The Panic and Pain of Mind-Body Dualism
In the opening scene of the classic semi-autobiographical comic novel Three Men In Boat, the writer Jerome K. Jerome is looking for a hay fever treatment when he casually begins reading about other diseases. By the time he’s finished, he concludes that he has every disease on the list. "I had walked into that reading-room a happy healthy man. I crawled out a decrepit wreck." He goes to his doctor, an "old chum" who gives a him prescription for a good meal, a pint of beer, a ten-mile walk every morning, and going to bed at 11 every night. "And don’t stuff up your head with things you don’t understand."
In the 21st century, the list of symptoms, ailments, and treatments seems to have expanded exponentially, and a few clicks online elicit total body panic, usually in the middle of the night. We are too tense to sleep. Even when we try to avoid cyber induced illnesses, we are confronted with TV ads interrupting our favorite shows with reminders that we pee too frequently, we’re not happy enough, and we should be getting more frequent and longer lasting erections. So we hurry ourselves to the doctor. What does our 21st century American doctor prescribe? Rather than telling us to walk ten miles, he or she doles out pharmaceutical samples, orders tests, and sends us on our way more convinced than ever that our few remaining days on earth will be "quite miserable." Writers seem particularly prone to this sort of panic (not to mention bad alliteration).
Many times, my imagination has been stoked by casual comments from well-meaning doctors. Once, a doctor who sounded as if he’d practiced several English phrases and used them with abandon, had his finger fully up my rectum and casually said, "So, have any other of your family members had prostate cancer?" Another time, a doctor in California, in 1982, cavalierly misdiagnosed me with an incurable disease. "You might," he said, "Never have these symptoms again." Then again, I thought, I just might. So after years of anxiety-induced discomfort, I summoned the courage to get the test that confirmed what I should have known all along. The doctor was dead wrong. Even now, thinking about it can sometimes bring on fear. There have been instances since then. Each time, fear and anxiety exacerbated a minor stress-induced problem. No wonder we avoid doctors.
But it’s not their fault. They are trained to be objective, to diagnose based on a 10-15 minute meeting and then treat the symptoms, usually by giving you some pills. If the pills don’t work, you go back for another 10-15 minutes. You get different pills because sometimes one pill doesn’t work when another will (nobody really knows why). Or you get a stronger dosage with more potential for uncomfortable side effects. When these pills fail, you’re often then propelled into the land of specialists and expensive testing. A year later, after numerous inconclusive tests, you’re feeling worse than you ever have. Each doctor has an opinion or theory based on their specialty. A urologist will think prostate infection, a orthopedist might say muscle tear or strain, and a neurologist blames nerve impingement. They don’t consider the effect of their musings. Sometimes they merely shrug and move onto the next patient.
A placebo might help you as effectively as any prescription, but doctors are reluctant to use them for obvious reasons. What if they give someone a sugar pill and the patient dies? Whoops. They must remain objective. Logically then, they cannot acknowledge the opposite of placebo -- the "nocebo effect," a belief your ailment will appear or get worse rather than disappear or get better. Often, the nocebo effect occurs after a speedy misdiagnosis. Have you ever had a minor pain and, when you were told it was some degenerative disease, felt much worse? A mild symptom like a burning feeling on your skin becomes "incurable neuropathy." Muscle pulls and strains send you into the claustrophobic MRI tube. When the results show a herniated disk, your worst fears have been confirmed -- you won’t be able to walk ever again. Anxiety can cause symptoms, which can cause more anxiety, which can cause more symptoms. If your doctor says you have a problem, you will be much more likely to experience that problem. Soon you are like Jerome K. Jerome and feeling "seedy." You imagine the end of the world.
However, most of it is balderdash. Everyone, as they age, develops such things as herniated disks and spinal stenosis but most don’t have any pain at all. So how did you get your back, thigh, groin, arm (endless list) pain? You did nothing different. Your pain seemed to come from nowhere. There was no injury that you can remember. Or you had an injury and everything healed properly. But you still have lots of pain. At this point, you should consider that you might be suffering from a "mind-body disorder." We all have some repressed anger. It’s a natural phenomena. Getting older can cause anger. After all, who among us likes to admit the five-mile run we used to speed through now takes twice as long and makes our body ache? Maybe you have repressed anger impinging on your already overstressed life. Maybe your pain has become a "habit" initiated by misdiagnosis and perpetuated by fear.
Such emotional factors can cause physical symptoms. This is the key premise behind the work of Dr. John Sarno and others who have followed him. You may be thinking the premise obvious. But current medical doctrine does not accept this notion, while paradoxically accepting that stress and anxiety can exacerbate symptoms. (Even stranger when you consider that doctors have no trouble accepting you’re stress-induced headache. So why not a backache?) If you read Sarno’s books, you may initially think they offer no solution at all. That’s because we’re all looking for a quick fix. We’re stuck in our pill-popping mentality. Thinking "psychological" when you have a "physical" pain is not what we’ve been taught to believe. It is more acceptable to have a horrible cold, a bad back, irritable bowel syndrome, constipation, and urinary frequency than to admit a "psychological problem." Suffering through your pain to "get it done" makes you a hero. What happens when you say you have "emotional problems?" What a wimp! Most of us would rather have the pain. But neither would be nice, wouldn’t it?
Sarno’s books are often repetitious. But as it turns out the repetition is important, like practicing your multiplication. The "solution" lies in accepting that your brain is causing your pain. Current studies of the brain show that you can change your neural pathways, and logically then eliminate or "unlearn" your pain. "When we learn a bad habit, it takes over a brain map, and each time we repeat it, it claims more control of that map and prevents the use of that space for ‘good’ habits. That is why ‘unleaning’ is often a lot harder than learning" (Norman Doidge in "The Brain That Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science"). Doidge also suggests that "brain exercises" can be as effective as drugs. The brain is nueroplastic. It changes. Often, even after an injury has healed, your brain remains changed. New neural pathways have been established. If you panic and obsess over the pain -- will I have pain for the rest of my life? -- the pathways become entrenched, "learned," and remain long after the injury has healed. You must then "unlearn" your pain.
For too long, we have unconsciously accepted Descartes’ mind-body dualism; that is, that the mind is completely different than the body. Sure, it is comforting to know that the mind can exist without the body, and therefore "life" after death is possible. But this same dualism creates a world in which we treat the body as if it were separate from the "mind." However, with new studies in nueroplasticity, the barrier between mind and brain have crumbled. We can now think of mind and brain as one. The mind becomes the brain. The brain is part of the body. Now we can integrate the mind and the body and treat individuals as whole human beings.
Know the Nocebo Effect
The "nocebo" effect is basically the opposite of the placebo effect. Like the placebo effect, the nocebo effect is a "self-fulfilling prophecy," only the nocebo is a belief that some ailment will appear or get worse, rather than disappear or get better. For example, if patients are warned about nausea as a side effect of their medication, they are, according to documented scientific research, three times as likely to experience nausea as those not warned. So, how do you tell if you are experiencing a nocebo effect?
- Have you experienced side effects from medicine in the past? If so, you are more likely to expect side effects from your current medication, and that expectation can increase the chances of a nocebo effect.
- Are you an anxious person, prone to depression? Anxiety and depression can cause physical symptoms. This can be a self-perpetuating cycle. Anxiety and depression can lead to medication, which can lead to the expectation of side effects, which can produce side effects, causing more anxiety… Insurance companies and doctors are quick to prescribe pills but not the therapy that is usually also required. And patients are quick to swallow pills because its conceivably more private than therapy, less time consuming, and easier to get insurance to pay.
- What color is your pill? Even the color of the pill can cause patients to have varying reactions. If your pill is blue or green, you might experience a depressant nocebo effect… sleepiness, fatigue, and so on. If your pill is red or orange, you will experience a stimulant nocebo effect.
- Have you had this symptom before? How often? If you’re sick, you are hyper-attentive to physical symptoms. A previous mild symptom like itchy skin, burning feeling, and aches morph in your mind to "incurable neuropathy" caused by your medicine, or worse.
- Do you trust your doctor? If you believe your doctor, then you are more likely to experience symptoms, or not, depending on what the doctor says.
- Are people around you experiencing similar symptoms? Many studies have shown "group effects," "mob mentality," and "mass hysteria." If you are around people who experience your symptoms, your are more likely to experience them yourself. On the other hand, of course, knowing that you are not alone can help ease your anxiety, and thus reduce symptoms. Know the difference between hysteria and commiseration. Online discussion forums can be helpful, but one-on-one personal interaction seems better, as long as you are both trying to lift each others spirits and are trying to overcome the nocebo effect.
If you suspect you are experiencing a placebo effect, think about something else. Distract yourself. Don’t question anything and forget about researching your condition. Try to enjoy feeling good.
Doctors, traditionally reluctant to accept or try to use the placebo effect, are not keen to recognize the nocebo effect. Imagine being sued for not telling a patient about possible side effects. Then being sued for telling a patient about possible side effects.
Futuristic Health Care – Fantasy?
Imagine hospitals full of life, glittering domes soaking up sunlight in winter and reflecting it in summer, hospitals where suffering is alleviated and patients wake to the smell of spring rain and lilacs. Your personal physician leads your health team, and you meet your team-leader, a specialist, scientist-teacher. You discuss your health while sitting on the wooden deck overlooking green hills.
Your specialist teaches you about your personal Nano-bio-machines swimming in a glistening drop of water, like tadpoles in a crystalline river, the drop dropping onto your dry lips, and rushing into the current of your body. Your Nano-bios are on their way to schedule a meeting with your tumor, traveling your electromagnetic aura, and your physician and specialist can smile and scientifically say the word "aura" without sniggering. Your specialist touches your arms and slowly runs fingers up, making a U-turn at your armpit, to your stomach and your tumor, where your Nano will settle, and translate, so that your specialist and your tumor can have a serious therapeutic discussion. Tell us, he asks, what is your purpose?
What will your tumor say? Will it respond that you always worried too much, and you held all that worry in your stomach, that you swallowed too much pride? And where did that pride come from? Did you want to become rich and famous, an entertainer, miserable, then dead? You tried. You tried hard, like the lone errant penguin heading toward the end of the earth. You kept pushing as if that glimpse of ice sparkling on your summit was worth the agony and worry? And now you cannot smell lilac in spring. Or perhaps you never ventured forth and are looking back on missed opportunities and have languished in a stagnant pool for too long, staring at someone else’s accomplishments, trying to understand a George Eliot quote, "It is never too late to be what you might have been." Or maybe you ate too many plastic foods.
Your specialist discusses these issues with the tumor. You listen to their conversation. It becomes a heated debate, fierce even, and you finally join in. Unable to keep silent any longer, you yell at yourself, and your specialist diverts your anger into a direct discussion with your tumor. After a lengthy lively exchange, you and your tumor agree, you convince your tumor to stop growing, to recede into the vapor, reform itself into a smile, or a touch, or the sweet smell of the lilac.
Your Nanos, having accomplished their task as translator, dissolve into a mild sedative interacting with your dopamine, stimulating your serotonin, and ready with a small shot of norephinephrine for you when you wake later ready to play soccer with your eight-year old daughter.