How the Mind Impacts Health and Healing
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This document discusses the mind-body connection and the role of the doctor-patient relationship in healing. It summarizes research showing that sustained stress can cause physical harm, while relaxation techniques and meditation can benefit health by reducing stress responses. Placebo effects are shown to significantly improve conditions like Parkinson's disease and back pain. The conclusion is that every medical interaction has the potential to be therapeutic by connecting with patients and harnessing the mind's innate healing abilities.
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How the Mind Impacts Health and Healing
- 1. Doctor or Healer? Dr Nicholas Martin 2016
- 2. The story of Kinjika - Darwin Hospital 1953
- 4. So what’s the point? Voodoo is real? Magic happens?
- 6. Erich Menninger Von Lerchenthal
- 7. Flipside
- 10. Spontaneous remission project • 1000’s cancer survivors with a very poor prognosis. • 9 factors common to most of the patients Dr Kelly Turner• Radically changed their diet • Took control of their health • Followed their intuition • Used herbs and supplements • Released suppressed emotions • Increased positive emotions • Embraced social support • Deepend their spiritual connection • Had strong reasons for living
- 11. What do these anecdotes and case reports suggest? The body and the mind are connected
- 14. Neuro/hormonal response to a perceived threat • Predominantly mediated through sympathetic pathways • Elevated HR / BP • Hypercoagulable – increased platelet function and blood viscosity • Endocrine changes mobilise glucose and fatty acids • Activation of Amygdala • Suppression of prefrontal cortex Activation Response
- 15. What happens when the Activation Response is sustained? Allostatic Load • Prolonged stress leads to wear and tear on the body • Allostatic load leads to: • Impaired immunity, atherosclerosis, metabolic syndrome, bone demineralization • Atrophy of nerve cells in the brain • Hyppocampal formation: Learning and memory • Prefrontal cortex: working memory, executive function • Growth of Amygdala mediates fear response • Many of these processes are seen in chronic depression and anxiety McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.
- 17. Robert Sapolsky carries a tranquilized baboon.
- 18. Depression • Independent risk factor for CAD (Relative Risk 4.5 independent of coronary RF) • 2 fold risk of all cause mortality in 8000 healthy volunteers over 6 years • Impaired recovery from stroke, hip fracture, MI • 40% higher all cause mortality in breast cancer patients
- 19. Work Stress and aging • Data from sample of 2911 of the Finnish working-age population aged 30-64 • Individuals with prolonged work stress – Maslach’s Burnout Inventory had leukocyte telomeres on average 0.042 relative units shorter than those with no exhaustion (p=0.009)
- 20. • High-Hostile men had significantly shorter leukocyte TL than their low-hostile counterparts • The relationship between hostility and disease is stronger in men than in women, and men generally have a shorter life expectancy than women. Hostility and telomere length
- 23. Studies on effects of Meditation (Pioneered Dr Herbert Benson) • Decreased metabolism in body • Reduced HR • Reduced RR • Reduced BP • Reduced oxygen consumption Relaxation Response
- 24. Relaxation response changes gene expression RR practice comparing • Novice • Short term practitioners • Long term practitioners Enhanced expression of genes associated with • energy metabolism, • mitochondrial function, • insulin secretion, • telomere maintenance Reduced expression of genes associated with • Inflammatory response • Stress related pathways
- 25. Mindfulness and cellular aging • Meditation may slow genetic ageing and enhance genetic repair • Increases Telomerase Activity • Increases Telomerase Length
- 26. So what does that have to do with being a doctor?
- 27. That pesky placebo effect – getting in the way of studies and fooling patients!
- 29. GERAC trial chronic back pain
- 30. Placebo Parkinsons • Improved motor scores 20-30% • Improvement and deterioration observed after introduction and discontinuation of placebo • Placebo human fetal transplantation surgery 30% improvement sustained for 18 months • Increased Dopamine release in response to placebo
- 31. Placebo is a mind induced healing response
- 32. 1 2 3 262 IBS patients Empathy Active listening Touch Thoughtful silence Components of placebo
- 35. The right words…
- 37. Every interaction has the opportunity to be therapeutic
- 38. Take home messages • The body and the mind are inseparable • The doctor patient relationship is a vehicle for harnessing the healing or destructive powers of the mind • It begins with connection
Editor's Notes
- In 1953, a dying Aborigine named Kinjika was flown from Arnhem Land in Australia's Northern Territory to a hospital in Darwin. Tests revealed he had not been poisoned, injured, nor was he suffering from any sort of injury. Yet, the man was most definitely dying. After four days of agony spent in the hospital, Kinjika died on the fifth. It was said he died of bone pointing. Kinjika had been accused of an incestuous relationship (their mothers were the daughters of the same woman by different fathers). Instead of going to his trial, he fled the village. The hunters found him and cursed him. It is said that is why he died
- "Bone pointing" is a method of execution used by the Aborigines. It is said to leave no trace, and never fails to kill its victim. The bone used in this curse either made of either human, kangaroo, emu or even wood. The shape of the killing-bone, or kundela, varies from tribe to tribe. The lengths can be from six to nine inches. They look like a long needle. At the rounded end, a piece of hair is attached through the hole, and glued into place with a gummy resin from the spinifex bush. Before it can be used, the kundela is charged with a powerful psychic energy in a ritual that is kept secret from women and those who are not tribe members. To be effective, the ritual must be performed faultlessly. The bone is then given to the kurdaitcha, who are the tribe's ritual killers. These killers then go and hunt (if the person has fled) the condemned. The name, kurdaitcha, comes from the slippers they wear while on the hunt. The slippers are made of cockatoo (or emu) feathers and human hair—they virtually leave no footprints. Also, they wear kangaroo hair, which is stuck to their bodies after they coat themselves in human blood and they also don masks of emu feathers. They hunt in pairs or threes and will pursue their quarry for years if necessary, never giving up until the person has been cursed. Once the man is caught, one of the kurdaitcha goes down onto one knee and points the kundela. The victim is said to be frozen with fear and stays to hear the curse, a brief piercing chant, that the kurdaitcha chants. Then, he and his fellow hunters return to the village and the kundela is ritually burned. The condemned man may live for several days or even weeks. But, he believes so strongly in the curse that has been uttered, that he will surely die. It is said that the ritual loading of the kundela creates a "spear of thought" which pierces the victim when the bone is pointed at him. It is as if an actual spear has been thrust at him and his death is certain
- But speaking after his public address Mr Howard dismissed the curse and said he would deal with the issue calmly.
- Eighteenth Century Viennese neurologist and university teacher, Erich Menninger von Lerchenthal, described how students at his medical school picked on a much-disliked assistant. Planning to teach him a lesson, they sprung upon him before announcing that he was about to be decapitated. Blindfolding him, they bowed his head onto the chopping block. One student swung and ax into a chunk of wood, while another dropped a wet cloth on his neck. Convinced it was the kiss of a steel blade, the poor man “died on the spot”. Case study that is the stuff of fairy tales, a woman born on Friday the 13th in the Okefenokee Swamp near the Georgia-Florida border was one of three girls delivered that day by a midwife, who proclaimed that all three girls, born on such a fateful day, were hexed. The first, she announced, would die before her 16th birthday. The second would not survive her 21st. And the patient in question was told she would die before her 23rd birthday. As it turns out, the first two girls died within one day of their 16th and 21st birthdays. The third woman, terrified that she would die on her 23rd birthday, showed up at the hospital the day before her birthday, hyperventilating. Soon afterwards, just before she turned 23, she died, proving the midwife’s predictions correct. Viktor Frankl noted the differences in survival for concentration camp victims who lost hope compared with those for whom some purpose or hope remained.
- Spontaneous remission, as it is often referred to, caught the attention of Kelly Turner, PhD, when she was an undergraduate at Harvard University in Boston
- You are wandering through the deep dark eucalyptus jungles of the southwest…
- And you are set upon by a drop bear. What are your physiological responses.
- McEwen BS. Ann N Y Acad Sci. 2004;1032:1-7.
- Whitehall study 1960’s british public servants observational study noted higher mortality in the lower grade civil servant jobs independent of other known CVS risk factors Whitehall II 1984 to current 10,308 demonstrating same trend and trying to understand psychosocial and behavioural pathways to pathophysiological changes. Of note lower grade civil servants noted to have higher resting cortisol and larger cortisol jump 30 min post waking up (more pronounced on work days) than higher grade Kunz-Ebrect, S. R.; Kirschbaum, C.; Marmot, M; Steptoe, A (2004). "Differences in cortisol awakening response on work days and weekends in woman and men from the Whitehall II cohort".Psychoneuroendocrinology. 29 (4): 516–528 Marmot, M. G.; Davey Smith, G.; Stansfield, S.; et al. (1991). "Health Inequalities among British civil servants: the Whitehall II study". Lancet. 337 (8754): 1387–1393
- http://news.stanford.edu/news/2007/march7/sapolskysr-030707.html
- Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up (epidemiologic catchment area).Pratt LA, Ford DE, Crum RM, Armenian HK, Gallo JJ, Eaton WW Circulation. 1996 Dec 15; 94(12):3123-9. (RR 4.5 CAD indpendant of coronary RF 1500 participants) Depression and cardiovascular diseases.Aromaa A, Raitasalo R, Reunanen A, Impivaara O, Heliövaara M, Knekt P, Lehtinen V, Joukamaa M, Maatela J Acta Psychiatr Scand Suppl. 1994; 377():77-82 (all cause mortality 8000 healthy volunteers followed over mean 6.6 years Mini-Finland Health Survey Twice has high all cause mortality) Robinson RG. Treatment issues in post stroke depression. Depress Anxiety. 1998;1:85–90 Garrity TF, Klein RF. Emotional response and clinical severity as early determinants of six-month mortality after myocardial infarction. Heart Lung. 1975;4:730–737 Covinsky K, Kahana E, Chin M, et al. Depressive symptoms and 3-year mortality in older hospitalized medical patients. Ann Intern Med. 1999;130:563–569
- BrydonL, Lin J, Butcher L, HamerM, ErusalimskyJD, Blackburn EH, Steptoe A. Hostility and cellular aging in men from the Whitehall II cohort. BiolPsychiatry. 2012 May 1;71(9):767-73. doi: 10.1016/j.biopsych.2011.08.020.
- You are wandering through the deep dark eucalyptus jungles of the southwest…
- Benson, Herbert, 1975 (2001). The Relaxation Response. HarperCollin The relaxation response: psychophysiologic aspects and clinical applications H Benson, MM Greenwood… - The International Journal …, 1975
- Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways http://dx.doi.org/10.1371/journal.pone.0062817 Manoj K. Bhasin , Jeffery A. Dusek , Bei-Hung Chang , Marie G. Joseph, John W. Denninger, Gregory L. Fricchione, Herbert Benson , Towia A. Libermann
- Epel E, Daubenmier J, Moskowitz JT, Folkman S, Blackburn E. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009 Aug;1172:34-53. Loving-Kindness Meditation practice associated with longer telomeres in women Brain, Behavior, and Immunity, Volume 32, Issue null, Pages 159-163 Elizabeth A. Hoge, Maxine M. Chen, Esther Orr, Christina A. Metcalf, Laura E. Fischer, Mark H. Pollack, Immaculata DeVivo, Naomi M. Simon Influence of Mindfulness-Based Stress Reduction (MBSR) on Telomerase Activity in Women With Breast Cancer (BC http://www.huffingtonpost.com/sonimacom/the-science-of-meditations-effects-on-aging_b_8688678.html
- Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D., Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D., Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D., for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa13051
- Arch Gen Psychiatry. 2010 Aug;67(8):857-65. doi: 10.1001/archgenpsychiatry.2010.88. Effects of expectation on placebo-induced dopamine release in Parkinson disease. Lidstone SC1, Schulzer M, Dinelle K, Mak E, Sossi V, Ruth TJ, de la Fuente-Fernández R, Phillips AG, Stoessl AJ. Science. 2001 Aug 10;293(5532):1164-6. Expectation and dopamine release: mechanism of the placebo effect in Parkinson's disease. de la Fuente-Fernández R1, Ruth TJ, Sossi V, Schulzer M, Calne DB, Stoessl AJ. http://www.apdaparkinson.org/the-placebo-effect-in-clinical-trials-in-parkinsons-disease/
- IBD trial (2003-2006) Diagnosis made (Hawthorne effect) Limited interaction: Diagnosis made + sham acupuncture treatment + technician interaction (Placebo effect) Augmented interaction: Diagnoses made + sham acupuncture treatment + warm support patient-doctor interaction (Response to patient-practitioner interaction) Incremental doses of placebo 262 patients with irritable bowel syndrome All assessed at baseline, 3 and 6 weeks. Needle went up handle of needle, only a scratch, not real acupuncture patient-doctor interaction (empathy, attentive listening, touch, 20 seconds of thoughtful silence) Content / questions: Symptoms, IBS effect on relationships and lifestyle Pts understanding of cause and meaning of their condition Behaviours: A warm, friendly manner Active listening (such as repeating patient’s words, asking for clarifications) Empathy (such as saying “I can understand how difficult IBS must be for you”) 20 seconds of thoughtful silence while feeling the pulse or pondering the treatment plan Communication of confidence Positive expectation (“I have had much positive experience treating IBS and look forward to demonstrating that acupuncture is a valuable treatment in this trial”). 2. German acupuncture trials (GERAC). Double blind, placebo-controlled, multi-centred, parallel-group trial wth 1162 patients aimed at comparing traditional therapy (drugs and exercises) for chronic low back pain against verum acupuncture (legitimate) vs sham acupuncture (with retractable needles). Findings: acupuncture twice as effective as standard conventional therapy, but SHAM acupuncture was virtually the same as REAL acupuncture – ie. sham acupuncture did better than standard recommended therapy for chronic back pain! What does this tell us? Healing rituals may have a real and significant effect on highly prevalent conditions such as chronic low back pain.
- These results indicate that warmth, empathy, duration of interaction, and the communication of positive expectation might indeed significantly affect clinical outcome. The patient-physician relationship is the most robust component of the placebo effect
- Therapeutic rituals have a healing process that are part of the placebo effect Patients have classical conditioning from the process of diagnosis, investigation, treatment If the results of medical interactions and treatments in the past have been positive, then a placebo effect may occur with future treatments and the converse is true with nocebo effects. Ie. TRUST is built through this process. Betrayal of trust nocebo effect Eg. “The doctor didn’t listen to my chest”
- Oliver sacks Conversion disorder Appropriate investigations, thorough assessment, then reassurance and prediction – “you will get better” IBS study: Group 1: Patients told positively that they would be better in a few days 64% improved Group 2: Patients told that the doctor could not be sure what was wrong with them 39% improved Both groups suffered from the same transient complaints and the only variable was the doctor’s manner. Social power – status afforded to physicians Charmismatic power – personal characteristics of the physician Aesculapian power – physician possesses by cirtue of her training Medical consultation – a socially constructed asymmetric power relationships which is stylised and full of rituals. The more elaborate the ritual the more likely it is that a placebo effect will occur – the neurological examination? Facilitates meaning for the patient and confidence, trust. Listening, spending time, being informative, encourgaging involvement in the decision making process - - - > trust Consequently may engender a placebo effect Betrayal of trust - nocebo effect Eg. “The doctor didn’t listen to my chest” Therapeutic rituals Psychological explanations of the placebo effect suggest a degree of classical conditioning from the process of diagnosis, investigation, treatment If the results of medical interactions and treatments in the past have been positive, then a placebo effect may occur with future treatments and the converse is true with nocebo effects. Anticipatory response expectancies – dopaminergic pathwasy (rewards) in mesolimbic and mesocortical systems.
- A 2001 study at the University of South Carolina found that primary care patients had only 12 seconds to speak before being interrupted by their physician “When patients are in a difficult spot and struggling, they want some kind of affective or emotional presence,” Post says. “There needs to be some dimension of — if you will — heart.” Old adage Cure rarely Relieve suffering Comfort always Modern era Cure always Relieve suffering if you have the time Let someone else do the comforting