by Wayne Jonas
These types of adverse childhood experiences (ACE) have been shown to produce lifelong challenges to health and healing for many people. Not only do those with high ACEs have more mental and physical health problems, such experiences establish behavioral, neurological, and physiological patterns that are difficult for people to change. They are a double whammy—producing poor health and inhibiting behavior change to improve that health. If physical or sexual abuse is also involved, these problems are literally beaten into the brain and body of a person, making the induction of healing through behavior especially difficult. Until a person learns to reprogram those automatic emotional and physiological responses, repeated attempts at behavior change often fail, further reinforcing the difficulty. Such reprogramming can be done, but to pull it off requires extra assistance with environmental and social support. This assistance focuses on developing a readiness to change. Once the readiness has been properly prepared, actual behavior change becomes easier.
BRINGING HEALING INTO HEALTH CARE
Just as there is no magic bullet for chronic illness with specific medical treatments—no drug or herb or needle or knife that by itself will make you well—there is also no magic diet or other behavior change that will do this. After my patients and research taught me that most healing was not coming from the treatments I was prescribing, I discovered that the same thing applied to lifestyle. Add to that the paucity of science being applied to understanding lifestyle as therapy, and you can see why we have a plethora of self-care books running the gamut of recommendations. As important as healthy behavior is, if you want to access its healing capacity beyond what you can expect from simply making a change, you must connect that behavior to your life in a unique and meaningful way.
Healing can happen by applying medical treatments like Norma, Aadi, Sergeant Martin, and Xiao did in earlier chapters. It can happen by changing the external environment as Susan and Clara did in chapter 5. It can also happen with behavior changes like those that Jeff, Maria, and Ensign Rogers made. In each case, they found the right combination of approaches for their lives. To do this, however, we needed to focus less on finding a cure—the magic bullet or latest self-improvement fad—and more on how to connect healthy behaviors to our deeper personal dimensions.
One fundamental sign that a medical treatment, physical environment, or lifestyle will tap into the 80% of your healing capacity is the return of joy—a joy that comes from the experience of meaning and purpose. Another sign is an intuitive sense of certainty—a gut feeling that goes beyond belief and superficial desires for things to be a certain way. This gut feeling alone, however, is not sufficient to ensure it’s the right healing choice for you. Any treatment or other healing approach should be verified with scientific evidence. What you decide to do should make sense to you and your doctor rationally, feel right to you emotionally, make sense socially, and be doable logistically. It is a committed embrace of the decision and follow-through that comes from your whole being. Many cultures describe this feeling in spiritual terms, but it is rarely seen that way in modern biomedicine. Modern medicine calls this approach by many names, such as person-centered care, precision health, or integrative medicine. The methods used to obtain this may involve personalized care planning, shared decision making, and health coaching. But optimal healing goes beyond the limited concepts of those terms. It involves the whole person and is produced by the meaning response. An emerging field that captures this most completely is called “integrative health.”
Whole system sciences is providing powerful tools to more efficiently track when and how healing happens—providing objective ways to check your gut feelings. For example, as part of the million-person NIH Precision Medicine Initiative I described previously, researchers at Stanford University tracked nearly two billion measurements (250,000 a day) on sixty people to see how their day-to-day patterns of behavior correlated with health or illness markers. By analyzing patterns of change in this data over several months, the researchers could predict risk and illness as well as what produced improvements and healing in those people. Currently, this tracking is cumbersome and expensive for a clinic or person to do—but soon it will be relatively easy and some of it is being offered now. Technology is advancing our ability to measure, analyze, and monitor the whole person in ever more rapid and refined ways. Dr. Eric Topol, director of the Scripps Translational Science Institute and editor-in-chief of Medscape, describes this brave new world in his book The Patient Will See You Now. Technology is increasingly able to continuously monitor the core components of chronic disease and its risk factors and directly guide patients on how to monitor their own behavioral changes to prevent such disease. Integrative health will take this same technology and flip this monitoring on its head. That is, you will be able to get a continuous “healthy aging” readout and adjust what you do, think, and take to keep in your optimal health and well-being zone. The goal of whole systems science is to see the impact of this whole-person healing approach—be it from conventional or complementary medical treatments, lifestyle medicine or behavior change, social relationships, thoughts and feelings, or maybe even what happens in our soul. That information will be at anyone’s fingertips. As this happens, we are creating a true science of whole person healing, and our ability to use it will improve. We will increasingly have precise ways to find the drugs to help each person, provide guidance on the environment to support optimal health, monitor the effect of daily behavior, and interpret a person’s intuition.
You don’t have to wait for this future, however. Much of this is available to you now—if you seek it and ask for it. There are already clinics and self-care tools delivering integrative health. These clinics and tools coordinate behavioral therapy, nutrition and lifestyle medicine, health coaching, and spirituality along with regular medical treatment. You can find them both inside and outside of medical centers. Those that are part of medical clinics are now delivering healing approaches and merging them with the approaches that seek to cure. I describe them and how you can access or create them at the end of this book.
The gap between our two health systems—between treatment and prevention—is being closed. But the area of behavior and lifestyle is not the widest gap between curing and healing. To understand what is, we must delve even deeper into how healing works—into the dimensions closest to the core of what it means to be human.
CHAPTER 7
Loving Deeply
How love and fear affect healing.
What are these other fundamental dimensions of being human needed for healing? Simply put, they are the emotions of love and fear—or more precisely, how we experience and manage them. How and what we love is intimately tied to our ability to find deep meaning and stimulate healing. The flip side of love is not hate; it is fear. Fear is the primary emotion alerting us to danger and drives our bodies to react—by fighting, fleeing, or freezing. Our entire brain (and body), with all its complexity, is constantly screening the environment for threats to our survival, asking what we should worry about and act on and what we can let go and relax around. When it thinks it has found a threat, it alerts us with fear and all the psychological and physiological reactions that accompany it.
If there is a single secret to how healing works, it can be found in how we handle our loves and fears. Love and fear are not intangibles—they have a physical effect and are, as we’ll explore in this chapter, a matter of life and death. Love opens. Fear contracts. Both of them are needed for healing.
One of the myths about love and fear is that we have no control over them—that they just happen to us. We “fall” in love. We are “seized” by fear. Being subjected to the slings and arrows of emotion is indeed how many people experience their life. But whole systems science has now shown that not only can we learn to manage these emotions, but our health and healing depend on having just the right balance of them in our lives—both to get healthy and to stay healthy. Modern medicine’s failure to take advantage of the social
and emotional dimensions that help us manage love and fear leaves much of our healing potential untapped. When health systems have made these social and emotional dimensions central to their operations, those systems universally produce better outcomes and reduce costs.
The importance of managing love and fear has actually been shown in the laboratory—using rats and rabbits. Let’s start with that.
THE RABBIT EXPERIMENTS
The rabbits were not dying, and that was a problem. How could the scientists find the cure to heart disease if they could not produce it? To study the effects of diet on heart disease, researchers fed different diets to two groups of rabbits and then compared the effects. One group ate a diet very high in fat and cholesterol; a control group ate a normal rabbit diet. Most of the rabbits who ate the high-fat, high-cholesterol diet developed high levels of cholesterol in their blood and blocked arteries in their hearts, putting them at increased risk of heart attack and stroke. It was a standard research test model that reinforced the cholesterol hypothesis of heart disease, a model demonstrated in laboratories all over the world and previously verified in the researchers’ own laboratory multiple times.
But this time the results for one group of the fat-eating rabbits were different. Although they developed high levels of blood cholesterol, the rabbits in cages on the lower laboratory shelves had fewer blockages in their arteries and were not dying. The researchers checked and rechecked both the type and the amount of food that the rabbits ate and made sure that these rabbits were identical to the other rabbits used in the experiment. However, they could come up with no explanation for the lower-shelf rabbits’ apparent immunity to the unhealthy diets. The researchers were confused. And then they talked to the lab technician.
The lab technician, a short woman, was taking the rabbits in the lower cages out of their cages every day and playing with them. She held them on her lap and petted them. She talked to them. Soothed them. Basically, she loved them. Then she would clean the cages and put them back in. Since she could not reach the higher cages, another technician was taking care of those animals. Those rabbits were not being petted—and they were dying at the normal rates.
The researchers were skeptical that simply soothing and petting an animal could negate the effects of a proven disease-producing diet. To have this effect, the loving touch these rabbits were getting only once a day would have to produce powerful chemicals that reduced the inflammation in the endothelium (lining) and the deposition of cholesterol in their coronary (heart) arteries and reduce blockages.
Most scientists would have not been distracted by the idea of love and simply told the technician to stop petting the rabbits. After all, their grant was funding them to test the diet-heart disease hypothesis, not the love-your-rabbit hypothesis. But the lead investigator was curious. Was love really overcoming diet? To rigorously test that hypothesis, the researchers designed an experiment that randomly divided a new set of rabbits into separate groups. They instructed the technicians to take the rabbits in certain groups out of their cages every day, play with them, stroke them, and love them for different amounts of time. They were to leave the other groups alone, except for routine feeding and care, without taking them out of their cages or touching them, except to transfer them quickly. They then studied the effect of this caring on cholesterol, endothelial function, artery narrowing, and heart disease.
What happened? Despite eating large amounts of fat and cholesterol, and even having elevated blood cholesterol levels, the cuddled rabbits had 60% less plaque in their arteries than the ignored rabbits, even though they were comparable in every other way—genetically, diet, weight, serum cholesterol, and heart rate. The factor that made the difference was love. The researchers were stunned. If only a few minutes of petting each day could reduce heart disease by 60% in a laboratory animal, imagine what power a lifetime of love (or its loss) could have on humans!
One patient in particular showed me clearly the power of love to heal the heart.
MABEL
Mabel was the “grand dame” of a large extended family. At eighty-four, she was the matriarch; for fifty years she had fretted, cared, and cooked for, disciplined, raised, and loved several generations. She was a sister, mother, grandmother, and great-grandmother to a family of nearly sixty—most of them relatives, others having showed up at her door and been “adopted” into the family. This included seven children of her own, nineteen grandchildren, and twenty great and great-great-grandchildren. Every week for three decades, the family had gathered at her house after church on Sundays for food, fellowship, and fun—and some of Mabel’s continuously dispensed wisdom. Usually, her advice started with the phrases “Lead with love” or “Love first” or “The Lord loves everyone.” If a child misbehaved, she might look at him sternly and say “Child…” Then she would advise the person to manage his anger or guilt or attitude better. “The Lord loves all people,” she would say—“you and them. It’s your job to catch up to the Lord.” Not everyone took Mabel’s advice, but everyone loved Mabel back.
Mabel’s emotional heart may have been healthier than most, but now her physical heart was failing. I had admitted her to the hospital with shortness of breath and a very low cardiac output, a sign that her congestive heart failure—a condition she’d had for more than a decade—had progressed to the end stages. Congestive heart failure (CHF) is one of the leading reasons for hospitalization and has a very high mortality rate—killing more than five million people a year in the United States alone. The death rate from CHF has increased by 35% since the 1990s as the population has aged and our ability to keep people from dying of a sudden heart attack has improved—leaving them to live with damaged hearts that are more likely to fail later. CHF is also one of the most expensive conditions to treat, with more than one million people a year hospitalized—30% to 60% of them more than once. Annual costs of treating CHF in the United States are estimated at $40 billion a year. Mabel had not been hospitalized for more than a year as we had kept her heart functioning, and her overall care improved at home. But that increased home care had a consequence.
Three months before this hospitalization, I had recommended that a home caregiver come in to help her function better in her house. She didn’t want that, but the family agreed with me so they found a home health care nurse. In addition, her family began to rotate coming over to be with her and help care for her each day. She didn’t like that either. She had always been the one to care for them—not the other way around. Mabel couldn’t love others in the way she had done before.
After admitting her to the hospital this time I found her numbers were off—her weight was up, largely from accumulation of water as her heart did not pump effectively. Her ejection fraction—a measure of how weak her heart was—had dropped. Her blood oxygen levels had also dropped—a sign that her lungs were filling up with fluid and not getting sufficient oxygen into the blood. I adjusted her medications and oxygen and diet to help these, and in a few days the numbers were better—but she was not.
One morning when I came in to check on her, she said, “Doc J, I appreciate all you doing for me. Just seems like too much bother, though.” She was clearly discouraged.
“No bother, Mabel,” I replied as I listened to her lungs and checked her weight. “That’s my job—to get you better.”
The next day she still complained of shortness of breath and weakness, and her blood oxygen was not quite as good. I prescribed physical therapy, upped her oxygen, and readjusted her medications a bit more. Her numbers improved again. But two days later, she was worse, as were her numbers. I checked a few more things—were her kidneys failing, too? Was her family slipping her salty snacks? Was she on the wrong medications? Was her heart just at the end of its life? Nothing seemed amiss. But this pattern repeated itself. This time I did not adjust any therapy. The numbers improved, then worsened, then improved. Her heart failure was going up and down almost independent of my treatments. I was not sure what was going on.