Might medical treatment sometimes work simply because we believe it will - the placebo effect? If so, can our mind help us prevent or recover from illness? Conversely if we believe bad things about our health (the nocebo effect) can this make us ill? Mind over Medicine looks at the evidence for a mind body connection – and the implications for our health.
We’ve probably all heard of the placebo effect ie a patient expects a treatment to help them recover and it is this mental expectation, rather than the treatment itself which cures them. This effect is recognised as real throughout the medical world. When pharmaceutical companies test new medicines, for instance, they test the medicine against an identical looking but neutral tablet or pill, to try to ensure it is the medicine not the placebo effect (the patient’s expectation) which is making the difference. And 97% of a sample of GPs surveyed in the UK in 2013 admitted to treating patients with placebos on occasion.
However, for a variety of reasons, officially at least, health professionals tend to downplay the placebo effect. There are sound ethical reasons for doing so but also less positive reasons, from pharmaceutical company profits to maintaining the status of health professionals. After all, if patients are healing themselves through what is going on in their own minds, rather than the medicine their doctor is prescribing, what questions might this raise about the need for doctors? Ironically, of course, it is that very trust in the power of doctors which helps make the placebo effect so powerful. If your next door neighbour gave you a pill this probably wouldn’t have the same effect.
In Mind over Medicine, Dr Lissa Rankin takes a positive approach to the placebo effect and to the power of the mind to help the body stay healthy and to recover from illness. She draws on evidence from over two hundred different medical and scientific sources, from 1950 to 2011, to support her case.
A good example is a 2002 study in the prestigious New England Journal of Medicine. An orthopaedic surgeon, seeking to prove the effectiveness of his knee surgery, carried out a randomized, double blind placebo controlled trial – the most rigorous type of medical research. One group of patients received the knee surgery. Another group received simulated surgery. To the surgeon’s surprise both groups reported the same level of improvement in knee pain. Dr Rankin observes this, ‘showed that a significant percentage of patients experienced resolution of their knee pain solely because they believed they got surgery.’ This is one of a range of examples the author provides, which leads her to conclude that placebos can not only change how you feel, but potentially also change your biochemistry.
Five possible explanations for the way the placebo effect works are explored ie the patient’s own expectations; a clinical conditioning response if the treatment your doctor has given you has worked in the past; the emotional support and attention patients receive during clinical trials; patients possibly taking other treatments unbeknown to the researchers; and the body’s ability to self heal, leading the disease to resolve itself.
Dr Rankin’s view is that the way we think affects our immune system. Constant stress has an adverse effect, whereas relaxation returns the body to normal and may boost the immune system. She goes on to say, ‘Whatever the mechanism, it’s clear that the mind and body communicate through hormones and neurotransmitters that originate in the brain and then leave the brain to signal other parts of the body.’
To explain this further cell biologist and author Dr Bruce Lipton is quoted: ‘The brain is the chemist changing the environment to which our cells are exposed. The brain releases neuropeptides, hormones, growth factors, and other chemicals, akin to adding chemicals to a Petri dish with a pipette, thereby changing the cell medium.’ To this Dr Rankin adds the impact of our subconscious minds, which may be full of beliefs downloaded from our parents, teachers and others – which may predispose the way our brains respond.
The nocebo effect is the opposite of the placebo effect ie negative beliefs leading to ill health. Mind over Matter illustrates this through an American study reported in The Lancet in 1993. The death records of 30,000 Chinese-Americans found that those with a combination of disease and a birth year that Chinese astrology and Chinese medicine considered ill fated died significantly earlier than normal. Dr Rankin wonders whether medical diagnoses such as ‘chronic,’ ‘incurable’ or ‘terminal,’ while perhaps statistically accurate, may unwittingly be contributing to a nocebo effect.
For some illnesses evidence is provided that a doctor’s approach to and relationship with a patient can influence the strength of the placebo (or nocebo) effect. For example a Harvard Medical School study reported in the BMJ in 2008 found that when doctors treated IBS (irritable bowel syndrome) patients with ‘warmth, attention and confidence’ their response to a placebo increased from 44% to 62%.
The placebo effect is also seen by Dr Rankin as the main reason why complementary and alternative medicine sometimes work, where they take place in the context of nurturing care from a practitioner in whom the patient has confidence and the positive physiological effect this triggers. This leads her to ask, ‘If the patient is getting better, does it really matter whether the treatment is better than the placebo? Is resolution of symptoms and cure of disease not the ultimate goal.’
Moving from symptoms to causes Dr Rankin argues the importance of understanding what is going on in our lives– for instance in our work, family, relationships and finances. Where these are positive experiences this is likely to be giving rise to less underlying stress which in turn is likely to mean a healthier immune system, leaving less vulnerability to illness.
Citing a number of different studies in the US she identifies loneliness as a particular health risk: ‘Lonely people have been shown to have higher rates of heart disease, breast cancer, Alzheimer’s disease and suicidal thoughts.’
Significant and prolonged overwork or stress at work is another risk factor. Indeed the Japanese now have a term (karoshi) meaning death by overwork, while a long term US study found that women who rarely took holidays were eight times more likely to develop coronary heart disease or have a heart attack than women who took holidays twice a year.
Conversely religious belief; having a spouse or partner (provided the relationship is not abusive or dysfunctional); a healthy sexual life; work we find fulfilling; and opportunities for creative expression usually appear to be protective – as does meditation and other forms of relaxation.
Not surprisingly perhaps, given the strong mind body connection indicated, Dr Rankin has also found evidence suggesting we will live longer and enjoy more years of good health if we are happy and optimistic than if we are unhappy and pessimistic.
What then is Mind over Matter’s prescription? Dr Rankin prescribes six steps to healing yourself ie Believe that you can heal yourself; Find the right support; Listen to your body and intuition; Diagnose the root cause of your illness (in particular any sources of chronic stress); Write your own prescription (making sure to address any sources of chronic stress, not just the symptoms of illness); and Surrender attachment to outcomes (if you’ve done everything you reasonably can, to recognise that it isn’t your fault if this isn’t enough to prevent your illness).
Whilst Mind over Medicine is a generally optimistic book, suggesting we can achieve more through our mind than we realise, it is ultimately realistic. As Dr Rankin says, ‘I believe that whilst we hold within us the power to make changes in our life designed to foster the body’s ability to self repair, we must accept that, when it comes right down to it, we have no guarantees as to whether or not we will stay sick or get well.’ What she is effectively arguing is that we can improve our chances of preventing or recovering from illness by supporting our body’s ability to self repair – but that sometimes this may not be enough and we may still fall ill or die.
Many of the examples in Mind over Matter are dramatic individual cases, including remission from cancer. Although these were usually confirmed by doctors at the time individual cases may not be typical, as any one of a range of factors may have led to recovery. However, the evidence also includes large scale, long term studies in reputable journals and these carry weight.
While there’s a strong emphasis on the dangers of chronic stress and the benefits of relaxation it might have been helpful to include the hormesis hypothesis to put stress in context ie it is believed that exposure to a modest amount of stress from time to time is actually good for us and keeps our immune system on its toes. Having said this, Dr Rankin does refer to studies showing the value of ‘participating in challenging and stimulating work experiences’ - implicitly recognising that we shouldn’t rely wholly on relaxation.
In some ways this is a book of two parts. The longer, diagnosis section presents a wide range of medical and scientific evidence from reputable sources (some a little long in the tooth but balanced by more up to date findings) building a persuasive case for the influence of the mind on the body and likely implications for preventing or recovering from illness.
The shorter, prescription section changes tone and may sound a bit ‘New Age’ to some readers – with images such as ‘inner pilot light’ and ‘whole health cairn. ’ There is also evident personal emotion underlying and motivating Mind over Medicine which is particularly evident here and to which some readers may respond more positively than others.Having said this the eight page Diagnosis Exercise provided looks like a useful way to help analyse where we are in our lives and identify possible sources of chronic stress which may need addressing.
Overall Mind over Matter provides a stimulating exploration of potential links between our mind and body and helpfully considers how we might apply this to improve our health. It presents an interesting alternative to the idea that good health and longevity are simply due to a combination of genes and physical lifestyle.
Mind over Medicine – Scientific Proof That You Can Heal Yourself: Dr Lissa Rankin (Hay House ISBN 978 – 1 84850 – 960 – 3)