Sunday, March 30, 2008
Researchers are exploring the scientific basis of this vital emotion that has the ability to alter the course of illness. By Ted Kreiter
The ability of the mind to foster healing has long been an intriguing concept. Ailing patients who believe that they can get better often do. In his practice, Dr. Jerome Groopman, an expert in blood diseases, cancer, and AIDS at Beth Israel Deaconess Medical Center in Boston, recognized that giving patients hope for recovery could be helpful in their treatment. But he never realized the full importance of hope for healing until he experienced it firsthand in his recovery from a chronic ailment. In his new book, The Anatomy of Hope: How People Prevail in the Face of Illness, Dr. Groopman tells the dramatic story of his delivery from pain and explains what researchers are discovering about how emotions can control the outcome of illness.
For 19 years, Dr. Groopman suffered from severe back pain. A spinal surgery had paralyzed his legs for a time, and ever since he had lived by restricting his movements for fear of debilitating muscle spasms that would erupt at the slightest provocation. To avoid hurting his back, Groopman had to get out of bed in a special way and sit in a particular manner. He could not play catch with his children and could walk only a few blocks at a time. For the scar tissue that was irritating his spinal nerves, he knew there was no surgical solution.
Dr. Groopman had long since given up seeing specialists for his condition. But in the summer of 1999, an extreme and persistent pain attack led him to Dr. James Rainville at the New England Baptist Hospital Spine Center.
After thoroughly examining Groopman, Dr. Rainville surprised him by saying that he could be freed of his pain. Rainville used a colorful metaphor to describe Groopman's condition. "You are worshiping the volcano god of pain," he said. "The volcano god of pain is your master."
He would have to stop sacrificing to the volcano god who would never be satisfied, Dr. Rainville said. To do this he would have to "reeducate" his muscles, tendons, and ligaments to "erase the memory of trauma" they carried. A program of therapy challenging him with increasing weights would rebuild his muscles, and the pain would eventually subside.
Although skeptical and fearful of the trauma the therapy would cause, Dr. Groopman decided reluctantly to try it. Dr. Rainville had given him something no one else had, a tantalizing vision of hope.
As expected, the therapy caused considerable pain. But while lying on soothing ice packs, Groopman visualized activities he would like to be able to do, such as walking with his daughter or dancing at a wedding. With these thoughts, a warm feeling seemed to envelop him.
After a little over a year of therapy, the pain subsided. Dr. Rainville had been right. The recovery "seemed almost magical," Dr. Groopman writes. Somehow he had taught his body to forget the pain, and was convinced that the emotion of hope had played a decisive role.
"I was most intrigued by the sense that I may have felt physical changes caused by hope," he writes. "But I distrusted my impression. So I asked, as a scientist, is there a biological mechanism whereby the feeling of hope can contribute to clinical recovery?"
Dr. Groopman delved into the various lines of research that are shedding light on the way the mind can affect the body and promote healing. One of them involves the placebo effect. A leader in this area is Dr. Fabrizio Benedetti of the University of Turin in Italy. The word "placebo," Dr. Groopman notes, is Latin for "I shall please" and comes from the Catholic vesper service for the dead, in which mourners were paid to participate to help calm grieving loved ones. Most people think of placebos as fake medications, the sugar pills once given to problem patients to assuage their demands for relief. The thing is, placebos really do work, and sometimes dramatically. Dr. Benedetti has shown experimentally that a neutral agent, such as saline, can actually be as effective as morphine in relieving pain when administered to a patient who is preconditioned to believe.
He theorizes that in responding to the placebo, the patient's body produces its own pain-relieving chemicals called endorphins and enkephalins that mimic morphine. He also has shown that subjects experience more pain relief when they are aware they are receiving a painkiller than when the painkiller is delivered unannounced, because in expectation of relief, the body's own pain relievers bolster the morphine's effects.
Just as important as this mind-body connection demonstrated in the placebo studies, Dr. Groopman suggests, is the opposite: a body-mind connection that occurs when an injured or ill part of the body suddenly improves and the brain detects it. This sparks hope in a patient, which sets off a chain reaction of pain-relieving chemicals. The possibility exists that if doctors can make a small improvement in just one symptom (a slight diminution in pain, for example) in an ill patient, the brain may kick in and help provide an even bigger boost toward recovery.
Studies of the circuitry and functioning of the brain have shown no single "hope center" or "hope neurotransmitter," Groopman writes. However, brain researchers such as Joseph LeDoux, professor of science at New York University, have learned that negative emotions such as fear arise in a deep brain structure called the amygdala.
What we have found out about the biological mechanisms of hope is only the beginning, Dr. Groopman writes. He had been taught in a traditional medical curriculum in which each organ was approached "in an isolated, reductionist way." The mind was linked to the body "only in rare instances" such as anxiety and despair. Now Groopman has come full circle in his beliefs. "We are just beginning to appreciate hope's reach and have not defined its limits," he writes. "I see hope as the very heart of healing."
Thursday, March 27, 2008
the health benefits of laughter
When we laugh we ...
- Alleviate depression;
- Lower our blood pressure;
- Promote relaxation;
- Reduce stress;
- Increase the oxygen level in our blood, giving us more energy;
- Increase the endorphin activity in our body resulting in a sense of well being;
- Are able to keep things in perspective;
- Banish boredom;
- Are more socially attractive - people enjoy being with those who laugh easily and often; and
- Immeasurably increase our enjoyment of life.
Laughter has been called social glue because it bonds us to the people we laugh with. The message is clear: To live better ... laugh more.
If it feels good to laugh then laugh to feel good.
© 2006 Self Improvement Online, Inc. By Mike Moore
Monday, March 17, 2008
"Placebo Nation: Just Believe"
It's not that medicines are 'crummy,' but that placebos are so powerful. It's time scientists learned why.
When you write about science, there is no shortage of topics that incite the wrath of readers. Climate change. Evolution. Racial differences in IQ. But say that dummy pills with no pharmacologically active ingredients—placebos—are about as effective as antidepressants in treating depression, and watch out. People are incensed at the very thought that the (often expensive) meds they rely on might be 21st-century versions of the magic feather that Dumbo, the flying elephant, was told would make him airborne. It was only when Dumbo dropped the feather he was clutching in his trunk while in free fall, and started flapping his ears, that he grasped that his powers actually came from within, allowing him to fly.
No one is saying "positive thinking" can cure cancer, or that patients should throw out their pills, let alone that illnesses that respond to the placebo effect are "all in your head"—imagined. But there is no denying the drumbeat of studies on the therapeutic power of placebos. Over the years they have been shown to relieve asthma, lower blood pressure, reduce angina and stop gastric reflux. An inert solution injected into the brains of patients with Parkinson's disease reduced muscle rigidity about as well as standard drugs. In a bizarre finding, sham surgery of the knee, in which patients got sedation and an incision but no actual procedure, relieved the pain of osteoarthritis better than actual arthroscopy—and produced an equal improvement in joint function, scientists reported in 2002. And last month an analysis of clinical trials of a range of antidepressants found that, except in the most severe cases, placebos lifted the black cloud as well as meds did.
To be sure, no study is perfect. In the antidepressant one, the placebo might not have looked as effective if it had been compared with the drug that worked best for each patient, rather than with the one that happened to be chosen for the clinical trial. (Some patients respond better to Paxil, some to Effexor or others, for reasons that remain murky.) But the fact remains that placebos are at least somewhat effective and sometimes very effective for some patients. Rather than railing against that finding or pretending it doesn't exist, what we should be doing is learning how brain activity that corresponds to the expectation of cure translates into clinical improvement. As Dan Ariely of Duke University says, "It's not that medicines are crummy, but that the placebo effect is so powerful."
There have been clues about the source of that power. In Parkinson's disease, studies find, the expectation of getting better raises brain levels of the neurochemical dopamine, whose shortage underlies Parkinson's, and normalizes the pattern of firing in a region of the brain where aberrant firing causes the loss of motor control. When the placebo effect relieves pain, it releases natural opioid-like molecules in the brain that have analgesic effects like morphine.
Ariely, a behavioral economist, saw the power of placebos during the three years he spent in a hospital recovering from a horrific accident that left him with third-degree burns over 70 percent of his body. Night after excruciating night, patients would beg for painkillers. One day, he recalls, "I overheard the doctors telling the nurses not to give a certain patient any more morphine. A few hours later, when the same patient started begging for painkillers I saw the nurse going to her room with an injection," and soon the patient fell asleep. When Ariely asked the nurse about it, she said the injection was plain saline—a placebo.
Ariely's curiosity about the power of expectation—which he explores in his new book, "Predictably Irrational"—inspired a study of what affects those expectations. He and colleagues gave 82 volunteers a brochure explaining that they would be testing a new pain drug called Validone that worked like codeine, but faster. (It was actually a placebo.) Each then received a series of electrical shocks on their wrists, rating them from "no pain at all" to "the worst pain imaginable." Each then took a "Validone." Half were told it cost $2.50, the other half that it cost a dime. They then received shocks again. Of those who got the $2.50 pill, 85 percent felt less pain from the same voltage than before taking it; 61 percent of those taking the cheap pill felt less pain, the scientists reported last week in The Journal of the American Medical Association. The pricier the drug, the higher the expectation of efficacy, and the stronger the placebo effect.
That will not surprise doctors whose arthritis patients screamed bloody murder after Vioxx was withdrawn from the market after studies showed it raised the risk of heart attacks. People insisted that switching to cheap aspirin just did not relieve their pain and suffering. Maybe. But in light of Ariely's research, you've got to wonder. And patients who protest when their insurer makes them switch from a name-brand drug to a cheaper, biologically identical generic? "Many claim the generic is less effective," says Ariely, "but you have to consider whether that's an effect of the price. The placebo effect is about expectations, and we expect more-expensive medicines to work better." Maybe researchers would be interested in figuring out how to harness that effect if only it were patentable.
Tuesday, March 4, 2008
- You cannot fix your partner. There is nothing you can do to make him or her well, so don't feel compelled to try. What you can do is be supportive, loving and handling the everyday details and practical issues of life that he or she cannot cope with.
- All members of the family have a responsibility to cope with the illness. Escape is not a helpful way of dealing with crisis. You all need each other.
- The ill partner must recognize and accept the illness, be willing to receive treatment, and if possible, learn to manage the illness. If the ill partner is not willing to do these things, it may become impossible for the family to continue to support him or her. The family is not required to throw away their own lives for someone who refuses to cooperate. There are limits and they must be enforced without feelings of guilt.
- Educate yourself concerning every aspect of the illness. Education brings compassion. Ignorance just encourages anger and fear.
- Grieve your loss. It is a great loss. You need to allow yourself the time and energy to experience the entire process of grieving.
- Get help for yourself to cope with this incredible challenge, either from your own counselor or a support group. You can't do it alone. Don't refuse to recognize your own need for help, just because the ill partner is getting most of the attention.
- Help your children understand the illness as much as their age allows. NO FAMILY SECRETS. Don't deny them the opportunity to learn about the illness, the unfair stigma attached to it, and developing their own skills in coping. It can be an incredible learning opportunity for them. If they need proof and help to understand it and their own feelings, get it for them.
- Try to create a safe environment for the partner to express himself/herself without feeling threatened, constrained or condemned. He or she desperately needs a nurturing, safe place to express the incredible frustration he or she is feeling about coping with mental illness.
- You and your children need to share your feelings, honestly and openly. It's okay to feel angry and cheated. At times you may feel embarrassed by the ill partner's behavior, avoid trying to protect your partner by not discussing the problem with family or friends. Don't require your children to conspire with you in a code of "family secrecy." Family secrets will only isolate you from others. Remember that small children, by their very nature, assume that they are responsible for anything in their environment that goes wrong.
- Never put yourself or your children in physical danger. If you sense your partner is becoming dangerous, you should leave and call for professional help. You should never tolerate abuse of you or your children. Trust your instincts and intuitions on this one. Say, "no way" and mean it.
- Become your partner's advocate with the medical professionals, assertively involved in his treatment and medications. If the medical professional or psychiatrist won't cooperate with you, demand a different one! Treatment should involve the entire family, so find a professional who will work with the whole family. You know more about your partner's illness than anyone else. Trust your instincts.
- Frankly assess what your partner can and cannot handle, the compensate assertively. Some people with mental illness cannot handle money, some household chores, time commitments and too much stress. You must not do things for your partner that he or she can do for themselves. Don't rob him or her of their dignity.
- Maintain your own identity; resist becoming consumed with your partner's illness. Life goes on. You have an obligation to yourself and your children to take care of yourself and meet your own needs. You all must continue to develop your own interests and talents. You are a valuable human being, so don't play the martyr role and sacrifice yourself. That's just self pity. "Get a life."
- Always hope for healing. The medications do work and new ones are being developed. You may get your partner back whole some day. If nothing else, the experience will broaden and deepen you in ways you never imagined. Or, you can choose to let it destroy you, your family and your relationship. It is your choice.
- Keep in mind that bad things happen to good people and you're no exception. You have not been singled out for a special persecution. Trying to make good choices in life won't protect you from misfortune. You haven't been "dumb" to "get yourself in this situation." It is not your fault. Life is not easy, we have to take what we get and make the best of it.
Excellent article found at this link. (healthyplace.com)