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The Mind Body Connection

For previous generations of doctors, who had few effective resources to treat disease, there was strong emphasis on patient factors in disease. Great medical minds of prior times were convinced that patients held the key to their recovery from illness. But today’s doctors, surrounded by a vast array of technological wonders and marvelous drug therapies, seem to have lost sight of just how important the patient is in determining recovery from illness.

The Patient’s Influence on Illness

What is it that sets apart people who recover from serious illness? In general they find the illness a challenge and an opportunity for personal growth. They tackle the illness actively, rather than being passive recipients of doctors’ treatments. They go to every source for information, are open-minded about unconventional therapies, try everything. They feel empowered by the discoveries they make to take control of their illnesses, and indeed, their lives.

There is a movement in medicine away from the conventional parentalistic view of impersonal doctors treating passive recipients of their care, patients who don’t argue or say what they want, and who are therefore not empowered to tackle the changes they must make to overcome disease. Visionary physicians like Deepak Chopra and Bernie Siegel lead this revolution. They understand what potential we have within us for modifying the course of disease, if only we choose to, and are allowed to use it. And of course we can learn much from individuals, such as Ian Gawler, who have themselves recovered from ‘terminal’ cancer. The messages from all of these people are surprisingly similar.
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Illness as a Challenge

Serious illness is a challenge. Many patients come to regard it as a gift. Like other challenges in life, out of the kernel of the problem may come wonderful insights and answers that transform our lives. For those of us with MS, and cancer, and many other serious diseases, it is worth remembering that the illness is part of us. I don’t like to think of tackling my illness as a fight. It doesn’t make sense to fight yourself. It’s just that some of the cells of our bodies are not behaving in the way we want them to behave. We have extraordinary power over how our bodies’ cells behave. If we get anxious and our blood pressure rises, we lower our heart rate to compensate. We don’t have to do it consciously, indeed we can’t do it consciously. If we get too cold, we start our muscles shivering to generate heat. Similarly if we get infected with a virus, we mobilise our immune system to fight the invader, and almost always win. When we break a bone, we don’t have to tell our body how to heal itself. Built into the DNA in every cell in our bodies is the blueprint for fixing itself when things go wrong, for developing into an adult, for producing children.

But in MS and cancer, something goes wrong with the message. If we can do all these other things, why can’t we control our bodies’ cells and stop the process going wrong when it does? The truth is that some people can. Countless case reports exist of patients terminally ill with cancer who go home and make a complete recovery. If they can do it, we all can, if we can work out how. It only has to happen once to make it possible. The body has a tremendously effective ability to heal when it is in balance. The difficulty is in quietening the mind long enough to allow the body to return to this natural state of balance. This is where meditation comes in.
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Faith

Imagine there is some greater plan for everything in the universe. Imagine things aren’t happening by accident. Imagine there is an intelligent energy running through all things, guiding them. Faith doesn’t necessarily mean believing this. Faith is living life as if this were true. Belief isn’t necessary to have faith. Faith and belief form part of a continuum. My friend Siegfried Gutbrodt, formerly of the Gawler Foundation, specialises in laughter therapy. Siegfried always tells his audience about the positive effect of laughter on our bodies, about the good chemicals that are released during laughter. But importantly, he points out that it can be faked. That even if you are not feeling too good but make the effort and have a big laugh, the same chemicals are released. It works too. Try it yourself if you don’t believe it. It’s amazing how much better you feel after a good laugh, even if you fake it. That analogy is useful for the concept of faith becoming belief. Faith is a little bit like faking it, living life as if something is true but not necessarily believing it to be true. But if you live that way long enough, you gradually start to believe it, and it gradually starts to happen. Part of the trick as far as faith is concerned is to let go, and just go with what is happening, and trust that things will work out. In the words of Bill Harris, of Centerpoint Technology, ‘Let whatever’s happening be OK’.
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Positivity

One of the things that people say all the time when first diagnosed with serious illness is that it is important to be positive. This is not as easy as it sounds. It is certainly no simple mental exercise to focus on the positives. The positives can come when you take the illness as a challenge to change your life. If the illness becomes a means to grow, then the positives start to flow from the process of change which accompanies that growth. Being positive is not something you can will yourself to be. But it is now emerging that being positive and happy has a profound effect on the immune system. The term psychoneuroimmunology has been coined to reflect the study of the effect of mind and emotions on immune function. Allowing yourself to become depressed by the illness can literally make you sicker.
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Fear Versus Faith

One of the ways in which this important energy we need for healing can be wasted is when we are consumed with fear. In many respects, fear is the opposite of faith. MS is a frightening disease, particularly when first diagnosed. Most of us want to live a long, healthy life. So often we hear people say ‘I hope I drop dead with a heart attack’ or ‘I hope I die in my sleep after a healthy life’. The fear of incapacity and a long drawn out demise is distressing for most people. Yet that is precisely what comes to mind when given a diagnosis of MS. Suddenly the wheelchair comes into view, and being fed, and catheters and so on. But most people, when told, are comparatively well. It makes no sense to spend some of the precious time we have now, when we are well, consumed with worry about what might be when we are not well. Worse, using that energy worrying, robs us of the energy we need to heal ourselves.

My great friend and mentor, Dr Ian Hislop captured it perfectly: ‘The principle is straightforward. You have to replace fear with faith. Faith in yourself, your future, and perhaps in something which transcends both.’
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Avoiding Depression Through Diet, Sunlight and Exercise

Hope and positivity are important factors in avoiding depression, but there is now a lot of evidence to show that physical factors are important as well. The omega-3 fatty acids have a key role here. What is becoming clear now is that a diet rich in omega-3s prevents depression. This is probably also due to a membrane effect on the nerve cells in the brain.

Both animal and human work has now shown that fish oil supplementation improves learning. But there is also evidence that low eicosapentanoic acid levels correlate with depression.1 There is also data from large population studies which shows that countries where fish forms a major part of the diet, have much lower rates of depression than those where fish is not eaten much. Japan and Taiwan, for example, where fish consumption is the highest in the world, report rates of depression below 1 per cent of the population. West Germany, Canada and New Zealand, where fish consumption is very low, report rates of 5 per cent or over. There is also evidence from small uncontrolled studies that omega-3 supplements can improve depression. So another benefit from changing to the diet I have suggested is that there is less likelihood of depression. This is important for people with MS particularly, because it has been shown that the lifetime risk of becoming depressed after diagnosis is over 50 per cent.2

As previously discussed, there is also good evidence that regular exercise prevents depression. Given its other health benefits, exercise should form part of the health program of everybody who is able to do it. Another important factor in preventing depression is getting adequate sunlight, or if that is not possible, supplementing with vitamin D.
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Counseling

Another way of avoiding depression is through counseling. I recommend everyone newly diagnosed with any major illness consider some psychological counseling. We need every bit of our energy to tackle the illness. If we are wasting any energy dealing with things we don’t need, or if we are tackling things in unproductive ways, it is usually easy for trained professionals to spot. Of course ongoing counseling may also be important. It is worth ‘shopping around’ a bit to find someone who really suits. An ongoing professional relationship with someone who really knows you, and who you know I can trust, is enormously helpful when the inevitable difficulties crop up in life.
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How We View Ourselves and the Illness

The way we feel about the illness and refer to it has a big bearing on our outcome in my view. These are things I cannot prove. To use Carolyn Myss’ terminology ‘biography becomes biology’. Like many others, she has seen that if people don’t express their grief, they end up radiating grief. They get depressed. If people can’t say what they want, repress their real wants and desires, and feel powerless, then something like cancer may literally start eating them away. If people see themselves as ‘suffering’ with MS, they will probably end up suffering, and get more attacks.

Now I know a lot of people with advanced MS are suffering. But I am hoping that people who take a positive approach to this illness, take an active stance, and make the necessary lifestyle changes, will do much better than if they allow it to dominate them. I don’t talk about ‘fighting’ MS. MS is a manifestation of an imbalance in my body. It is not some outside invader like malaria or a virus. All the cells involved in MS are my cells and part of me. It makes no sense for me to fight myself. It is not about fighting, it is about healing. Healing is multi-faceted. It is not just physical healing. Indeed, it is becoming clear that being sick spiritually impairs physical healing.
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Feeling in Control of the Illness

There is considerable literature on the positive effects of people having a feeling of control over illness. Dr Bernie Siegel’s books are rich with anecdotes about people he has seen, who have transformed themselves, and overcome serious illness, because they were active, positive participants in the process. Bernie describes the survivors of serious illness as people who, on learning of the diagnosis, actively seek out information, look for people to talk to who have overcome such illness, question their doctors about alternatives, and generally become what doctors think of as ‘difficult’ patients.

This is one of the reasons I am so keen on what many people call ‘complementary’ or ‘alternative’ therapies, but are just really healthy and healing lifestyle choices. These are generally things people actively do to change the course of an illness, such as dietary changes, exercise, meditation, getting adequate sunlight, and so on. Why they should they be called complementary or alternative? In what way is improving nutrition and actively calming the mind alternative? Surely developing a toxic chemical in a laboratory and then injecting it into people, knowing that it will cause damage to their bone marrow, hair, gut and sense of well-being, is more alternative?

Fortunately we are seeing a move back towards more holistic medicine in many Western countries. Our eastern neighbours have known about these other therapies for centuries. Deepak Chopra has recently written about his re-discovery of ayurvedah, the long time Indian traditional healing method. Many mainstream medical scientists are now using good scientific methods to prove these things, about which we have known for centuries. Researchers have investigated how people with MS respond to practitioners of so-called alternative medicine compared with conventional doctors.3 They found that although MS patients got significant benefit from drug therapies and medical providers, practitioners of alternative medicine were rated significantly higher in listening skills, care and concern, and patient empowerment. The authors concluded that more study should be done on the benefits of emotional support gained from medical and alternative practitioners to quality of life in MS.
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Writing Down Feelings

In April 1999, Smyth and co-workers from the Department of Psychiatry at the State University of New York published the results of a simple study in the JAMA.4 They performed a well-constructed RCT, using 112 patients with chronic asthma or rheumatoid arthritis (RA). Like MS, RA is an auto-immune disease, but the target of the immune system is the joints rather than the nervous system. Asthma is also a disease mediated by the immune system. The ‘treatment’ group was asked to write on just one occasion about the most stressful event of their lives. The ‘control’ group was asked to write about a neutral topic.

With this simple intervention, that is getting people to express feelings that may not have been completely released before, the ‘treated’ patients got better and the others did not. This should not surprise us, but to a skeptical medical community this scientific ‘proof’ was something of a shock. The p values were 0.001, so the result was unlikely to have occurred by chance. Further, the magnitude of the effect was stunning. The RA patients had a 28 per cent reduction in disease severity (this is about the same benefit as derived from interferon and glatiramer in MS), and the asthma patients a 19 per cent improvement in lung function. And this effect persisted for four months after the ‘treatment’. Effects of this size and duration are difficult to achieve with drug therapies, without producing side-effects. Yet all this was achieved with only one session. Imagine if these people had regularly expressed their feelings.

JAMA carried a powerful editorial commenting on the article, by David Spiegel, a psychiatrist from Stanford University.5 Perhaps the most surprising thing about the editorial is that he sounds surprised. Yet there is abundant scientific evidence of the effects of the mind and spirit on illness. Most of us know these things to be so resonant with truth that they require no proof. But the medical community has become sceptical in these days of miraculous drug therapy. This is despite evidence that people are more likely to die after than before their birthdays and holidays,6 for example. Or evidence that patients with psoriasis (a chronic skin condition) heal faster with meditation training tapes played during treatment than without.7 Or the abundant literature that patients who express their negative feelings8 or develop a fighting spirit9 do better in recovery from cancer. These things have been known for a long time. Spiegel concludes with an interesting point:

Were the authors to have provided similar outcome evidence about a new drug, it is likely that it would be in widespread use within a short time. Why? We would think we understood the mechanism (whether we did or we did not) and there would be a mediating industry to promote its use. Manufacturers of paper and pencils are not likely to push journaling as a treatment addition for the management of asthma and rheumatoid arthritis.

Bernie Siegel recommends, not only to people with serious disease, but to everyone, that they start keeping a journal or diary.
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Meditation

Another important daily ritual is meditation, and I believe this is a key part of the overall package. There are many types of meditation. It is important to choose one that suits, and this may take a bit of trial and error. There is quite a science around the beneficial physical effects of meditation as well as the mental benefits. Much of this can be found in the mainstream medical literature. Regular meditators have lower blood pressure, less heart disease, and so on. There are now over 1 500 papers in the medical literature on the health benefits of meditation. I have become increasingly convinced that meditation should form a key part of healing from any disease. My work with Ian and Ruth Gawler at the Gawler Foundation in Victoria has shown me the profound benefits of this simple technique. Ian’s teaching has been that the body is capable of healing any illness. To heal though, it needs to be in a state of balance, to allow the body’s natural healing mechanisms to operate. Meditation can help achieve that balance. Ian’s book ‘Meditation Pure and Simple’ is a must for anybody wishing to deepen their meditation. I recommend it strongly.

Others find alternatives to meditation that may be just as effective. Researchers have shown for instance that music therapy improves acceptance, and reduces anxiety and depression in people with MS.10
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Overview

It is possible to heal all illness. Even if unable to heal an illness, how illness affects people is profoundly dependent on their reaction to it, and their emotional state. But we need resources to tackle illness. It is important to get a sense of some control over the process. Conventional medicine, with its emphasis on patients behaving as expected, and being passive recipients of care, serves us poorly in this regard. It is important for patients to be ‘difficult’, to be actively involved in their management.
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  1. Adams PB, Lawson S, Sanigorski A, et al. Arachidonic acid to eicosapentanoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996; 31:S157-S161
  2. Sadovnick AD, Remick RA, Allen J, et al. Depression and multiple sclerosis. Neurology 1996; 46:628-632
  3. Shinto L, Yadav V, Morris C, et al. The perceived benefit and satisfaction from conventional and complementary and alternative medicine (CAM) in people with multiple sclerosis. Complement Ther Med 2005; 13:264-272
  4. Smyth JM, Stone AA, Hurewitz A, et al. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA 1999; 281:1304-1309.
  5. Spiegel D. Healing words: emotional expression and disease outcome. JAMA 1999; 281:1328-1329
  6. Phillips DP, Ruth TE, Wagner LM. Psychology and survival. Lancet 1993; 342:1142-1145
  7. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 1998; 60:625-632.
  8. Derogatis LR, Abeloff MD, Melisaratos N. Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA 1979; 242:1504-1508
  9. Greer S. Psychological response to cancer and survival. Psychol Med 1991; 21:43-49
  10. Ostermann T, Schmid W. Music therapy in the treatment of multiple sclerosis: a comprehensive literature review. Expert Rev Neurother 2006; 6:469-477