by Wayne Jonas
For a description of the social approach to healing individuals in the Navajo Beauty Way and other similar ceremonies, see gonativeamericanconcepts.wordpress.com/the-blessing-way/ and gonativeamerica.com/10-NavajoBeautyway.html.
Moerman, D. E. Meaning, Medicine, and the ‘Placebo Effect’. Cambridge, MA: Cambridge University Press, 2002. The definitive summary of how meaning and context work across cultures to explain the placebo response.
For a description on how relationship-centered care improved the health of a community of people and became a demonstration model for using the social and emotional dimensions of healing health care, see Gottlieb, K. (2013). “The Nuka System of Care: improving health through ownership and relationships.” International Journal of Circumpolar Health 72(1): 211–218; and, Driscoll, D. L., V. Hiratsuka, J. M. Johnston, S. Norman, K. M. Reilly, J. Shaw, and D. Dillard (2013). “Process and outcomes of patient-centered medical care with Alaska Native people at South Central Foundation.” The Annals of Family Medicine 11(Suppl 1): S41–S49.
Group care not only can address loneliness but also facilitate behavioral change and impact health care costs. For a description of the approach taken by Dr. Jeffery Geller, see Geller, J., P. Janson, E. McGovern, and A. Valdini (1999). “Loneliness as a predictor of hospital emergency department use.” Journal of Family Practice 48(10): 801–807; and, Geller, J. S., A. Orkaby, and G. D. Cleghorn (2011). “Impact of a group medical visit program on Latino health–related quality of life.” EXPLORE: The Journal of Science and Healing 7(2): 94–99.
CHAPTER 8: FINDING MEANING
It is difficult for scientists and physicians to believe that the subtle and largely immeasurable aspects of our mind and spirit are important for healing. But they are. They need to be considered and used in health care. I have spent a considerable part of my research career exploring this area, seeking to increase the scientific rigor and amount of evidence in the mental and spiritual dimensions of healing. Of course, more research is needed. While the role of mind-body practices, mindfulness, and mind-set is increasingly accepted in medicine, the subtler spiritual aspects of our lives is still largely taboo in medicine.
One of the most thoughtful writers in this area is Dr. Larry Dossey, whose books explore these areas. I recommend starting with his classic, Healing Words: Power of Prayer and the Practice of Medicine (San Francisco: Harper Collins, 1993), and also his Healing Beyond the Body: Medicine and the Infinite Reach of the Mind (Boulder, CO: Shambhala Publications, 2003).
Daniel Benor’s Healing Research (Munich: Helix Verlag, 1993) contains a detailed summary of research. A criteria-based, critical evaluation of these areas can be found in Jonas, W. B. and C. C. Crawford (eds.). Healing, Intention and Energy Medicine: Science, Methodology and Clinical Implications. London: Churchill Livingston, 2003.
For extensive summaries of the health effects from religious and spiritual practices, see Koenig, H., D. King, and V. B. Carson, Handbook of Religion and Health, 2nd Edition. New York: Oxford University Press, 2012; especially for nurses, see Carson, V. B. and H. Koenig Spiritual Dimensions of Nursing Practice. West Conshohoken, PA: Templeton Foundation Press, 2008; and especially for physicians, see Puchalski, C. and B. Ferrell Making Health Care Whole: Integrating Spirituality into Patient Care. West Conshohoken, PA: Templeton Foundation Press, 2011. Professor Puchalski conducts an annual training at George Washington University on spiritual issues in medicine.
Other selected references readers may find of interest mentioned in this chapter include (in order of their description):
Classics in the use of guided imagery for healing are the books by Jeanne Achtenberg (Imagery in Healing, Boston: Shambhala, 1985) and Carl Simonton (The Healing Journey, New York: Bantam, 1992) and Belleruth Naprastek (Staying Well with Guided Imagery, New York: Warner, 1994).
Newer, practical sites for getting both information and downloads of guided imagery for use in life can be obtained from the Academy for Guided Imagery (acadgi.com) and the website of Dr. Naprastek at healthjourneys.com. I have been involved in clinical studies with veterans using the work of Dr. Naprastek and found it useful and effective.
The remarkable effects of imagery and healing touch when used with Marines for PTSD can be found in Jain, S., G. F. McMahon, P. Hasen, M. P. Kozub, V. Porter, R. King, and E. M. Guarneri (2012). “Healing Touch with Guided Imagery for PTSD in returning active duty military: a randomized controlled trial.” Military Medicine 177(9): 1015–1021.
Veterans deployed to war have almost twice the rate of exceptional and spiritual experiences than the general population. See Hufford, David. “Spiritual experiences in Veterans deployed to Iraq and Afghanistan.” Personal communication; and, Hufford, D. J., M. J. Fritts, and J. E. Rhodes (2010). “Spiritual fitness.” Military Medicine 175(8S): 73–87.
We can teach the body to respond in specific ways to inert substances or other signals through the process of classical conditioning. For examples of this, see the classic study of immune suppression in rats by Ader, R. and N. Cohen (1975). “Behaviorally conditioned immunosuppression.” Psychosomatic Medicine 37(4): 333–340; and, in humans by Goebel, M. U., et al. (2002). “Behavioral conditioning of immunosuppression is possible in humans.” Federation of American Studies for Experimental Biology Journal 16:1869–1873; and, in other conditions, see Kroes, M. C. W., J. E. Dunsmoor, W. E. Mackey, M. McClay, and E. A. Phelps (2017). “Context conditioning in humans using commercially available immersive Virtual Reality.” Scientific Reports 7:8640. doi:/10.1038/s41598-017-08184-7; and, Colloca, L., L. Lopiano, M. Lanotte and F. Benedetti (2004). “Overt versus covert treatment for pain, anxiety, and Parkinson’s disease.” The Lancet Neurology 3: 679–684.
Branding (the label on the pill) and price (expensive or cheap) make a difference in the effectiveness of treatments. See Margo, C. E. (1999). “The Placebo Effect.” Survey of Ophthalmology 44: 31–44, for an example of branding; and, Waber, R. L., B. Shiv, Z. Carmon, and D. Ariely (2008). “Commercial features of placebo and therapeutics.” Journal of the American Medical Association 299(9): 1016–7 for an example of how price impacts effectiveness. Drug companies know about these effects. How much of the fluctuation in branding and drug prices is to impact their perceived effectiveness rather than because of their real effects?
Moerman, D. E. Meaning, Medicine, and the ‘Placebo Effect’. Cambridge, MA: Cambridge University Press, 2002. The definitive summary of how meaning and context work across cultures to explain the placebo response.
For a detailed description of the use of conditioned immunosuppression in an eleven-year-old child with a life-threatening disease by Dr. Karen Olness, professor of pediatrics at Case Western Reserve, see Marchant, J. “You can train your body into thinking it’s had medicine.” Mosaic: The Science of Life. mosaicscience.com/story/medicine-without-the-medicine-how-to-train-your-immune-system-placebo.
Siegel, Daniel J. Mind: A Journey to The Heart of Being Human. New York: W.W. Norton & Company, 2016. A visionary book by a University of California, Los Angeles, psychiatrist on how the mind works, both inside and outside the body.
For a study on how expectations can be established during a single clinical visit and profoundly affect outcomes in primary care, see Thomas, K. B. (1987). “General practice consultations: is there any point in being positive?” British Medical Journal (Clinical Research Edition) 294(6581): 1200–1202.
Gracely, R. H. (1979). “Physicians expectations for pain relief.” Society for Neuroscience Abstracts 5: 609; also in Levine, J., N. Gordon, and H. Fields (1978). “The mechanism of placebo analgesia.” The Lancet 312(8091): 654–657. It matters what your physician believes will work, not just what you believe. Ask your doctor about his or her belief in a treatment.
Lang, E. V., O. Hatisopoulou, T. Koch, K. Berbaum, S. Lutgendorf, E. Kettenmann, L. Henrietta, T. J. Kaptchuk (2005). “Can words hurt? Patient-provider interactions during invasive procedures.” Pain 114: 303–309. Don’t let yo
ur doctor say “This will hurt,” because it will if he does.
Schedlowski, M., P. Enck, W. Rief, and U. Bingel (2015). “Neuro-bio-behavioral mechanisms of placebo and nocebo responses: implications for clinical trials and clinical practice.” Pharmacological Reviews 67(3): 697–730. The side effects of drugs increase the more we expect them to.
The study on death in China, related to astrology, is found in Phillips, D. P., T. E. Ruth, and L. M. Wagner (1993). “Psychology and survival.” The Lancet 342(8880): 1142–1145.
A spiritual view of healing through and because of trauma: Nouwen, Henri J. M. The Wounded Healer: Ministry in Contemporary Society. New York: Image/Doubleday Books, 1979.
Shanafelt, T. D., L. N. Dyrbye, and C. P. West (2017). “Addressing Physician Burnout: The Way Forward.” Journal of the American Medical Association 317(9): 901–902. Up to 50% of doctors are burnt out and say they have lost their passion for medical practice and empathy for patients.
Murphy, Robin. The Future of the Body: Explorations into the Further Evolution of Human Nature. New York: Tarcher/Putnam, 1992. Mr. Murphy has provided an encyclopedic review of our body’s remarkable ability to heal.
Temel, J. S., J. A. Greer, A. Muzikansky, E. R. Gallagher, S. Admane, V. A. Jackson, et al. (2010). “Early palliative care for patients with metastatic non–small-cell lung cancer.” New England Journal of Medicine 363(8): 733–742. By providing less treatment and more comfort and caring for patients with advanced lung cancer, they felt better and lived longer.
Doctors and our health care system do not deal well with death and dying. See Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, D. C.: National Academies Press, 2015 and Gawande, Atul. Being Mortal: Medicine and What Matters in the End. New York: Metropolitan Books, 2014. Dr. Gawande writes about the need to extend healing into times of death and dying. I write about the need to extend healing into routine medical care at all times.
For studies on the value and limitation of intuition, see the extensive work by Professor Gerard Hodgkinson and his team of the Centre for Organizational Strategy, Learning and Change at Leeds University, England. Their findings are summarized at leeds.ac.uk/news/article/367/go_with_your_gut__intuition_is_more_than_just_a_hunch_says_leeds_research.
For a rigorous evaluation, using three types of validity, of the research done on mind and spirit for healing, see Jonas, W. B. and C.C. Crawford (eds.). Healing, Intention and Energy Medicine: Science, Methodology and Clinical Implications. London: Churchill Livingston, 2003.
For a review and statistical comparison of the outcomes of prayer-like (psychic intention) activity, showing that the effects are similar to that of aspirin in preventing heart disease, see the 1995 study “An Assessment of the Evidence for Psychic Functioning” by Professor Jessica Utts, who chairs the Department of Statistics, University of California, Irvine, and is the past president of the American Statistical Association. Find the study online at citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.40.8219&rep=rep1&type=pdf.
CHAPTER 9: INTEGRATIVE HEALTH
Leaders in medical education and practice regularly call for more holistic, humanistic, personalized care. Unfortunately, technology, economics, politics, or tradition often subvert these recommendations. Then, calls for more healing reassert themselves under various names—biopsychosocial, patient-centered, relationship-centered, personalized, humanistic, proactive, holistic, or sharing medicine, for example. Integrative health is the most recent and comprehensive attempt to return healing to health care. We cannot afford a health care system that does not value health, healing, and well-being. If I were to recommend just one book about these dynamics, it would be Kenneth Ludmerer’s A Time to Heal (New York: Oxford University Press, 1999), which is an encyclopedic history of the forces and dynamics facing a more holistic, humanistic, caring medical system.
Hypertension, like Trevor had, is one of the most important individual and public health conditions in the world. It is treatable, and its complications, which are myriad and include heart disease, stroke, and kidney failure, are top causes of death and disability. For a summary, see the World Health Organization (2013). “A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013.” who.int/cardiovascular_diseases/publications/global_brief_hypertension/en.
At the time that Trevor went to the doctor, the major guidelines for treating and managing hypertension were in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). See nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf. The more recent guidelines (called JNC8) have even less detail on integration of the social and nondrug approaches to hypertension, saying it is “beyond the scope” of the recommendations. Without integration of these dimensions into practice, however, more patients like Trevor may fall through the gap.
Other references of interest mentioned in this chapter include the following:
Steinberg, D., G. G. Bennett, and L. Svetkey (2017). “The DASH diet, 20 years later.” Journal of the American Medical Association 317(15): 1529–1530.
Trevor’s “natural medicine” practitioner may have been influenced by a popular book on the Rice Diet. See Rosati, Kitty Gurkin and Robert Rosati. The Rice Diet Solution: The World-famous Low-sodium, Good-carb, Detox Diet for Quick and Lasting Weight Loss. New York: Simon and Schuster, 2006. However, what Trevor did not understand was that the original diet, developed by Duke physician Walter Kempner in 1939, was for a very different type of patient than he was. See Klemmer, P., et al. (2014). “Who and what drove Walter Kempner? The rice diet revisited.” Hypertension 64(4): 684–688.
For summaries of the factors that contribute most to population health and how our health care systems can better address those factors and close the gap see: Kindig, D. A., B. C. Booske, and P. L. Remington (2010). “Mobilizing Action Toward Community Health (MATCH): metrics, incentives, and partnerships for population health.” Preventing Chronic Disease 7(4): A68; and, Dzau, V. J., M. B. McClellan, J. M. McGinnis, S. P. Burke, M. J. Coye, A. Diaz, T. A. Daschle, W. H. Frist, M. Gaines, M. A. Hamburg, J. E. Henney, S. Kumanyika, M. O. Leavitt, R. M. Parker, L. G. Sandy, L. D. Schaeffer, G. D. Steele, P. Thompson, and E. Zerhouni (2017). “Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative.” Journal of the American Medical Association 317(14): 1461–1470; and, Samueli Institute’s “Wellbeing in the Nation: A Plan to Strengthen and Sustain our Nation’s Wellbeing, Community by Community” available at wellbeinginthenation.org.
For information about evidence-based medicine and why it has become so important, see Belsey, Jonathan and Tony Snell (1997). “What is evidence-based medicine?” Hayward Medical Communications; and, Jaeschke, R. and G. H. Guyatt (October 1999). “What is evidence-based medicine?” Seminars in Medical Practice 2(3): 3–7.
The term salutogenesis meaning “the generation of health” was first coined by psychologist Aaron Antonovsky. See Antonovsky, Aaron. Unraveling the Mystery of Health. San Francisco: Jossey-Bass, 1987. I have expanded the use of the term salutogenesis beyond psychology into medicine and use it to complement the concept of pathogenesis meaning “the generation of disease.” See Jonas, W. B., R. A. Chez, K. Smith, B. Sakallaris, and C. Crawford (2014). “Salutogenesis: The Defining Concept for a New Healthcare System.” Global Advances in Health Medicine 3: 82–91.
Hölzel, Britta K., et al. (2011). “Mindfulness practice leads to increases in regional brain gray matter density.” Psychiatry Research: Neuroimaging 191(1): 36–43. This research is what made us think that Mandy would benefit from an eight-week session of mindfulness before we resumed acupuncture treatment for her chronic pain.
While the story about the origins of Tibetan medicine as an intentional synthesis from multiple traditions did not likely occur exactly like this
, the story does speak to the fact that Tibetan medicine is a tradition that intentionally draws from the multiple healing approaches from India, China, and the Middle East—and, more recently, the West.
For serial data on the growing popularity and use of complementary and alternative medicine in the United States, see Eisenberg, D. M., R. B. Davis, S. L. Ettner, S. Appel, S. Wilkey, M. Van Rompay, R. C. Kessler (1998). “Trends in alternative medicine use in the United State 1990–1997: Results of a follow-up national survey.” Journal of the American Medical Association 280(18): 1569–1575; and, Nahin, R. L., P. M. Barnes, B. J. Stussman, and B. Bloom (2009). “Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007.” National Health Statistics Reports 18: 1–14; and, Clarke, T. C., L. I. Black, B. J. Stussman, P. M. Barnes, and R. L. Nahin (2015). “Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012.” National Health Statistics Reports 79:1–16.
World Health Organization (1948). “Definition of health” see who.int/suggestions/faq/en/; also, see “Constitution of WHO: principles.” who.int/about/mission/en.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy of Sciences Press, 2001. A landmark study in which person-centered care is clearly defined and called for.
Ornish, Dean. The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health. New York: Ballantine Books, 2008. Dr. Ornish is a pioneer in health promotion and lifestyle medicine and this is his most holistic view yet.