the help of "health psychologists" to find nontraditional ways to treat patients with common disorders like cancer, heart disease and gastrointestinal problems. In doing so, doctors have had to come to grips with something that many have been reluctant to admit: that a patient's beliefs can affect the healing process, and that the so-called placebo effect is not an exercise in self-deception, but an authentic biological reaction orchestrated by the brain.

"Over the last several decades the empirical evidence (for the placebo effect) has really mounted, and people in our culture today are much more likely to embrace this mind-body interaction and synthesis," says Kim Lebowitz, director of cardiac behavioral medicine, who was recruited in 2004 by Northwestern Memorial, becoming the first psychologist in the country to be hired full time by a hospital cardiac unit.

Health psychologists are not like psychiatrists, who try to uncover childhood roots of emotional problems. Rather, their practice, called behavioral medicine, is based on studies showing that stress, anxiety and depression - which show up as physical symptoms and are a major reason 60 percent of patients visit doctors - can harm the body just as directly as germs, artery-clogging diets, lack of exercise, obesity and misbehaving genes. They are at the interface of psychology and biology, where what people think and their beliefs can either increase the risk of disease on the one hand, or restore equanimity on the other.

Patricia Mumby, assistant professor in the department of behavioral neurosciences at Loyola University Medical Center, is part of the new breed. A longtime registered nurse, she became dissatisfied with medicine's half measure of care and went back to school to study psychology. She felt it was an untapped reservoir of healing.

"Patients are recognizing the (mind-body) connection, and they want more control over their own health care and their own well-being. Health care providers are recognizing it too and are more open to it."

The healing power of the tools used by health psychologists - relaxation techniques, self-hypnosis, biofeedback, yoga, acupuncture, exercise, coping skills - rests on two revolutionary findings by researchers into how the brain works. One is that a vast network of nerves hard-wires the brain to all the body's organs in more ways than previously thought. The second is that the brain constantly sends out streams of hormones to regulate the digestive, heart and immune systems and then responds to the chemical messages sent back.

This field of research, with the formidable name of psychoneuroimmunology, studies how stressors, and the negative emotions they generate, are translated into physical changes. The brain, for example, carries on a two-way conversation with the immune system, and stress can dial up such hormones as cortisol and adrenaline, increasing the risk of infection and delaying healing. Laughter and exercise, on the other hand, can release hormones that subdue inflammation and jack up natural killer cells, which may provide increased protection against cancer.

Descartes knew that the brain could easily be deceived, that the thrill experienced by someone mistaking a piece of glass for a diamond would feel as genuine as if they had found the real thing. What recent research has revealed are the chemical alterations in the brain that underlie these emotions. New findings show, amazingly, that the brains of people in clinical trials who take what they think is a potent drug, but which really is a sugar pill or placebo, produce almost the identical neurochemical changes as the brains of drug takers.

In one study, during which Parkinson's disease patients got noticeably better on a sham drug, imaging showed their brains were producing more of the muscle-controlling chemical acetylcholine as were the patients receiving the real medication. Placebos routinely improve disease symptoms 30 to 60 percent of the time, compared to active medications, which often do not do much better. And, like real drugs, placebos can produce adverse side effects when subjects think those side effects are possible.

It is 21st century evidence for what the Stoic philosopher, Lucius Seneca, noted some 2,000 years ago: "It is part of the cure to wish to be cured."

Dr. Patrick McCarthy, co-director of Northwestern Memorial Hospital's Bluhm Cardiovascular Institute, understands what Seneca was talking about. "With surgery we can fix hearts that are (diseased), but that only goes so far," he says. Patients may still be dealing with depression or stress or some other condition that can affect their hearts.

"Twenty years ago, if you'd suggested to someone that they should see a clinical psychologist, they probably would have had a lot of resistance - `I'm not crazy. I don't need them,'" McCarthy says. "It's a lot more accepted now. People realize that depression is part of their heart condition."

Delores Rogalski, a 57-year-old from St. Joseph, Mich., underwent a heart transplant at Northwestern Memorial after dealing with a "plateful" of stress in a tumultuous four-month period, including a divorce, lung operation, her daughter's hospitalization, deaths of a close friend and mother-in-law and her transplant.

Rogalski's treatment included sessions with Lebowitz, the director of behavioral medicine, to reverse her downward spiral of stress. People try to predict or control their environment, Lebowitz says, and when problems pile up, anxiety results: They tend to concentrate on all the things that are out of their control.

Before the transplant, Lebowitz taught Rogalski mental and behavioral exercises to relax her mind and body. She started with slow, deep breathing, then moved on to progressive relaxation of every muscle system from head to toe. Learning to imagine pleasant things transported her mind into a safe, healing place. She imagined being on a beach or in the countryside, recalling all the delightful smells, colors and vistas.

"I'm not anything like the person that walked in here," Rogalski says. "I've accepted my divorce. I've accepted the things that I couldn't do anything about. I put things in perspective in my life. That's the key thing. Emotionally, I was all over the place."

After Rogalski got her transplant, "I was having her imagine this powerful heart, very healthy, very pink, beating very rhythmically," Lebowitz says. That was a very profound image for her. It gave her a lot of comfort and strength."

When scientists talk about stress, they mean chronic stress, the kind that lasts at least two weeks, not the everyday variety that virtually everyone experiences, like a mood swing caused by a friend's careless remark, a temporary setback at work or declining stock prices.

Like Bruce McEwen, a Rockefeller University neuroendocrinologist, they have found that such stress can change the brain's wiring in harmful ways. His research shows that stress hormones can activate an inflammatory response in the body that doubles back to hit the brain, not only in the areas that govern blood pressure, heart rate, intestinal activity and other responses, but in areas of higher cognitive function that processes memories, fear and anxiety.

"It turns out that circuits in these parts of the brain are very sensitive to stress, and we're just beginning to realize the myriad consequences that this will have on a person," he says.

One characteristic of chronic stress and depression is called the "sickness syndrome."

"You feel like when you have a cold or the flu," McEwen says. "You feel totally without energy. Your brain is foggy. You can't remember anything that's happening. You feel physically sick. This is caused by an inflammatory response in your body which is then transmitted into the brain."

And then transmitted from the brain back to the heart or other organs.

"Your gut's fundamentally a dumb beast. Your heart's fundamentally a dumb beast. They take their direction from the central nervous system," says Dr. Michael Jones, director of Northwestern Memorial's Center for Functional Gastrointestinal and Motility Disorders.

That connection has been lost, he says, since the Enlightenment in the 18th Century, when scientists decided to study the human condition and Descartes was one of its luminaries. "That was also the time of the Inquisition," Jones notes, "and the Catholic Church basically said: `Rene, that's a wonderful idea, but I just really want you to keep in mind that the mind and the soul belong to God and the Catholic Church.'"

Mind-body dualism also was an efficient business model - you have an ill, I have a pill. But it neglected the natural healing - and potentially destructive - power of the brain, Jones says.

The brain's effect on the body has always been evident in some ways: A stressful situation triggers a feeling of butterflies in the stomach, one of the first organs to be hit by chronic stress. The meal you are enjoying will not digest as well if it is interrupted by a call from the IRS saying your tax return will be audited.

It doesn't matter if you're stressed because you're making your gut miserable or whether you're stressed because you're gut is making you miserable, Jones says. What matters is breaking the cycle.

"I've got the latest and greatest motility drugs and visceral analgesics," Jones says. "We have all the bells and whistles, and none of it really does anything (if chronic stress is involved). But when you talk to people and put their problem in the context of their lives and look at the big picture, they start to get better."

Three years ago when Seth Knocke was 16, the youth began experiencing severe nausea after eating. He saw several doctors to no avail and finally was referred to Jones, who first tried his "bells and whistles." An anti-nausea drug had no effect. That was followed by an antidepressant to relax the digestive system's smooth muscles. That worked for eight months, then the nausea returned as intensely as before.

That's when Jones called in clinical psychologist Laurie Keefer, now a full-time member of his team at Northwestern. Jones figured out that Knocke's troubles began with a stomach virus that made him nauseated when he ate. Even after the virus went away, his brain retained that association and released nausea-producing chemicals whenever he consumed food.

To break that noxious cycle, Keefer tried teaching Knocke self-hypnosis, in which the patient remains fully conscious but relaxes to the point where he is in a state near falling asleep, preparing his brain to accept information that would disassociate food from nausea.

Staring at a lighted picture in a dark room, Knocke listened to Keefer suggest that he was making a gentle descent on a soft cloud to a boat in a tranquil pond. Drinking the cool water would feel like medicine going down his throat and into his stomach, where it would cure any nausea.

After five once-a-week sessions, the nausea went away. The few times since then that it threatened to return, Knocke went into his self-hypnosis mode, soothing his stomach with an imaginary sip of cool water. Now a freshman at Beloit College, he plans to major in psychology, inspired by his experience with the healing power of self-hypnosis.

"They said my brain was essentially a computer with a hard drive," Knocke says. "What got loaded into my brain was this nausea and they just needed to rewire it and I'll be OK."

Irritable bowel syndrome is the No. 1 reason people seek out gastroenterologists. Since current drug therapy for this condition often is disappointing, an increasing number of physicians are switching to treating the brain in order to calm the gut.

A recent study by University of Manchester researchers found that at the end of one year, both psychotherapy and antidepressants were better at reducing symptoms and improving quality of life than routine care. Furthermore, psychotherapy was the cheapest to provide, costing 22 percent less than antidepressants and 41 percent less that standard therapy.

Selma Holme turned to a stress-reduction regimen while she was being treated for uterine cancer two years ago. After 14 years of caring for her husband, Jack, who has Parkinson's disease, she felt as if her immune system had burned out.

Holme first turned to guided imagery to relax and then to self-hypnosis. A year ago, she started receiving acupuncture treatments as part of Loyola's stress-reduction program. It wasn't long before her husband commented on how she wasn't as uptight as before, then her daughter remarked on how well she and her husband were getting along.

"I have more energy. I'm optimistic," says Holme, who is now cancer-free after radiation therapy.

Obviously, behavioral medicine cannot replace vaccines, drugs, surgery or other conventional medicine, and no one knows exactly how effective it is. But there is a growing consensus in the medical community that stress, anxiety and depression are bad for health and need to be treated.

In 1995, Ohio State University researchers Janice Kiecolt-Glaser and her husband, Ronald Glaser, published a pivotal study showing that relatives who cared for Alzheimer's patients, a stressful task, took 24 percent longer to heal from small, laboratory-induced superficial flesh wounds than people in the same age and economic bracket who were not caregivers.

That was followed by a second study showing that wound-healing in students facing midterm exams took 40 percent longer than when they looked forward to summer vacation.

Stress plays havoc with hormones like cortisol, known as the stress hormone, and adrenaline, the fight-or-flight hormone, says Glaser, director of OSU's Institute for Behavioral Medicine Research. They can cause blood cells to lose their equilibrium, change their function and deregulate the immune system, he explains. Immune cells start pumping out inflammatory proteins called cytokines, which in the short run speed healing but when produced in excess can damage tissue all through the body, increasing the risk of cancer, heart disease, osteoporosis and diabetes.

"When Jan and I started working with each other, quite frankly I didn't believe this," Glaser says, referring to the impact of stress on disease and healing. "I said, `OK, we'll do a study and if it doesn't work that'll be the end of it.' So here we are 20 years later still doing this research, because obviously it worked."

In fact, it's changing medicine, he says. "Physicians will start asking patients what's going on in their lives when they come in with infectious diseases or cancer or metabolic diseases or diabetes or obesity. Because now we know that what's going on in their lives is affecting those diseases."

The first indication that stress was not just a nuisance but could hammer internal organs came in the early 1900s, when Harvard's Walter Cannon discovered that whenever people feel threatened, the body rushes to raise blood pressure, heart rate, muscle tension and breathing.

sixty years later, in the same laboratory used by Cannon, Dr. Herbert Benson discovered the antidote to stress: the "relaxation response."

During his research, Benson was leery of incurring the scorn of his Harvard colleagues, so he waited until the dark of night to bring in subjects, who practiced transcendental meditation. Simply by thinking, he found, they could dramatically alter body functions. Breathing slowed by 25 percent, oxygen consumption declined by 17 percent, blood pressure fell and heart rate slowed.

And it wasn't just meditation that reduced stress. Further research showed that deep breathing, progressive muscle relaxation, hypnosis, guided imagery, prayer and other techniques could achieve relaxation.

"Any disorder that is caused or made worse by stress, to that extent the relaxation response is an effective therapy," says Benson, the Mind/Body Medical Institute associate professor of medicine at Harvard Medical School. "We found it useful in hypertension, anxiety, mild and moderate depression, excessive anger and hostility, and insomnia, among other things."

People intuitively feel that doing something to calm their nerves helps, he says. A federally funded study in 2004 revealed that half of all Americans practice some form of relaxation, although most never tell their physicians.

"We view health and well-being as akin to a three-legged stool," Benson says. "One leg is drugs and the second leg is surgery and medical procedures. But there has to be a third leg and that's self-care, which involves such things as the relaxation response, nutrition and exercise."

Benson's investigation of the placebo effect, which is different than the relaxation response, leads him to conclude that it works by triggering memory traces that regulate stress hormones, a process he calls "remembered wellness."

"There are three components of the placebo effect," he says. "The belief and expectations of the patient, the belief and expectations of the physician or health professional and the belief and expectations that come from the relationship of the two.

"When they're in sync, remarkable healing properties come about. If you believe yourself (to be) well, you can often be well. Will this cure all diseases? Of course not. But many medicines are perhaps working because of the placebo effect."

Psychological interventions may aid healing, but can they prolong the lives of seriously ill patients? That remains controversial, though some studies suggest a positive effect. Alastair J. Cunningham of the Ontario Cancer Institute found that terminally ill cancer patients who remained upbeat tended to live longer than equally ill patients who succumbed to stress and depression.

"We have some evidence that when people get very involved in helping themselves in these ways they can live longer," Cunningham says. "But there are no guarantees."

If stress causes bad chemical changes in the brain, can happiness produce good changes? Finding out is the goal of Lee Berk, associate professor of health promotion and education at Loma Linda University near Los Angeles.

Spurred on in his research by the late Norman Cousins, who maintained that laughing at Laurel and Hardy comedies helped him overcome a life-threatening autoimmune disease, Berk discovered that laughter, as well as exercise, music and meditation increase levels of endorphin, a key brain chemical. Endorphin, which is actually morphine produced by the body, is a mood elevator and reduces levels of stress hormones.

"It slows the heart rate, lowers blood pressure and reduces respiration so you don't need to breathe fast," Berk says. "It plugs into immune cells and produces beneficial changes."

Berk's study of patients who suffered their first heart attack showed that those who watched a comedy or sitcom half an hour a day were significantly less likely to suffer a second attack than comparable patients who were not given a prescription for humor.

"If we could package mirthful laughter in a pill, it would literally require FDA approval to give it to patients because of all the changes that take place," he says.

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