Overview
Most traditional medical
systems make use of the interconnectedness of mind and
body and the power of each to affect the other. During
the past 30 years there has been a growing scientific
movement to explore the mind’s capacity to affect the
body. The clinical aspect of this enterprise is called
mind-body medicine. Mind and body are so integrally
related that it makes little sense to refer to therapies
as having impact just on the mind or the body.
Mind-body interventions
often help patients experience and express their illness
in new, clearer ways. Distinctions between curing and
healing have little place in contemporary medical practice
but are important to patients. Perceived meaning has
direct consequences to health. The placebo response
is one of the most widely known examples of mind-body
interactions in contemporary, scientific medicine, yet
it is also one of the most undervalued, neglected assets
in medical practice. That the placebo response relies
heavily on the relationship between doctor and patient
says a great deal about the importance of the doctor-patient
relationship and the need to provide further medical
training on understanding and using this relationship.
The therapeutic potential of spirituality, as well as
religion, also has been neglected in the teaching and
practice of medicine.
Interest in the mind’s
role in the cause and course of cancer has been substantially
stimulated by the discovery of the complex interactions
between the mind and the neurological and immune systems,
the subject of the rapidly expanding discipline of psychoneuroimmunology.
The profound differences in the psychological stances
taken by people who survive cancer suggest that there
is extreme variation both among cultures and within
cultures.
Psychotherapy
Psychotherapy directly
addresses a person’s emotional and mental health, which
is, in turn, closely interwoven with his or her physical
health. It encompasses a wide range of specific treatments
from combining medication with discussion, to simply
listening to the concerns of a patient, to using more
active behavioral and emotive approaches. It also should
be understood more generally as the matrix of interaction
in which all the helping professions operate. Conventional
psychotherapy is conducted primarily by means of psychologic
methods such as suggestion, persuasion, psychoanalysis,
and reeducation. It can be divided into general categories.
All of the therapies can be undertaken either individually
or in groups.
Research indicates that psychotherapeutic treatment
can hasten a recovery from a medical crisis and is in
some cases the best treatment for it. Psychotherapy
also appears to be valuable in the treatment of somatic
illnesses in which physical symptoms appear to have
no medical cause. These symptoms are often improved
markedly with psychotherapy. In addition, psychotherapy
has been shown to speed patients’ recovery time from
illness. This, in turn, leads to smaller medical bills
and fewer return visits to medical practitioners.
Support
Groups
Support groups, as the
research literature demonstrates, can have a powerful
positive effect in a wide variety of physical illnesses,
from heart disease to cancer, from asthma to strokes.
Indeed, one study found that women with breast cancer
who took part in a support group lived an average of
18 months longer (a doubling of the survival
time following diagnosis) than those who did not participate.
In addition, all the long-term survivors belonged to
the therapy group.
Support groups have two other major benefits:
- they help members form
bonds with each other, an experience that may empower
the rest of their lives; and
- they are low cost or
even "no cost" (for example, Alcoholics Anonymous).
Meditation
Mediation is a self-directed
practice for relaxing the body and calming the mind.
Most meditative techniques have come to the West from
Eastern religious practices, particularly India, China,
and Japan, but can be found in all cultures of the world.
Until recently, the primary purpose of meditation has
been religious, although its health benefits have long
been recognized. During the past 15 years, it has been
explored as a way of reducing stress on both mind and
body. It is often recommend it as a way of reducing
high blood pressure.
Some studies have found
that regular meditation can reduce healthcare use; increases
longevity and quality of life; reduces chronic pain;
reduces anxiety; reduces high blood pressure; reduces
serum cholesterol level; reduces substance abuse; increases
intelligence-related measures; reduces post-traumatic
stress syndrome in Vietnam veterans; reduces blood pressure;
and lowers blood cortisol levels initially brought on
by stress.
Imagery
Imagery is both a mental
process (as in imagining) and a wide variety of procedures
used in therapy to encourage changes in attitudes, behavior,
or physiological reactions. As a mental process, it
is often defined as "any thought representing a sensory
quality." It includes, as well as the visual, all the
senses — aural, tactile, olfactory, proprioceptive,
and kinesthetic.
Imagery has been successfully tested as a strategy for
alleviating nausea and vomiting associated with chemotherapy
in cancer patients, to relieve stress, and to facilitate
weight gain in cancer patients. It has been successfully
used and tested for pain control in a variety of settings;
as adjunctive therapy for several diseases, including
diabetes; and with geriatric patients to enhance immunity.
Imagery is usually combined with other behavioral approaches.
It is best known in the treatment of cancer as a means
to help patients mobilize their immune systems, but
it also is used as part of a multidisciplinary approach
to cardiac rehabilitation and in many settings that
specialize in treating chronic pain.
Hypnosis
Hypnosis and hypnotic suggestion
have been a part of healing from ancient times. The
induction of trance states and the use of therapeutic
suggestion were a central feature of the early Greek
healing temples, and variations of these techniques
were practiced throughout the ancient world.
Modern hypnosis began in the eighteenth century with
Franz Anton Mesmer, who used what he called "magnetic
healing" to treat a variety of psychological and psychophysiological
disorders, such as hysterical blindness, paralysis,
headaches, and joint pains. Since then, the fortunes
of hypnosis have ebbed and flowed. Freud, at first,
found it extremely effective in treating hysteria and
then, troubled by the sudden emergence of powerful emotions
in his patients and his own difficulty with its use,
abandoned it.
In the past 50 years, however, hypnosis has experienced
a resurgence, first with physicians and dentists and
more recently with psychologists and other mental health
professionals. Today, it is widely used for addictions,
such as smoking and drug use, for pain controls, and
for phobias, such as the fear of flying.
One of the most dramatic uses of hypnosis is the treatment
of congenital ichthyosis (fish skin disease), a genetic
skin disorder that covers the surface of the skin with
grotesque hard, wartlike, layered crust. Hypnosis is,
however, most frequently used in more common ailments,
either independently or in concert with other treatment,
including the management of pain in a variety of settings,
reduction of bleeding in hemophiliacs, stabilization
of blood sugar in diabetics, reduction in severity of
attacks of hay fever and asthma, increased breast size,
the cure of warts, the production of skin blisters and
bruises, and control of reaction to allergies such as
poison ivy and certain foods.
Biofeedback
Biofeedback is a treatment
method that uses monitoring instruments to feed back
to patients physiological information of which they
are normally unaware. By watching the monitoring device,
patients can learn, by trial and error, to adjust their
thinking and other mental processes in order to control
bodily processes heretofore thought to be involuntary--such
as blood pressure, temperature, gastrointestinal functioning,
and brain wave activity.
Biofeedback is used to treat a very wide variety of
conditions and diseases, ranging from stress, alcohol
and other addictions, sleep disorders, epilepsy, respiratory
problems, and fecal and urinary incontinence to muscle
spasms, partial paralysis, or muscle dysfunction caused
by injury, migraine headaches, hypertension, and a variety
of vascular disorders. More applications are being developed
yearly.
Yoga
Yoga is a way of life that
includes ethical precepts, dietary prescriptions, and
physical exercise. Its practitioners have long known
that their discipline has the capacity to alter mental
and bodily responses normally thought to be far beyond
a person’s ability to modulate them. During the past
80 years, health professionals in India and the West
have begun to investigate the therapeutic potential
of yoga. To date, thousands of research studies have
been undertaken and have shown that with the practice
of yoga a person can, indeed, learn to control such
physiologic parameters as blood pressure, heart rate,
respiratory function, metabolic rate, skin resistance,
brain waves, body temperature, and many other bodily
functions.
Regular yogic meditation also has been shown to reduce
anxiety levels; cause the heart to work more efficiently
and decrease respiratory rate; lower blood pressure
and alter brain waves; increase communication between
the right and left brain; reduce cholesterol levels
(when used with diet and exercise); help people stop
smoking; and successfully treat arthritis.
Dance
Therapy
Dance therapy began formally
in the United States in 1942, and in 1956 dance therapists
from across the country founded the American Dance Therapy
Association, which has now grown to over 1,100 members.
It publishes a journal, the American Journal of Dance
Therapy, fosters research, monitors standards for
professional practice, and develops guidelines for graduate
education.
Dance/movement therapy has been demonstrated to be clinically
effective in the following: developing body image, improving
self-concept and increasing self-esteem; facilitating
attention; ameliorating depression, decreasing fears
and anxieties, expressing anger; decreasing isolation,
increasing communication skills and fostering solidarity;
decreasing bodily tension, reducing chronic pain, and
enhancing circulatory and respiratory functions; reducing
suicidal ideas, increasing feelings of well-being, and
promoting healing; and increasing verbalization.
Music
Therapy
Music therapy is used in
psychiatric hospitals, rehabilitation facilities, general
hospitals, outpatient clinics, day-care treatment centers,
residences for people with developmental disabilities,
community mental health centers, drug and alcohol programs,
senior centers, nursing homes, hospice programs, correctional
facilities, halfway houses, schools, and private practice.
Studies have found music therapy effective as an analgesic,
as a relaxant and anxiety reducer for infants and children,
and as an adjunctive treatment with burn patients, cancer
patients, cerebral palsy patients, and stroke, brain
injury, or Parkinson’s disease patients.
Art
Therapy
Art therapy is a means
for the patient to reconcile emotional conflicts, foster
self-awareness, and express unspoken and frequently
unconscious concerns about his/her disease. In addition
to its use in treatment, it can be used to assess individuals,
couples, families, and groups. It is particularly valuable
with children who often cannot talk about their real
concerns.
Research on art therapy has been conducted in clinical,
educational, physiological, forensic, and sociological
arenas. Studies on art therapy have been conducted in
many areas including with burn recovery in adolescent
and young patients, with eating disorders; with emotional
impairment in young children, with reading performance,
with chemical addiction, and with sexual abuse in adolescents.
Prayer
and Mental Healing
Prayer and mental healing
techniques fall into two main types. In Type I healing,
the healer enters a prayerful, altered state of consciousness
in which he views himself and the patient as a single
entity. There need be no physical contact and there
is no attempt to "do anything" or "give something" to
the person in need, only the desire to unite and "become
one" with him or her and with the Universe, God, or
Cosmos. Type II healers, on the other hand, do touch
the healee and describe some "flow of energy" through
their hands to the patient’s areas of pathology. Feelings
of heat are common in both healer and healee. These
healing techniques are offered only as generalities.
Some healers use both methodologies, even in the same
healing session, and other healing methods could be
described.
Many published reports exist, of experiments, in which
persons apparently were able to influence a variety
of cellular and other biological systems through mental
means. The target systems for these investigations have
included bacteria, yeast, fungi, mobile algae, plants,
protozoa, larvae, insects, chicks, mice, rats, gerbils,
cats, and dogs, as well as cellular preparations (blood
cells, neurons, cancer cells) and enzyme activities.
In human "target persons," eye movements, muscular movements,
electrodermal activity, plethysmographic activity, respiration,
and brain rhythms have been apparently affected through
direct mental influence.
These studies assess the ability of humans to affect
physiological functions of a variety of living systems
at a distance, including studies where the "receiver"
or "target" is unaware that such an effort is being
made. The fact that these studies commonly involve nonhuman
targets is important; lower organisms are presumably
not subject to suggestion and placebo effects, a frequent
criticism when human subjects are involved.
Many of these studies do not describe the psychological
strategy of the influencer as actual "prayer," in which
one directs entreaties to a Supreme Being, a Universal
Power, or God. But almost all of them involve a state
of prayerfulness — a feeling of genuine caring, compassion,
love, or empathy with the target system, or a feeling
that the influencer is "one" with the target.
Conclusion
In addition to preventing
or curing illnesses, these therapies by and large provide
people the chance to be involved in their own care,
to make vital decisions about their own health, to be
touched emotionally, and to be changed psychologically
in the process. Many patients today believe their doctor
or medical system is too technical, impersonal, remote,
and uncaring. The mind-body approach is potentially
a corrective to this tendency, a reminder of the importance
of human connection that opens up the power of patients
acting on their own behalf.
More work needs to be done, but there is already a growing
amount of evidence that many of the mind-body therapies
discussed in this report, if appropriately selected
and wisely applied, can be clinically as well as economically
cost-effective, that they work, and that they are safe.
Adapted from Alternative Medicine: Expanding Medical
Horizons, a report prepared under the auspices of
the Workshop on Alternative Medicine, held in Chantilly
VA on September 14-16, 1992.
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