by Jo Marchant
It’s a bold idea, but a lot of people seem convinced. Scientists I talk to rave about Tracey’s work. Publications from Forbes to Scientific American have splashed on his story.43 And while biofeedback struggles for funding, companies and governments are throwing money at the idea of implanted bioelectronic devices. In 2013, GSK announced a $1 million innovation prize (in addition to $50 million it was already spending on research), and the NIH announced a seven-year program worth $248 million; in 2014, a new DARPA initiative was highlighted by President Obama.44
Meanwhile Tracey has started a scientific journal dedicated to bioelectronics, as well as a company, SetPoint, which aims to develop miniature injectable nerve stimulators, perhaps as small as a grain of rice, that will be charged wirelessly and controlled via an iPad. The idea is that eventually these devices will work in real time, to monitor the incoming signals traveling along our nerves and, where needed, modulate their output to our organs.
But what about the conscious mind? Can we learn to harness the inflammatory reflex with our thoughts?
Tracey has argued that in theory, we might. Back in 2005, he suggested that insights from his work could help to direct research into mind–body therapies,45 and this is now starting to happen. For example, several scientists are studying whether techniques like biofeedback and meditation, which influence vagus nerve activity, can reduce inflammation through this pathway.46
For severely injured patients or acute situations such as septic shock, a strong, swift dose of electrical stimulation is probably going to work best. But Tracey suggested that for chronic illness—anything from hypertension to rheumatoid arthritis and inflammatory bowel disease—perhaps we might take a longer-term, preventative approach, using techniques such as meditation or biofeedback to improve vagal tone gradually over time.
I don’t know what Tracey thinks now about the potential for psychological approaches—he declined an interview for this book so I wasn’t able to ask him. He doesn’t mention mind–body therapies in more recent articles, and instead suggests that the tiny injectable devices his company is developing will become routine.
Researching both methods makes sense to me, however. The potential for bioelectronics in medicine sounds truly exciting, but understanding how mind–body techniques can influence the nervous system over time might help in less extreme cases to avoid the need for stimulators—a highly invasive solution, after all, that would leave millions of us dependent on expensive implants with significant medical risks (not to mention security concerns—a 2014 New York Times article pointed out that putting our nervous systems under wireless control might leave them open to being hacked).47
Either way, though, thanks to Tracey’s work, the role of the brain and the nervous system in health is finally moving center stage. And the potential for transforming the treatment of so many conditions is something that he feels finally gives some meaning to Janice’s death. He thinks of her, he said in 2005, as “like an angel.”48 In his research, and in the patients he helps, she lives on.
We wheel her in on a gurney. She’s in her nineties, perhaps, with pale, squashy flesh and gnarled hands and feet; her face all thread veins and no teeth. The bed nearly fills the square cubicle. Behind her is the blue-and-white-striped curtain she entered through. On either side, the tiled walls are lined with plastic chairs and hooks. Ahead, past her feet, is another curtain.
She’s shaking as we undress her, unbuttoning her blouse to reveal a voluminous tummy. “Ne vous inquiétez pas,” Madame—a squat, Spanish lady—instructs her. Don’t worry.
Soon she’s naked except for an enormous nappy. Two of us stand on each side, working together, our moves choreographed and rehearsed. We roll her one way and then the other as we slide a sheet underneath her hefty body. We place a blue blanket over her, lift her up on the sheet to slide a stretcher underneath, then we whisk the blanket away and over goes another sheet like a tablecloth, except that this one is cold and wet.
It takes seven of us (three on each side plus one at the head) to carry the stretcher, feet first, past the inner curtain and into a second chamber. It’s a small, austere space, lined with gray stone. Square but with a high, curved ceiling, it gives the impression of a miniature chapel.
The floor is tiled, wet and treacherous, and in the middle is a rectangular stone trough, filled to knee height with cold, blue-tinged water. A small, blue-and-white statue stands at the far end: the Virgin Mary. We shuffle down a couple of steps until the woman’s stretcher is over the water, head resting on the top step. Then we count together, un, deux, trois, and plunge her into the water.
I’ve been doing this all day; dipping woman after woman into these icy baths. This little space is the last of a row of ten or so similar curtain-lined cubicles, each with its own team led by a Madame. We’re all unpaid volunteers, and it’s unlike any job I’ve done before. We start each shift with 20 minutes or so of singing and prayer, voices sailing up above the cubicle walls.
Then the women come in (there are separate baths for men, and one for children). They’ve been queuing for hours for this moment, and they’ve traveled from around the world, just as the volunteers have. They’re American, Italian, Indian, Irish. Young, old, well, sick. They’re all here in the belief that these waters have healing powers. This is Lourdes.
A small town in the foothills of the Pyrenees Mountains in France, Lourdes was relatively unknown until 1858. Then at this remote grotto, a 14-year-old girl named Bernadette claimed to have several visions of the Virgin Mary, and, according to the story, a spring began to flow at the site. Lourdes is now one of the major pilgrimage sites of the Catholic Church. More than five million people come here every year, looking for spiritual—and physical—healing. Three intertwined churches now rise out of the rock around and above the grotto, and there’s a series of fountains where visitors can drink the blessed water. But for most, their experience centers on the baths.
Many religions have holy places where devotees travel in the hope of healing, and to wash away their sins. Millions of Muslims congregate in Mecca in Saudi Arabia for the annual Hajj pilgrimage, while Hindus gather every 12 years at the Ganges River in India. Other Catholic destinations sparked by apparitions of the Virgin Mary include Medjugorje in Bosnia and Herzegovina, and Fátima in Portugal. But Lourdes is unusual, perhaps unique, among religious pilgrimage sites, because it claims to validate scientifically any cures that happen here.
If someone claims a dramatic recovery in Lourdes, a committee of physicians collects relevant medical records and investigates whether there is any possible scientific explanation. If not, a bishop then decides whether to afford the unexplained cure the status of a miracle. Since 1858, more than 7,000 people have reported themselves cured to the committee, and 69 of them have been stamped as miracles. These lucky few have apparently been freed from ailments including tuberculosis, blindness, multiple sclerosis and cancer.
I’m interested in these apparent cures. I don’t personally believe in miracles, at least not the kind that defy nature’s laws. But these cases raise a profound question: can religious experience and belief affect our brains and in turn our bodies? Lourdes seems a good place to look.
I start in the baths. We work three-hour shifts, hot and crowded in the cubicles, as pilgrim after pilgrim appears through the curtain. We ask the women to undress, and wrap a sheet around them. Doing our best to communicate in sign language, we help each one with her buttons, undo her shoelaces, unhook her bra. Then, one by one, we usher them through the inner curtain. In an organized, mechanical set of movements we walk them to the far end of the bath and swoosh them backwards. Some women cry, some cry out, as they’re plunged into the cold water. Some touch and kiss the Mary statue. Some are stiff and tense, resisting the water; others throw themselves back with such force that we barely catch them before their heads hit the tiled steps.
One American woman stands for a long time, whispering to the statue. A Nigerian mother sobs and asks me to pray
for her son. We turn them around, saying prayers as we walk them out of the water. Then we dress them and send them out through the curtain into the spring sun.
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DOES BELIEVING in God make you healthier? It’s fair to say that this question has not been a top priority for scientists. The word “spirituality” barely appeared on the PubMed database (which collates the world’s biomedical journals) until the 1980s. High-profile scientists such as Richard Dawkins and Stephen Hawking have written entire books dedicated to eradicating the need for God.1 According to one scholar who works in this area, investigating the relationship between religion and health was seen until recently as an “anti-tenure” factor,2 a sure way to send your career crashing.
But in recent years, there has been a surge of interest. Thousands of studies on the topic have now been published in major medical and psychiatric journals, while U.S. medical schools routinely offer courses on religion, spirituality and health.
Much of this research concludes that being religious leads to better emotional or psychological health. But an increasing number of studies are claiming physical benefits too. In the last few years, believing in God has been linked with lower rates of heart disease, stroke, blood pressure and metabolic disorders, better immune functioning, improved outcomes for infections such as HIV and meningitis, and lower risk of developing cancer. Religious people have lower risk of cognitive impairment and disability with age, faster recovery following surgery, and lower rates of medical service use.3
Based on these results, some scholars argue that religion should be integrated into the medical system, with doctors inquiring about and supporting their patients’ spiritual health. But critics like Richard Sloan, professor of behavioral medicine at Columbia University in New York, and author of Blind Faith: The Unholy Alliance of Religion and Medicine, argue that many of these trials don’t adequately tease out other factors that aren’t directly connected with belief in God.4 Religious people tend to have healthier lifestyles, for example—they drink less, smoke less and have less unprotected sex.
What’s more, big surveys often use church attendance as measure of how religious someone is. In general, religious attendance is associated with 7–14 years of additional life.5 But you need a certain level of health to get to church in the first place, so perhaps it’s not surprising that this group lives longer. Those who attend church may also have stronger social bonds, and as Sloan points out, “There are plenty of other ways to enhance social connectedness.”6
On the other hand, a recent meta-analysis of 91 studies tentatively concluded that even after accounting for these factors, “religiosity/spirituality” may have a protective effect in initially healthy people, with those who attend church regularly around 20% less likely to die (when followed for periods of five years or more) than those who don’t.7
If there is an effect, it might be partly due to placebo responses; improvements in health triggered by the belief that God will heal us. A 2011 poll of more than 900 American adults found that 77% of them believe prayer can help to heal people from an injury or illness.8 Belief in fake treatments banished the symptoms of Linda Buonanno’s irritable bowel syndrome and Bonnie Anderson’s fractured spine. Similar biological pathways presumably help many of those who pray, or visit a pilgrimage site such as Lourdes.
But I soon find there’s a lot more to it than that.
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SHERI KAPLAN describes herself as “a nice Jewish girl.” She’s pretty with blue eyes and curly red hair. She grew up in Florida but spent her mid-twenties in Manhattan: partying, dating and working for a magazine. After that she returned to Miami, started a catering business with her sister, and settled down with a steady boyfriend. Then in 1994, when she was 29, everything changed. She was diagnosed with HIV.
“I was numb,” she said in an interview in 2005. “It’s like being hit by a train—there’s confusion, fear, anger, grief, sadness.”9 Her boyfriend left. She was convinced she was going to die. She gave up the catering business and maxed out her credit cards on a two-month trip to Europe. She thought it was a final fling, but it turned out to be a new beginning, and she returned to Miami determined to make the most of whatever time she had left. She looked for a patient support group but couldn’t find one that catered for heterosexuals with HIV—they were all aimed towards gay men or drug addicts. So she founded her own.
The Center for Positive Connections started as a handful of women Sheri found through local clinics, who met each week to chat over coffee. A few years later, the group had a half-million-dollar budget and over 1,500 members. It provided social activities, support groups, national hotlines, personals ads and an annual Caribbean cruise. Sheri traveled the world with her work, winning awards and meeting celebrities like Richard Gere.
And through the group, she found a new purpose in life, interpreting her illness as part of God’s plan. “I got HIV because it is my purpose of being,” she said. “I had to understand what it is like so I can help the community on a different level and help create social change.”10 Amazingly, she stayed well, and she believed her religious faith was helping to keep her virus at bay. She wasn’t alone—a 2006 study found that 50% of HIV patients thought their religion/spirituality was helping them to live longer.11 But was she right?
It sounds a bit crazy. HIV infects the immune system’s CD4 cells, using them to make thousands of copies of itself and killing them in the process. Eventually the number of CD4 cells in the body drops so low that the immune system stops working, leaving patients vulnerable to life-threatening illnesses. Treatments available today allow many people infected with HIV to live a long and healthy life, but in the mid-1990s, before those drugs were available, infection was generally seen as a death sentence.
But Gail Ironson, a psychologist at the University of Miami in Florida, noticed that some of the patients she saw didn’t get sick. Many of those patients talked about the importance of spirituality in their lives, and she began to wonder whether it really did influence their health.
Ironson interviewed around 100 recently diagnosed HIV patients, including Sheri, about their lives and beliefs, then followed their progress for four years. She found that 45% of the patients became more religious after their diagnosis, while 42% didn’t change their beliefs significantly and 13% became less religious. Ironson’s hunch turned out to be right. Those patients who became more religious lost CD4 cells much more slowly over the four years, and had lower counts of virus in their blood.12 Take Sheri, for example. In 2005, 11 years after she was diagnosed, she still had no symptoms, and enough CD4 cells that she did not need to start HIV medication.
Changes in religious belief are likely to alter behavioral factors that could in turn influence disease progression, such as living healthily or taking regular medication. But Ironson says that her result was significant even after accounting for differences in lifestyle, medication and other psychological factors such as optimism and depression.
This study isn’t conclusive on its own and, as far as I know, nobody has tried to replicate Ironson’s result. If she’s right, though, there’s no need to invoke divine intervention to explain why patients who turned to God did better. Ironson believes instead that this lowered their levels of stress.
There’s substantial evidence that stress accelerates the rate at which asymptomatic infection with HIV progresses to full-blown AIDS. In particular, the stress hormone noradrenaline helps the virus to enter CD4 cells, and to replicate faster once it is inside.13 In one high-profile study,14 which followed HIV-positive men for nine years, each extra (moderately severe) stressful event increased their risk of progressing to AIDS during that time by 50%. Some trials suggest that reducing stress levels through meditation or cognitive behavioral therapy can slow the progression of the disease.15 Trusting in God may work through the same pathway.
In fact, the apparent health benefits of religion—including reduced risk of chronic diseases such as diabetes, dementia and stroke—look ver
y similar to those you get from lowered stress. Neuroscientist Andrew Newberg of Thomas Jefferson University and Hospital in Philadelphia, who studies the effects of religion on the brain, tells me that like meditation, prayer lowers heart rate and blood pressure, and helps us to regulate our emotional responses to stressful situations. Religion helps believers “understand themselves, it helps them to understand the world, it helps them to cope with things,” he says.16
Believing in God may also provide us with the ultimate social support in the face of adversity. “There’s a sense of someone else beyond you who is your fall guy,” says Michael Moran, a Catholic doctor from Belfast who is a member of the International Medical Committee of Lourdes and volunteers regularly. “At times, it almost feels like you’re being taken into someone’s arms and held.”
But, warns Newberg, as with the placebo effect, religious belief has a dark side, for example if you’re in a church or religious group that espouses hatred and anger towards others. “Those are typically very negative emotions which can be detrimental to the person’s brain and body.” Reducing stress and benefiting health, Newberg argues, requires “being religious in a way that espouses positive emotions; emotions of love, compassion, connectedness, a sense of unity and so forth with other people. Not only people in your group but people outside of that group.”
Even within mainstream religions, going through a spiritual struggle or believing in an angry or judgmental God seems to make people more stressed, with subsequent effects on their health. In a 2001 study, psychologist Kenneth Pargament of Bowling Green University in Ohio followed nearly 600 hospital patients aged 55 and over for two years.17 Those who experienced spiritual struggles related to their illness—wondering whether God had abandoned them, questioning God’s love for them, or deciding that the devil had made them ill—were more likely to die in that time, even after controlling for other factors.