2. Mind-Body Medicine
The overall concept of there being an interplay between the mind and body in a state of health is not a new one. As far back as ancient Egypt healing as a modality was addressed on all levels; whether it is the body, mind or spirit. The Egyptians realized that treating the person as an integrated individual carried the greatest potential for a cure of any illness, and this still holds true today. In their world the healing process was an integration of elements of the mind, which may have involved prayers, incantations or spells, and it involved the purification of the body through bathes, herbs and special diets. But always it was the priest and his influence over the mind of the patient that carried the greatest possibility for a cure.
There are basically 3 distinct schools of thought regarding this interplay of the mind, body and spirit;
1. Material - in this state mind and matter are of one nature and arise and exist together.
2. Cartesian dualism - in this state mind and matter exist together in a substantial relationship, but they arise separately.
3. Fundamental mind - mind and matter arise separately but are intimately related.
In the material state the mind is said to function only on a physical level, where thoughts are reduced to chemical reactions and the only things of substance are the hormones and neurotransmitters that are produced. In other words everything that exists only exists because it has a physical reality and the mind is a byproduct of the body. The mind and body work according to the same principles that govern non-organic matter and everything is reducible to its component atoms and such.
Cartesian dualism is the brain child of Rene Descartes, who coined the phrase "I think, therefore I am". Cartesian Dualism, or Mind-Body dualism, is the basis for science and medicine and their separation of mind and body that lingers to this day. This concept is not new by any means, and has been found amongst ancient concepts in the Greek culture where body and mind were found to be of an entirely different essence. Yet is was Descartes who drew a strict distinction whereby the mind was responsible for things like imagination, feelings, will and all forms of rational thought and body was of the material realm. Descartes believed that the mind could cause the body to act and the body could cause the mind to have a variety of sensations. To Descartes the mind had a reality apart from the body while at the same time is was substantially united with the body and therefore had an impact on the physiological state. While he admitted that this approach left many things unexplained he persisted in spreading this philosophy to all who would listen. This type of approach exists in western, or what we call allopathic medicine, to this day due to the persuasiveness of Descartes. Inroads into breaching this philosophy have existed for generations and currently this philosophy is under considerable assault from the field of quantum mechanics. This approach however supports a distinction between physical phenomena and those of a mental or emotional nature.
The third philosophical approach, or the fundamental mind, is well over 2,000 years old and has its roots in ancient Buddhism, yet continues to this day. In this view mind and matter arise separately but are related in much the same way as a rider may mount a horse for a journey. In this approach there is the acknowledgement of a profound connection between the mind and body. Mind and body are seen to have functions that are cooperative as well as having the potential for a profound influence on each other's states. This particular connection is detailed in the latest book by the Dalai Lama "The Universe in a Single Atom" and is well worth the read. The Dalai Lama makes a compelling argument, often times elegant in its grandeur and simplicity, regarding current discoveries in the field of quantam mechanics, and the inability to separate the observer from the observed as distinct entities, as evolving explanations for theories that Buddhist monks have espoused for over a thousand years.
While you can see that this has been a topic of discussion for many millenniums, the discussion continues and is evolving while we speak. Dating back over 4,000 years in ancient Egypt, thru traditional Chinese and Ayurvedic medicine, thru Hippocrates and up the 20th century with the work of Walter Canon, and his documentation of the relationship between stress and neuroendocrine responses in animals, this model of a mind-body relationship has persisted, despite some very dogged opposition at the hands of very skilled and articulate detractors. Even Dr. Henry Beecher, and his use of placebos during World War II when there was a morphine shortage, showed how powerful the mind could be controlling pain.
However the past 30 years has shown a tremendous amount of research in the field of mind body medicine and even before that, in the mid 1960's, Dr Elmer Green began his pioneering research into what eventually became popularized as biofeedback. Dr Green began his career as a physicist and later got his PhD in biopsychology for the University of Chicago and this launched a 40 year career in the field of mind-body medicine. Dr Green has left his mark on the field with his work in the field of biofeedback and psychophysiologic self-regulation. But in reality his work is a combination of his own research and that of Oskar Vogt, the brain physiologist at the Brain Neuro Biological Institute in Berlin. Dr. Vogt noticed that some patients could put themselves in a self-hypnotic state which would have positive effects on their recuperation and could also, independent of this work, relieve many stress related symptoms and diseases.
Biofeedback as field of research goes back over at least 100 years, but it was Dr. Elmer Green who was granted the first NIH grant for research in this field and deserves much of the credit for helping to gain a greater understanding of biofeedback. His work in disseminating this body of information to the general public has helped it gain a much wider acceptance as well. Dr. Green was the father of autogenic biofeedback training and developed his techniques while at the Menninger Clinic with his wife, Alyce Green and with colleague Dale Walters as they studied EEG biofeedback as well as the process of meditation. Elmer and Alyce Green co-authored a wonderful book "Beyond Biofeedback" in 1977 which is a must read for people interested in this field. Dr. Green is well into his 90's and continues to write and research in this field.
Another leader in this field is Dr. Herbert Benson, from Harvard University, who has studied meditation, relaxation and the physiologic response that occurs. Much of his work goes hand in hand with that of Dr. Green and both are to be congratulated for looking outside the box of western allopathic medicine to help bring these healing modalities into the forefront of the healing arts. Dr. Benson explained in his book "The Relaxation Response" how meditation can be an excellent antidote for stress as it has a positive effect on lowering heart rate, decreasing the respiratory rate, decreasing blood pressure, decreasing muscle tension and decreasing oxygen consumption. A classic paper was printed in Psychiatry 1974 which shows demonstrable changes with such mind-body practices as meditation, yoga, autogenic training and hypnosis.
Even as far back as the early 20th century, Dr. Ivan Pavlov demonstrated a conditioned response in a dog. This work won him the Nobel Prize and has been used as a model for changing behavior since. His classic book "Conditioned Reflexes" continues to be used as a basis for modifying behavior to this day.
The list of contributors to this field of endeavor is quite large and the purpose of this discussion is to provide a history perspective and to allow one to see that this is not a new approach to healing. The opposition to Mind-Body medicines is pervasive today so I thought a brief historical perspective was in order. The essence of this approach is that it stresses an interconnection of physical, chemical, emotional, mental and spiritual properties. There are many modalities, and the purpose here is to open a debate and pique the interest of the reader to delve into other areas if he or she so desires. Although there are many modalities to be explored, we will discuss the following:
1. Biofeedback
2. Relaxation training
3. Autogenic training
4. Psychosynthesis
5. Meditation
6. Guided Imagery
7. Spiritual Healing
8. Prayer
9. Logotherapy
10. Gestalt Therapy
1. Biofeedback:
Biofeedback has evolved, due to various discoveries over the years, into a system where the individual practitioners have been able to control a variety of physiologic responses in the body. In what was originally thought to be under autonomic control (control through the unconscious mind), it has been found that various functions in the body could be altered through the exertion of mind and will. It has now been proven the the ability to control certain "automatic" body functions such as blood pressure and heart rate, amongst others, is an innate ability and even laboratory animals have been able to change the body temperature of various parts of their body in order to receive a food reward. Migraine headache sufferers can short circuit a headache simply by changing the temperature of their hands, and these techniques can be taught in just a few short weeks. Pain responses can be blocked for such conditions as colitis and neuritis as well as constipation.
In an article in Gut, biofeedback showed positive results in obstructive constipation and the results lasted for over 6 months, with later studies showing good results in chronic constipation in general. Researchers in Taiwan(1) were able to show positive results with neck pain and spasm using biofeedback in conjunction with cervical traction. Alan Brauer M.D., in a relatively thorough review of biofeedback and anxiety, walks through much of the research of the time surrounding biofeedback. This article, found in Psychiatric Times, Feb. 1999, Vol XVI, Issue 2 gives an excellent treatise for the efficacy of biofeedback and should help to dispel any fears one may have revolving around this healing approach.
2. Relaxation Training:
The heart of this approach is detailed in Dr. Herbert Benson's book, "The Relaxation Response", but for a brief review of the actual technique I will detail for you his 6 steps to the relaxation state.
1) Sit quietly in a comfortable position.
2) Close your eyes.
3) Deeply relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
4) Breathe through your nose. Become aware of your breathing. As you breath out say the word, "ONE", silently to yourself. For example, breathe IN...OUT, "ONE," ...OUT, "ONE", etc. Breathe easily and naturally.
5) Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes opened. Do not stand up for a few minutes.
6) Do not worry about whether you are successful in achieving a deep level of relaxation. Maintain a positive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by not dwelling on them and return to repeating "ONE". With practice, the response should come with little effort. Practice the technique once or twice a daily, but not within 2 hours after any meal, since the digestive processes seem to interfere with the elicitation of the Relaxation Response.
- The Relaxation Response, Herbert Benson, M.D.
The number of studies undertaken to investigate the various physical processes impacted are too numerous to elucidate at this time. Researchers continue to discover how controlling basic functions through relaxation can modify things like heart rate dynamics(2) or in playing a role in modifying certain brain chemicals like nitric oxide (NO) (3), which itself plays a very intricate roll in stress related diseases as well as immunological, cardiovascular and neurodegenerative/mental disorders. In the journal Neuroreport(4), where functional MRI was utilized, specific areas of the brain were identified that were active during a simple form of meditation. These areas are numerous and are involved in attention and control of the autonomic nervous system. The relaxation response has been shown to assist in improvement of sleep in the insomniac(5). The treatment of pain is both costly and frustrating for all involved but it has been shown that this too can be impacted through the person's own control of their physiologic processes. The overall complexity of the pain syndrome is multifactorially influenced involving behavioral patterns, socioeconomic factors, belief systems and family dynamics as well as many physiologic and mechanical components. However, with the interjection of behavioral modification techniques(6), like relaxation training, decreasing in the need for visits to the doctor, for pain management, could yield a projected savings of $23,000 per patient by the second year. For economic reason alone we need to consider this mode of treatment and certainly the patients themselves would do better if there was a decreased dependency on the physician for pain management.
Whether for assistance in cancer patients and the relief of their psychological distress(7), to improved hemodynamic functioning in middle aged adults(8), or an impact on the blood pressure of youths at risk for hypertension(9), the roll of the relaxation response has been shown to be of enormous benefit. I have given only a few of the various ways that this technique has been of benefit to a variety of disease states, but this should provide the impetus for further investigation to anyone interested in utilizing this as a tool in their approach to healthy living.
3. Autogenic Training:
Autogenic training, which actually means 'self origin', was devised by Johannes Schulz in the 1930's and was a discipline where the mind provides directions and the body follows. Dr. Schulz was a respected psychiatrist and neurologist who also became interested in the work of Oskar Vogt and was attempting to expound on some of his earlier research. This particular technique is described in Dr. Schulz's book "Autogenic Therapy" and gives in excellent detail both the training and descriptions of the six autogenic states utilized in this approach today. Dr. Schulz was attempting to find a way to switch off the "fight or flight" system of the body and thus bring about a healthier state in the body. The Autogenic process is one that involves progressive relaxation of various body parts and organs and is carried out in a state of passive concentration. Dr Schulz described 6 autogenic states and they are as follows:
a) focus on heaviness in the arms and leg
b) focus on warmth in the arms and legs
c) focus on warmth and heaviness in the heart area
d) focus on breathing
e) focus on warm in the abdomen
f) focus on coolness in the forehead
An essential feature to this approach is that it is carried out in a state of passive concentration, with no direct attempt at an outcome by the conscious mind. There are many similarities to the work by Dr. Jon Kabat-Zinn and his "Mindfulness Meditation" as well as the Buddhist work on mindfulness as a meditative approach. This form of relaxation therapy, and others in this mind-body approach, has been shown to be effective in treating a variety of disorders as was reviewed in the International Journal of Molecular Medicine(10). This approach also encourages a healthier lifestyle. The list of disorders that can aid by this approach is quite numerous and further research into this area is well justified.
4. Psychosynthesis:
Psychosynthesis, whose development was brought about by Roberto Assagioli, the Italian psychiatrist, is known as an approach to human development where an individual is focusing on a blending, or coming together, of all the various aspects of an individual’s personality into a more cohesive unit. It is believed that through this action a person's life can be more authentic and therefore more fulfilling. Psychosynthesis further asserts an affirmation of the higher or transpersonal self, which is a spiritual dimension and therefore a source of wisdom, unconditional love and inspiration that can lend a meaning to our life. Psychosynthesis has been deeply involved in the movement for increasing human potential due to its basic tenet that we live in an orderly universe and that it is structured to enhance the evolution of consciousness. This process helps an individual discover his or her owns purpose and meaning to their life.
Psychosynthesis is considered one of the most coherent and effective frameworks of transpersonal psychology and as a whole this approach addresses the entire spectrum of the human experience from the aspect of prepersonal consciousness into the development of a healthy personality and beyond into higher states of consciousness. There are numerous steps that one goes through from ego-death to the emergence of an expanded sense of one's self, both from an individual perspective to a universal one. This movement is one that espouses the belief that there is a natural tendency towards a progression of unfoldment, an evolution if you will, not only on the individual level, but on the universal level as well. This movement is one that aids in that evolution by assisting the individual to go inwards, to find that connection of the physical, emotional, mental and spiritual essences that exist inside of our consciousness and then help one become aware of the self as an active and directing agent on the journey towards living is a state of unconditional love. To experience love, compassion and many other wonderful emotions as one evolves into a state of universal consciousness.
There are 2 basic stages of Psychosynthesis: a) the personal level and b) the transpersonal level. At the heart of this process is the recognition that each person is an individual with the experience manifesting each time in a unique way.
In personal psychosynthesis there is an integration of the personality that revolves around assisting the individual in attaining a healthy functioning in both his relationships and in his work. This approach utilizes such things as guided imagery, training of the will and goal setting, toward the development of intuition and imagination while using meditation and dreamwork as well as other techniques to help facilitate the process. This approach treats the individual as a whole and any one session of psychosynthesis work may involve only one aspect to be integrated or many. The overall focus is on an integration of mind, body and feelings to help the individual see this as an ongoing and creative process with the ultimate goal of a joyful and harmonious life.
In transpersonal psychosynthesis one takes these lessons and transforms them to a larger scale where one sees such things as altruistic love and enhanced social responsibility as achievable things. Where one can visualize a greater spirit of cooperation, not only on an individual level but on the level of nations as well to bring about a grander global perspective of collaboration.
Psychosynthesis is a blending of western analytic depth psychology (e.g. Freud) and eastern meditative psychology into an approach that intended to enhance both human growth and development. Its intent is to assist us on the personal level to recognize when a temporary feeling like anger can cause us to distort our true perspective and to help us to recognize when we are simply responding to a particular situation because that is the way we may have always responded or perhaps we saw a parent respond that way. Dr. Assagioli called this a pre-programmed routine and much of the basic work in this approach is to recognize these false identifications and harmonizing them so we are no longer controlled by them but can bring them under our conscious direction. This technique helps us to find our path to our true identity, which is a center of awareness and will.
5. Meditation:
There are numerous types of meditation, many of which are involved in the healing modalities all over the world. Here we are going to discuss their implications for those of us going about our daily lives, as well as for physicians that practice in the world of allopathic medicine. Meditation as a process is one where you are attempting to alter your state of consciousness by quieting your busy mind. The attempt here is to get the mind to stay in the present moment and to have the mind be in the center of feelings of peace and calmness.
The varieties of approach to the field meditation include; Inner Light Meditation, Mindfulness Meditation, Relaxation Meditation, Energy Healing Meditation, Color Healing Meditation and many more. All of these techniques seem to embody the same basic intent, although th approaches vary. Many of these techniques have their origins in antiquity, like Mindfulness which has been portrayed as having been taught by Buddha to his followers over 2,500 years ago. Dr. Jon Kabat-Zinn has been instrumental in helping to bring this approach to non-buddhist people, and the Dalai Lama, in his recent book, "The Universe in a Single Atom" stated emphatically that this is a practice that is not only deeply steeped in Buddhist tradition but continues to be practiced today. For anyone interested in the audio book version of this book, I would highly recommend the heartfelt version as read by the actor and practicing Buddhist Richard Gere, and this can be purchased easily at audible.com.
But how does this impact health? There is a fairly large volume of research that can be found on this subject. In the area of aging there appeared to be not only a retardation of aging but also its reversal(11). There was also a healthy form of regeneration that not only had anti-aging properties, but also one that was antagonistic to oncogenesis or the formation of tumors. This recent information is groundbreaking in its implications and has helped us to identify a host of molecular mediators including DHEA, various interleukins and especially melatonin. Given our earlier discussion on the need for sleep it is interesting how melatonin, a hormone released by the pineal gland and is used to help induce sleep, now has been shown to be released while utilizing meditation. Meditation has been shown to be a powerful tool in conjunction with other non-pharmacologic interventions to assist in the anti-aging process, as well to having properties that are antagonistic to tumor formation meditation.
But what of those that have advanced in years, those of us who have reached the retirement age? In a sweeping review of research into meditation and spirituality over the past 25 years, as found in the journal Geriatric Nursing(12), these practices were beneficial in improving physical health, reduceing pain, enhanced immune response and an improvement in emotional well being. This practice helped to foster spiritual growth and could be easily taught to the elderly and even enhanced the life of those with dementia. These practices promoted social and emotional benefits for those in social isolation with specific benefits for those in nursing homes. This article recommended further investigations were indicated for nursing home residents and, with the growth of the portion of the population entering retirement, could well go a long way towards reducing the staggering health care costs that accumulate in the last few years of a person’s life, as well as improving the quality of life.
In the field of mental health one of the most frustrating areas is the field of suicide and people harboring suicidal thoughts. I have been involved in emergency medicine for going on 13 years and have seen an untold number of people who visit the emergency room because life’s frustrations and disappointments have become too great and the only solution for some people is to take their life. It is difficult to portray to you the sense of urgency one feels when somebody comes through your ER after having overdosed on any one of a variety of things. The Journal of Clinical Psychology(13) cited meditation and its usefulness as intervention towards preventing recurrence of suicidal behavior. Anyone who works in this field, or anyone who has a friend, family member or loved one who has attempted or contemplated suicide should read this article and give it serious thought.
The implications of this modality are not the sole dominion of aging, the elderly or even mental health. All of these were mentioned to encourage an active investigation into this field. Research has shown that this need not be a practice that is restricted to any one religious practice(14), as was shown in a Korean study, but rather one that can expand your faith in your own religious practice. It has been shown to assist in the recovery from disease in this same study as well as stabilizing ones physical, psychological and social daily living. Meditation was shown to be a path for discovering one's true self through a process of entering a religious discipline, embodying religious discipline, self-accomplishing religious faith and recovering mind-body health. I have only touched on a portion of the data and research in this field, but I hope that all can see that this is a powerful healing modality that is little utilized and can have powerful effects in all areas of health and healing.
6. Guided Imagery:
Guided imagery is a healing modality that uses the creative imagination of the patient to create positive images or affirmations to bring about a better state of health. So what is guided imagery? Guided imagery is a relaxation technique that is promoting the easing of stress; it promotes an incorporation of the power of the mind to assist the healing of the body. All this through an involvement of an emotional connection between the mind, body and spirit. Guided imagery uses the power of the mind as a powerful resource to help bring about changes in your life on all levels. It helps bring about a balance between all 3 levels by relaxing the mind and helping the mind is more open and receptive to new information.
While there have been many books written on this subject the one I found to be very practical in its approach was written by Steven Covey in his book "Seven Habits of the Most Effective People" which describes a guided imagery process that he calls the 5 basic ingredients of a good affirmation:
a) It's personal
b) It's positive
c) It's present tense
d) It's visual
e) It's emotional
Dr. Covey does and excellent job of portraying just how powerful this adjunct can be in changing your life through this simple practice. As he quotes in his book "We are what we repeatedly do. Excellence, then, is not as act, but a habit." - Aristotle. I would highly recommend this book to anyone looking for a practical way to integrate this practice into ones life.
Guided imagery has been utilized from open heart surgery with success(15), assisting in the cessation of smoking(16), to having effects for the elderly in simple things like balance and attention(17). In many studies a noticeable change occured in both stress levels and mood improved as well as health status(18). Better sleep and decreased nightmares were found to be present(19) and guided imagery provided some assistance in depression and post-traumatic stress.
As one can glean from all this information, this modality has implications at nearly every level of life. The implications are not just for the medical practitioner, but for anyone looking to have a happier, healthier and more successful life.
7. Spiritual Healing:
What is spiritual healing, or better yet what is spirituality? Spirituality is at the core of virtually all of our belief systems whether it is Buddhism, Christianity, Muslim, Hinduism or the Jewish system. But spiritual healing is the involvement of subtle energies that are only just starting to be recognized in the western world. However these energies are well recognized in a host of other medical systems, and are called "Qi or Chi" in traditional Chinese medicine, "Prana" in Ayurvedic medicine and as such are related to one's consciousness. Some of the more common practices for a spiritual healing include; prayer, visualization, channeling of spiritual energy or spirit guides and teachers as well as psychic abilities.
Spiritual healing has at its source a deeply spiritual recognition and acceptance of a Universal Consciousness and that this consciousness can provide inspiration, joy, peace of mind and guidance in the healing process. This may involve a caring touch, kind words or even just listening to the patient. This type of healing can be practiced through prayer, either individually or in groups, but if done when the person is not present is called distant healing. In any event this process is described as a channeling of energies being transferred to the patient, with the caveat that the healing does not come from the channeler, but rather the healing comes from the source of Universal Consciousness.
So much of what the research into this area is anecdotal by our modern standards, as we in the west have come to be dependent on the double blind testing methods as the gold standard. Scientists believe that all testing should adhere to very strict principles or it is invalid. Yet simply because something cannot be quantified does not mean it does not exist, it may mean that we simply lack the ability or technology to measure it. Given the fact that we are not able to fully understand how some medicines work, yet use them anyway, does not mean they should not be utilized. This is especially true of drug therapy in the field of mental health where a lot of their chemical interactions are based on conjecture and hypothetical models.
In the handbook called, "Comprehensive Handbook of Psychotherapy and Integration", by Robert N. Sollod describes a most fascinating model whereby spiritual healing could be folded into a typical psychologists practice with no compromising of standard psychotherapeutic models. He poses very interesting questions as to how such a model could emerge. This is a field of endeavor that is still in its infancy in the west and it will be a model that could easily emerge in the decades to come.
It is easy to speculate how such an effect could be made by looking at the field of quantum mechanics. As early as the 1920's Dr. Niels Bohr described a theory that later became known as the Copenhagen interpretation, or what is known as the Observer Effect, in where he postulated that the event and the observer were inseparable on a quantum level. In actuality there is no effect or phenomenon until it is observed. He found that at a quantum level things exist as a wave, but through the direction of consciousness these subatomic waves become a particle. This effect implies that the physical universe is a direct result of consciousness whereas our western science implies that human consciousness is the result of the inner physical workings of the human brain. Further research into modern physics has found that the observer actually determines the nature of the subatomic matter and that when they look for them as particles they show up as particles and when looking for them as waves they show up as waves, which makes the role of consciousness even more implicit.
So how does all this relate to spiritual healing? What if on a subatomic level the healer is producing change via his interaction with the healed? What if there is a rearranging of matter at this subatomic level that is conducive to a healing state, or a state of enhanced well being? I throw all this out for conjecture because, like you, I am looking for answers.
8. Prayer:
The general discussion of prayer is an area that does not lend itself well to the scientific approach. Prayer in and of itself has always been in the domain of a variety of belief systems. In this area people feel that they are seeking communion with God, through prayer. This has been described as a communication between their mind and that of God. So how prevalent is prayer? According to Self magazine as reported in an April 1994 survey, 88% of people in the USA pray and 59% of them meditate, while 89% believed in some sort of God or a higher consciousness. Clearly prayer is not an isolated or rare event. But does prayer belong in medicine and does it make a difference?
A lot of the early research was anecdotal, due to the extreme difficulty in quantifying prayer in the field of scientific research. Rupert Sheldrake PhD, in his paper "Prayer-A Challenge for Science", discusses how since ancient times a strong belief exists that consciousness is not limited to the physical body and that prayer is an access point to this realm. Dr. Sheldrake gives insight into the mechanistic mindset of the scientist and the difficulty that science has in evaluating something that is not easily quantified. Many of the researchers have difficulty separating the mind from something that exists inside of the brain.
One of the first studies utilizing the scientific approach, the double blind study, the cardiologist Randolph Byrd M.D. looked at the use of prayer in a cardiac care unit(20). He found that the use of prayer had a statistically significant benefit for those that received prayer. This study was criticized by in mainstream medicine. The best assessment of this study from the perspective of a non-partial point of view was by a fellow cardiologist, the respected Larry Dossey, M.D., in his book "Healing Words", he explains the strengths and weaknesses of this study, but congratulates Dr. Byrd for the courage in both performing and bringing out this study. Dr. Dossey concludes that there have been no conclusive studies done on human subjects on the power of prayer that would meet the guidelines of double blind studies.
Does this mean that prayer does not work or does it indicate that we perhaps lack the means to study it adequately? There is a difference between something not existing and being incapable of proving the non-existence of a thing. From the standpoint of current scientific thinking if a thing cannot be proved it does not exist. To say that something does not exist because we cannot proves its existence represents a metaphysical position rather than a scientific one and it would be more scientific to continue to accumulate empirical data and to keep our minds open. In science we take our empirical data and form our conclusions. If we attempt to form a conclusion and them make the empirical data fit that conclusion then that would be like trying ro reform our feet to fit our shoes as the Dalai Lama so aptly stated.
Perhaps the answer to this will indeed come from the field of quantum mechanics. Dr. David Bohm makes a compelling argument in his book, "Wholeness and the Implicate Order" that all things are connected on a subatomic level. As we learned earlier the observer can have an effect on the observed simply by his conscious interaction and the actual nature of matter at the subatomic level would change by virtue of this interaction. Is prayer simply the insertion of a conscious stream of intention that alters the health state of the person being prayed on?
The thoughts of one of the greatest minds of the 20th century perhaps ring truer now than ever before: Albert Einstein stated; "Now, even though the realms of religion and science are clearly marked off from each other, nevertheless there exist between the two strong reciprocal relationships and dependencies. Though religion may be that which determines the goal, it has, nevertheless, learned from science, in the broader sense, what means will contribute to the attainment of the goals it has set up. But science can only be created by those who are thoroughly imbued with the aspiration towards truth and understanding. This source of feeling, however, springs from the sphere of religion....The situation may be expressed by an image: Science without religion is lame, religion without science is blind."
9. Logotherapy:
Logotherapy, according to it founder Dr. Viktor Frankl, is based on the belief that all life has meaning and the focus of therapy was to assist the patient in their quest to find meaning in life’s daily activities; as well as to help them live a responsible and meaningful life, irregardless of the circumstances they found themselves in. Dr. Frankl described logotherapy as "a psychology in spiritual terms"; however this was not intended to be a religious based endeavor. But rather that it was the spirit of the will of the human being which could affect health, the capacity for love, the imagination and even enhance personal religious faith at the same time. At the heart of this approach is the search for meaning, however, and not the search for God.
Dr. Frankl has espoused 3 basic tenets of his therapy:
1) Life has meaning under all circumstances or meaning of life
2) our main motivation for living is our will to find meaning in all things in life or will to meaning
3) we have freedom to find meaning in what we do and experience or free will.
Dr. Frankl believed that each person exists in 3 dimensions; the body, the mental or mind and the spiritual and that these 3 components comprise a totality or a unit and could not be broken down to their individual parts but must be treated as a whole. Dr Frankl believed that is was this spiritual component that was unbreakable and that it remained intact in even the worst of conditions, be they physical or mental.
The basic tenets of logotherapy were developed as early as the 1920's, while Viktor Frankl was still in his teens. Yet it was in the concentration camps of Nazi Germany that he got to see first hand how his theories were supported by his personal experience and observation. After spending 3 years total in Auschwitz and Dachau, he observed that those individuals whose focus was on the future and a meaning to life were the ones most apt to survive. This experience stands alone in the field of psychotherapy where the therapist had the opportunity to test his theories under such extreme circumstances.
Dr. Frankl believed that if this search for meaning was not at the heart of ones being that we would exist in a state of emptiness and that it would be evidenced as boredom. He believed that this was as a by product of industrialization, the breakdown in the family and the rampant dehumanization of individuals, as he personally experienced. This feeling of meaninglessness in today’s world in what Dr. Frankl called the mass neurotic triad, in other words depression-addiction-aggression.
The 4 main techniques are:
a) paradoxical intention - the patient is encouraged to do or wish to happen the very thing they fear
b) dereflection - patients are asked to redirect their attention away from what is bothering them to more positive things going on their lives. This method is used to help them transcend themselves as see themselves as being more creative
c) modification of attitudes - in this approach the patient is taught to reframe many of the negative attitudes to positive ones. Help them to see the beneficial aspects to whatever the current situation is.
d) The appealing technique - in this approach the actual appeal is to the human spirit inside of everyone and through the power of suggestion; the therapist expresses belief in the dignity, the ability to accept responsibility, the inner drive of the human spirit to seek meaning and the potential for change that the patient possesses.
In a study at Hamamatsu University(21), School of Medicine, Health Administration Center in 2003 both DHEA and cortisol were studied in conjunction logotherapy and loxoprofen sodium (a non-steroidal anti-inflammatory drug like aspirin). This study revolved around low back pain and it found that by utilizing logotherapy there was a discernable difference in the release of beneficial hormones in the body and there was an active mechanism in stimulating human brain function. Logotherapy has been found to be beneficial in the treatment of alcoholics(22), as well as new approaches are being utilized at Sloan-Kettering Cancer Center(23) in their psychotherapeutic interventions at the end of life. Further research on cancer and logotherapy was undertaken in Japan reported in 2006(24) and its role in spiritual care. In an article reported in Journal of Mental Health Counseling, Vol. 26, 2004 Robert G. Blair reported promising results using logotherapy in the treatment of depression in older adolescents.
Perhaps at its heart, logotherapy espouses the philosophy of its founder, Dr. Viktor Frankl. Dr Frankl argued that the spiritual dimension needed to be added to the physical and mental dimensions because ultimate meaning exists and is a unique to each person and experience. He believed that this meaning to life was accomplished through 3 ways:
1) Creativity, to give something to the world, by way of our talents, through the process of self expression, whether it is gifts or through the type of work we do.
2) Experiencing, through the process of receiving via relationships, our culture or various interactions with nature or the environment.
3) Change in attitude, we always have control over our attitude towards any situation and that it is up to us to develop a way of transcending ourselves to find the deeper meaning of things, even in the face of suffering.
He felt that meaning was meant to be discovered, recognized and fulfilled and that even in the worst of situations something meaningful could be found if one had the courage.
10. Gestalt Therapy:
Gestalt therapy was born out of the existential movement that sprang up in Germany in the 1920's. The collaboration of Frederick Perls M.D., and his work in the field of psychoanalysis under the direction of Wilhelm Reich studying brain injured soldiers from WWI, and his wife Laura Perls Ph.D. and her work with the noted existential philosopher Martin Heidegger were the beginnings of this approach. Existentialism focuses on the direct experience of relationships of pain, joys, suffering as experienced through our interaction with others and that through this process we are always discovering not only ourselves but are also capable of remaking ourselves in the process.
After having fled Nazi Germany to the safer confines of South Africa both of the Perl's were exposed to Jan Smuts who later became the prime minister of South Africa and started to espouse what Mr. Smuts called "holism". This blending of Gestalt psychology, existential philosophy and psychoanalysis helped Dr.'s Perl to formulate a new approach to the field of psychiatry and psychology that embodied a holistic approach that they termed Gestalt Therapy. Dr. Perls was trained as a Freudian psychoanalyst but he felt that Dr. Freud was too dogmatic in his approach and that a much larger picture would emerge through the patients acknowledgement of personal responsibility for their actions, through an understanding that there are choices that everyone has in creating their personal existence and through forming what he called an existential dialogue. He felt that the emotions and feelings that were present in every moment needed to be dealt with and that only through gaining an awareness of these processes could true mental health be achieved.
In an elaborate book by Gary Yontef, Ph.D. "Awareness, Dialogue and Process" and later in his collaboration with James S. Simkin, Gestalt therapy was described as a process where enhanced awareness was the goal. This was not to be accomplished through the interpretation of an analyst, but rather through the perceptions and feelings of the actual patient. Through enhanced awareness, insight is gleaned and this type of awareness could only be achieved through a present-centered approach, or living in the moment, not in the past or the future. Gestalt therapists believe that through this awareness, and the insight that is garnered, patients can not only change those things about themselves that are harming them in some ways, but that they can learn to accept and value themselves in the process.
Awareness has 5 distinct qualities:
a) Contact - Where are we in relation to the world we live in or relative to our environment. This describes not only our interaction with other people but anything that is different from what we may think, feel or experience as being from ourselves or us.
b) Sensing - Includes a variety of things like body sensations, emotions, thoughts or even dreams, but is essentially the very nature of awareness. This process involves being aware of ourselves, our environment and how we are interacting within that environment.
c) Excitement - This covers both the physiological as well as the emotional response we may go through when we encounter something in our environment. This may involve an increased heart rate, a flush of memories or a rush of anxiety or dread or any of a myriad of things.
d) Figure formation - This describes the very way that awareness is both shaped and developed. Figure formation is the process whereby we give shape and organization to the things we interact with, or contact, in our environment. With figure formation we use every part of ourselves be it the mind, the heart, the body, the soul, the intellect or the mind. This is what is known as a gestalt formation.
e) Wholeness - "The whole is greater than the sum of its parts" is in the most famous phrase of Gestalt psychology and embodies the thinking of current Gestalt therapy to this day.
At the Los Angeles Jewish AIDS Service(25) this approach was found to be of benefit in HIV - related therapy and in a study in Japan (26) general neurotic symptoms were found to be reduced by this approach. Researchers have found that using this approach also helps in the field of nursing (27) by allowing nurses to explore their creativity and to improve the professional practice. In an interesting article(28) discussing chronic or life-threatening illnesses, Gestalt therapy was found to be of benefit and in the field of schizophrenia(29) Gestalt theory was felt to be a viable therapy and underutilized if not forgotten.
Perhaps one of the most exciting things to come out of Gestalt therapy is Neurolinguistic Programming (NLP). In NLP, communication impacts and is impacted by sensory experience. NLP is a model for how language influences mental states, and was developed by John Grinder and Richard Bandler in the 1970's. NLP utilizes the work of Fritz Perls and others to construct a model for communication and how thinking and mental states are related to physiology. NLP stresses how important our mind is as a healing tool, how powerful our subconscious is as an engine that powers our lives and how intimately they are involved with health and well being. This field of endeavor has been utilized in Russia on people with acute coronary syndrome with excellent results (30).
Gestalt therapy believes that it is through the integration of all the various aspects of our essence and through conscious awareness of ourselves that we will be best able to function in a healthy manner. The practitioners in this field believe that there is a constant element of change within us and that by staying in the moment and staying aware, we are best suited to fully participate in life and all it has to bring.
Conclusion:
As the reader can appreciate the field of Mind-Body Medicine is wide ranging and encompasses many theories and disciplines. This body of knowledge and experience has engaged some of the best minds of many generations from the fields of philosophy, science and spirituality. Each of these areas alone comprise a rich body of knowledge and insight gleaned from some of the best thinkers of the last 100 years, however, it is through the integration of these various approaches that we will come to understand how to improve and maintain our health.
References:
(1). J Biomech Eng. 1996 Nov;118(4):597-600.
(2). Int J Cardiol. 2004 May;95(1):19-2.
(3). Med Sci Monit. 2002 Jun;8(6)RA103-118.
(4). Neuroreport. 2000 May 15;(7):1581-5.
(5). Behav Modif. 1993 Oct;17(4):498-509.
(6). Clin J Pain. 1991 Dec;7(4):305-10.
(7) Gen Hosp Psychiatry. 2001 Sep-Oct;23(5):272-7.
(8). Psychosom Med. 1999 Jul-Aug;61(4):525-31.
(9). Am J Hypertens. 2004 Apr;17(4):366-9.
(10). Int J Mol Med. 2005 Oct;16(4):621-30.
(11). Ann N Y Acad Sci. 2005 Dec;1057:28-29.
(12). Geriatr Nurs. 2005 Nov-Dec;26(6):372-7.
(13). J Clin Psychol. 2006 Feb;(2):201-10.
(14). Taehan Kanho Hakhoe Chi. 2005 Oct;35(6):1025-35.
(15). Ann Thor Surg. 2006 Jan;81(1):201-5.
(16). J Nurs Scholarsh. 2005;37(3):245-50.
(17). Aging Clin Exp Res. 2005 Jun;17(3):223-8.
(18). BMC Complement Altern Med. 2005 Dec 20;5-21.
(19). Behav Sleep Med. 2005;(3):151-7 .
(20). South Med J. 1988 Jul;(7):826-9.
(21). Seishin Shinkeigaku Zasshi. 2003;105(4):459-67
(22). Int J Addict. 1979 Aug;14(6):847-53.
(23). Can J Psychiatry. 2004 Jun;49(6):366-72.
(24). Support Care Cancer. 2006 Jan;14(1):65-70.
(25). Focus. 1997 Mar;12(4):1-4.
(26). Sehshin Shinkeigaku Zasshi. 2003;105(5):589-92.
(27). Rev Bras Enferm. 1999 Apr-Jun;52(2):283-92.
(28). J Clin Psychol. 2002 Nov;58(11):1361-73.
(29). Am J Psychol. 2004 Summer;117(2):259-77.
(30). Klin Med (Mosk). 2000;78(6):16-20.
There are basically 3 distinct schools of thought regarding this interplay of the mind, body and spirit;
1. Material - in this state mind and matter are of one nature and arise and exist together.
2. Cartesian dualism - in this state mind and matter exist together in a substantial relationship, but they arise separately.
3. Fundamental mind - mind and matter arise separately but are intimately related.
In the material state the mind is said to function only on a physical level, where thoughts are reduced to chemical reactions and the only things of substance are the hormones and neurotransmitters that are produced. In other words everything that exists only exists because it has a physical reality and the mind is a byproduct of the body. The mind and body work according to the same principles that govern non-organic matter and everything is reducible to its component atoms and such.
Cartesian dualism is the brain child of Rene Descartes, who coined the phrase "I think, therefore I am". Cartesian Dualism, or Mind-Body dualism, is the basis for science and medicine and their separation of mind and body that lingers to this day. This concept is not new by any means, and has been found amongst ancient concepts in the Greek culture where body and mind were found to be of an entirely different essence. Yet is was Descartes who drew a strict distinction whereby the mind was responsible for things like imagination, feelings, will and all forms of rational thought and body was of the material realm. Descartes believed that the mind could cause the body to act and the body could cause the mind to have a variety of sensations. To Descartes the mind had a reality apart from the body while at the same time is was substantially united with the body and therefore had an impact on the physiological state. While he admitted that this approach left many things unexplained he persisted in spreading this philosophy to all who would listen. This type of approach exists in western, or what we call allopathic medicine, to this day due to the persuasiveness of Descartes. Inroads into breaching this philosophy have existed for generations and currently this philosophy is under considerable assault from the field of quantum mechanics. This approach however supports a distinction between physical phenomena and those of a mental or emotional nature.
The third philosophical approach, or the fundamental mind, is well over 2,000 years old and has its roots in ancient Buddhism, yet continues to this day. In this view mind and matter arise separately but are related in much the same way as a rider may mount a horse for a journey. In this approach there is the acknowledgement of a profound connection between the mind and body. Mind and body are seen to have functions that are cooperative as well as having the potential for a profound influence on each other's states. This particular connection is detailed in the latest book by the Dalai Lama "The Universe in a Single Atom" and is well worth the read. The Dalai Lama makes a compelling argument, often times elegant in its grandeur and simplicity, regarding current discoveries in the field of quantam mechanics, and the inability to separate the observer from the observed as distinct entities, as evolving explanations for theories that Buddhist monks have espoused for over a thousand years.
While you can see that this has been a topic of discussion for many millenniums, the discussion continues and is evolving while we speak. Dating back over 4,000 years in ancient Egypt, thru traditional Chinese and Ayurvedic medicine, thru Hippocrates and up the 20th century with the work of Walter Canon, and his documentation of the relationship between stress and neuroendocrine responses in animals, this model of a mind-body relationship has persisted, despite some very dogged opposition at the hands of very skilled and articulate detractors. Even Dr. Henry Beecher, and his use of placebos during World War II when there was a morphine shortage, showed how powerful the mind could be controlling pain.
However the past 30 years has shown a tremendous amount of research in the field of mind body medicine and even before that, in the mid 1960's, Dr Elmer Green began his pioneering research into what eventually became popularized as biofeedback. Dr Green began his career as a physicist and later got his PhD in biopsychology for the University of Chicago and this launched a 40 year career in the field of mind-body medicine. Dr Green has left his mark on the field with his work in the field of biofeedback and psychophysiologic self-regulation. But in reality his work is a combination of his own research and that of Oskar Vogt, the brain physiologist at the Brain Neuro Biological Institute in Berlin. Dr. Vogt noticed that some patients could put themselves in a self-hypnotic state which would have positive effects on their recuperation and could also, independent of this work, relieve many stress related symptoms and diseases.
Biofeedback as field of research goes back over at least 100 years, but it was Dr. Elmer Green who was granted the first NIH grant for research in this field and deserves much of the credit for helping to gain a greater understanding of biofeedback. His work in disseminating this body of information to the general public has helped it gain a much wider acceptance as well. Dr. Green was the father of autogenic biofeedback training and developed his techniques while at the Menninger Clinic with his wife, Alyce Green and with colleague Dale Walters as they studied EEG biofeedback as well as the process of meditation. Elmer and Alyce Green co-authored a wonderful book "Beyond Biofeedback" in 1977 which is a must read for people interested in this field. Dr. Green is well into his 90's and continues to write and research in this field.
Another leader in this field is Dr. Herbert Benson, from Harvard University, who has studied meditation, relaxation and the physiologic response that occurs. Much of his work goes hand in hand with that of Dr. Green and both are to be congratulated for looking outside the box of western allopathic medicine to help bring these healing modalities into the forefront of the healing arts. Dr. Benson explained in his book "The Relaxation Response" how meditation can be an excellent antidote for stress as it has a positive effect on lowering heart rate, decreasing the respiratory rate, decreasing blood pressure, decreasing muscle tension and decreasing oxygen consumption. A classic paper was printed in Psychiatry 1974 which shows demonstrable changes with such mind-body practices as meditation, yoga, autogenic training and hypnosis.
Even as far back as the early 20th century, Dr. Ivan Pavlov demonstrated a conditioned response in a dog. This work won him the Nobel Prize and has been used as a model for changing behavior since. His classic book "Conditioned Reflexes" continues to be used as a basis for modifying behavior to this day.
The list of contributors to this field of endeavor is quite large and the purpose of this discussion is to provide a history perspective and to allow one to see that this is not a new approach to healing. The opposition to Mind-Body medicines is pervasive today so I thought a brief historical perspective was in order. The essence of this approach is that it stresses an interconnection of physical, chemical, emotional, mental and spiritual properties. There are many modalities, and the purpose here is to open a debate and pique the interest of the reader to delve into other areas if he or she so desires. Although there are many modalities to be explored, we will discuss the following:
1. Biofeedback
2. Relaxation training
3. Autogenic training
4. Psychosynthesis
5. Meditation
6. Guided Imagery
7. Spiritual Healing
8. Prayer
9. Logotherapy
10. Gestalt Therapy
1. Biofeedback:
Biofeedback has evolved, due to various discoveries over the years, into a system where the individual practitioners have been able to control a variety of physiologic responses in the body. In what was originally thought to be under autonomic control (control through the unconscious mind), it has been found that various functions in the body could be altered through the exertion of mind and will. It has now been proven the the ability to control certain "automatic" body functions such as blood pressure and heart rate, amongst others, is an innate ability and even laboratory animals have been able to change the body temperature of various parts of their body in order to receive a food reward. Migraine headache sufferers can short circuit a headache simply by changing the temperature of their hands, and these techniques can be taught in just a few short weeks. Pain responses can be blocked for such conditions as colitis and neuritis as well as constipation.
In an article in Gut, biofeedback showed positive results in obstructive constipation and the results lasted for over 6 months, with later studies showing good results in chronic constipation in general. Researchers in Taiwan(1) were able to show positive results with neck pain and spasm using biofeedback in conjunction with cervical traction. Alan Brauer M.D., in a relatively thorough review of biofeedback and anxiety, walks through much of the research of the time surrounding biofeedback. This article, found in Psychiatric Times, Feb. 1999, Vol XVI, Issue 2 gives an excellent treatise for the efficacy of biofeedback and should help to dispel any fears one may have revolving around this healing approach.
2. Relaxation Training:
The heart of this approach is detailed in Dr. Herbert Benson's book, "The Relaxation Response", but for a brief review of the actual technique I will detail for you his 6 steps to the relaxation state.
1) Sit quietly in a comfortable position.
2) Close your eyes.
3) Deeply relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
4) Breathe through your nose. Become aware of your breathing. As you breath out say the word, "ONE", silently to yourself. For example, breathe IN...OUT, "ONE," ...OUT, "ONE", etc. Breathe easily and naturally.
5) Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes opened. Do not stand up for a few minutes.
6) Do not worry about whether you are successful in achieving a deep level of relaxation. Maintain a positive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by not dwelling on them and return to repeating "ONE". With practice, the response should come with little effort. Practice the technique once or twice a daily, but not within 2 hours after any meal, since the digestive processes seem to interfere with the elicitation of the Relaxation Response.
- The Relaxation Response, Herbert Benson, M.D.
The number of studies undertaken to investigate the various physical processes impacted are too numerous to elucidate at this time. Researchers continue to discover how controlling basic functions through relaxation can modify things like heart rate dynamics(2) or in playing a role in modifying certain brain chemicals like nitric oxide (NO) (3), which itself plays a very intricate roll in stress related diseases as well as immunological, cardiovascular and neurodegenerative/mental disorders. In the journal Neuroreport(4), where functional MRI was utilized, specific areas of the brain were identified that were active during a simple form of meditation. These areas are numerous and are involved in attention and control of the autonomic nervous system. The relaxation response has been shown to assist in improvement of sleep in the insomniac(5). The treatment of pain is both costly and frustrating for all involved but it has been shown that this too can be impacted through the person's own control of their physiologic processes. The overall complexity of the pain syndrome is multifactorially influenced involving behavioral patterns, socioeconomic factors, belief systems and family dynamics as well as many physiologic and mechanical components. However, with the interjection of behavioral modification techniques(6), like relaxation training, decreasing in the need for visits to the doctor, for pain management, could yield a projected savings of $23,000 per patient by the second year. For economic reason alone we need to consider this mode of treatment and certainly the patients themselves would do better if there was a decreased dependency on the physician for pain management.
Whether for assistance in cancer patients and the relief of their psychological distress(7), to improved hemodynamic functioning in middle aged adults(8), or an impact on the blood pressure of youths at risk for hypertension(9), the roll of the relaxation response has been shown to be of enormous benefit. I have given only a few of the various ways that this technique has been of benefit to a variety of disease states, but this should provide the impetus for further investigation to anyone interested in utilizing this as a tool in their approach to healthy living.
3. Autogenic Training:
Autogenic training, which actually means 'self origin', was devised by Johannes Schulz in the 1930's and was a discipline where the mind provides directions and the body follows. Dr. Schulz was a respected psychiatrist and neurologist who also became interested in the work of Oskar Vogt and was attempting to expound on some of his earlier research. This particular technique is described in Dr. Schulz's book "Autogenic Therapy" and gives in excellent detail both the training and descriptions of the six autogenic states utilized in this approach today. Dr. Schulz was attempting to find a way to switch off the "fight or flight" system of the body and thus bring about a healthier state in the body. The Autogenic process is one that involves progressive relaxation of various body parts and organs and is carried out in a state of passive concentration. Dr Schulz described 6 autogenic states and they are as follows:
a) focus on heaviness in the arms and leg
b) focus on warmth in the arms and legs
c) focus on warmth and heaviness in the heart area
d) focus on breathing
e) focus on warm in the abdomen
f) focus on coolness in the forehead
An essential feature to this approach is that it is carried out in a state of passive concentration, with no direct attempt at an outcome by the conscious mind. There are many similarities to the work by Dr. Jon Kabat-Zinn and his "Mindfulness Meditation" as well as the Buddhist work on mindfulness as a meditative approach. This form of relaxation therapy, and others in this mind-body approach, has been shown to be effective in treating a variety of disorders as was reviewed in the International Journal of Molecular Medicine(10). This approach also encourages a healthier lifestyle. The list of disorders that can aid by this approach is quite numerous and further research into this area is well justified.
4. Psychosynthesis:
Psychosynthesis, whose development was brought about by Roberto Assagioli, the Italian psychiatrist, is known as an approach to human development where an individual is focusing on a blending, or coming together, of all the various aspects of an individual’s personality into a more cohesive unit. It is believed that through this action a person's life can be more authentic and therefore more fulfilling. Psychosynthesis further asserts an affirmation of the higher or transpersonal self, which is a spiritual dimension and therefore a source of wisdom, unconditional love and inspiration that can lend a meaning to our life. Psychosynthesis has been deeply involved in the movement for increasing human potential due to its basic tenet that we live in an orderly universe and that it is structured to enhance the evolution of consciousness. This process helps an individual discover his or her owns purpose and meaning to their life.
Psychosynthesis is considered one of the most coherent and effective frameworks of transpersonal psychology and as a whole this approach addresses the entire spectrum of the human experience from the aspect of prepersonal consciousness into the development of a healthy personality and beyond into higher states of consciousness. There are numerous steps that one goes through from ego-death to the emergence of an expanded sense of one's self, both from an individual perspective to a universal one. This movement is one that espouses the belief that there is a natural tendency towards a progression of unfoldment, an evolution if you will, not only on the individual level, but on the universal level as well. This movement is one that aids in that evolution by assisting the individual to go inwards, to find that connection of the physical, emotional, mental and spiritual essences that exist inside of our consciousness and then help one become aware of the self as an active and directing agent on the journey towards living is a state of unconditional love. To experience love, compassion and many other wonderful emotions as one evolves into a state of universal consciousness.
There are 2 basic stages of Psychosynthesis: a) the personal level and b) the transpersonal level. At the heart of this process is the recognition that each person is an individual with the experience manifesting each time in a unique way.
In personal psychosynthesis there is an integration of the personality that revolves around assisting the individual in attaining a healthy functioning in both his relationships and in his work. This approach utilizes such things as guided imagery, training of the will and goal setting, toward the development of intuition and imagination while using meditation and dreamwork as well as other techniques to help facilitate the process. This approach treats the individual as a whole and any one session of psychosynthesis work may involve only one aspect to be integrated or many. The overall focus is on an integration of mind, body and feelings to help the individual see this as an ongoing and creative process with the ultimate goal of a joyful and harmonious life.
In transpersonal psychosynthesis one takes these lessons and transforms them to a larger scale where one sees such things as altruistic love and enhanced social responsibility as achievable things. Where one can visualize a greater spirit of cooperation, not only on an individual level but on the level of nations as well to bring about a grander global perspective of collaboration.
Psychosynthesis is a blending of western analytic depth psychology (e.g. Freud) and eastern meditative psychology into an approach that intended to enhance both human growth and development. Its intent is to assist us on the personal level to recognize when a temporary feeling like anger can cause us to distort our true perspective and to help us to recognize when we are simply responding to a particular situation because that is the way we may have always responded or perhaps we saw a parent respond that way. Dr. Assagioli called this a pre-programmed routine and much of the basic work in this approach is to recognize these false identifications and harmonizing them so we are no longer controlled by them but can bring them under our conscious direction. This technique helps us to find our path to our true identity, which is a center of awareness and will.
5. Meditation:
There are numerous types of meditation, many of which are involved in the healing modalities all over the world. Here we are going to discuss their implications for those of us going about our daily lives, as well as for physicians that practice in the world of allopathic medicine. Meditation as a process is one where you are attempting to alter your state of consciousness by quieting your busy mind. The attempt here is to get the mind to stay in the present moment and to have the mind be in the center of feelings of peace and calmness.
The varieties of approach to the field meditation include; Inner Light Meditation, Mindfulness Meditation, Relaxation Meditation, Energy Healing Meditation, Color Healing Meditation and many more. All of these techniques seem to embody the same basic intent, although th approaches vary. Many of these techniques have their origins in antiquity, like Mindfulness which has been portrayed as having been taught by Buddha to his followers over 2,500 years ago. Dr. Jon Kabat-Zinn has been instrumental in helping to bring this approach to non-buddhist people, and the Dalai Lama, in his recent book, "The Universe in a Single Atom" stated emphatically that this is a practice that is not only deeply steeped in Buddhist tradition but continues to be practiced today. For anyone interested in the audio book version of this book, I would highly recommend the heartfelt version as read by the actor and practicing Buddhist Richard Gere, and this can be purchased easily at audible.com.
But how does this impact health? There is a fairly large volume of research that can be found on this subject. In the area of aging there appeared to be not only a retardation of aging but also its reversal(11). There was also a healthy form of regeneration that not only had anti-aging properties, but also one that was antagonistic to oncogenesis or the formation of tumors. This recent information is groundbreaking in its implications and has helped us to identify a host of molecular mediators including DHEA, various interleukins and especially melatonin. Given our earlier discussion on the need for sleep it is interesting how melatonin, a hormone released by the pineal gland and is used to help induce sleep, now has been shown to be released while utilizing meditation. Meditation has been shown to be a powerful tool in conjunction with other non-pharmacologic interventions to assist in the anti-aging process, as well to having properties that are antagonistic to tumor formation meditation.
But what of those that have advanced in years, those of us who have reached the retirement age? In a sweeping review of research into meditation and spirituality over the past 25 years, as found in the journal Geriatric Nursing(12), these practices were beneficial in improving physical health, reduceing pain, enhanced immune response and an improvement in emotional well being. This practice helped to foster spiritual growth and could be easily taught to the elderly and even enhanced the life of those with dementia. These practices promoted social and emotional benefits for those in social isolation with specific benefits for those in nursing homes. This article recommended further investigations were indicated for nursing home residents and, with the growth of the portion of the population entering retirement, could well go a long way towards reducing the staggering health care costs that accumulate in the last few years of a person’s life, as well as improving the quality of life.
In the field of mental health one of the most frustrating areas is the field of suicide and people harboring suicidal thoughts. I have been involved in emergency medicine for going on 13 years and have seen an untold number of people who visit the emergency room because life’s frustrations and disappointments have become too great and the only solution for some people is to take their life. It is difficult to portray to you the sense of urgency one feels when somebody comes through your ER after having overdosed on any one of a variety of things. The Journal of Clinical Psychology(13) cited meditation and its usefulness as intervention towards preventing recurrence of suicidal behavior. Anyone who works in this field, or anyone who has a friend, family member or loved one who has attempted or contemplated suicide should read this article and give it serious thought.
The implications of this modality are not the sole dominion of aging, the elderly or even mental health. All of these were mentioned to encourage an active investigation into this field. Research has shown that this need not be a practice that is restricted to any one religious practice(14), as was shown in a Korean study, but rather one that can expand your faith in your own religious practice. It has been shown to assist in the recovery from disease in this same study as well as stabilizing ones physical, psychological and social daily living. Meditation was shown to be a path for discovering one's true self through a process of entering a religious discipline, embodying religious discipline, self-accomplishing religious faith and recovering mind-body health. I have only touched on a portion of the data and research in this field, but I hope that all can see that this is a powerful healing modality that is little utilized and can have powerful effects in all areas of health and healing.
6. Guided Imagery:
Guided imagery is a healing modality that uses the creative imagination of the patient to create positive images or affirmations to bring about a better state of health. So what is guided imagery? Guided imagery is a relaxation technique that is promoting the easing of stress; it promotes an incorporation of the power of the mind to assist the healing of the body. All this through an involvement of an emotional connection between the mind, body and spirit. Guided imagery uses the power of the mind as a powerful resource to help bring about changes in your life on all levels. It helps bring about a balance between all 3 levels by relaxing the mind and helping the mind is more open and receptive to new information.
While there have been many books written on this subject the one I found to be very practical in its approach was written by Steven Covey in his book "Seven Habits of the Most Effective People" which describes a guided imagery process that he calls the 5 basic ingredients of a good affirmation:
a) It's personal
b) It's positive
c) It's present tense
d) It's visual
e) It's emotional
Dr. Covey does and excellent job of portraying just how powerful this adjunct can be in changing your life through this simple practice. As he quotes in his book "We are what we repeatedly do. Excellence, then, is not as act, but a habit." - Aristotle. I would highly recommend this book to anyone looking for a practical way to integrate this practice into ones life.
Guided imagery has been utilized from open heart surgery with success(15), assisting in the cessation of smoking(16), to having effects for the elderly in simple things like balance and attention(17). In many studies a noticeable change occured in both stress levels and mood improved as well as health status(18). Better sleep and decreased nightmares were found to be present(19) and guided imagery provided some assistance in depression and post-traumatic stress.
As one can glean from all this information, this modality has implications at nearly every level of life. The implications are not just for the medical practitioner, but for anyone looking to have a happier, healthier and more successful life.
7. Spiritual Healing:
What is spiritual healing, or better yet what is spirituality? Spirituality is at the core of virtually all of our belief systems whether it is Buddhism, Christianity, Muslim, Hinduism or the Jewish system. But spiritual healing is the involvement of subtle energies that are only just starting to be recognized in the western world. However these energies are well recognized in a host of other medical systems, and are called "Qi or Chi" in traditional Chinese medicine, "Prana" in Ayurvedic medicine and as such are related to one's consciousness. Some of the more common practices for a spiritual healing include; prayer, visualization, channeling of spiritual energy or spirit guides and teachers as well as psychic abilities.
Spiritual healing has at its source a deeply spiritual recognition and acceptance of a Universal Consciousness and that this consciousness can provide inspiration, joy, peace of mind and guidance in the healing process. This may involve a caring touch, kind words or even just listening to the patient. This type of healing can be practiced through prayer, either individually or in groups, but if done when the person is not present is called distant healing. In any event this process is described as a channeling of energies being transferred to the patient, with the caveat that the healing does not come from the channeler, but rather the healing comes from the source of Universal Consciousness.
So much of what the research into this area is anecdotal by our modern standards, as we in the west have come to be dependent on the double blind testing methods as the gold standard. Scientists believe that all testing should adhere to very strict principles or it is invalid. Yet simply because something cannot be quantified does not mean it does not exist, it may mean that we simply lack the ability or technology to measure it. Given the fact that we are not able to fully understand how some medicines work, yet use them anyway, does not mean they should not be utilized. This is especially true of drug therapy in the field of mental health where a lot of their chemical interactions are based on conjecture and hypothetical models.
In the handbook called, "Comprehensive Handbook of Psychotherapy and Integration", by Robert N. Sollod describes a most fascinating model whereby spiritual healing could be folded into a typical psychologists practice with no compromising of standard psychotherapeutic models. He poses very interesting questions as to how such a model could emerge. This is a field of endeavor that is still in its infancy in the west and it will be a model that could easily emerge in the decades to come.
It is easy to speculate how such an effect could be made by looking at the field of quantum mechanics. As early as the 1920's Dr. Niels Bohr described a theory that later became known as the Copenhagen interpretation, or what is known as the Observer Effect, in where he postulated that the event and the observer were inseparable on a quantum level. In actuality there is no effect or phenomenon until it is observed. He found that at a quantum level things exist as a wave, but through the direction of consciousness these subatomic waves become a particle. This effect implies that the physical universe is a direct result of consciousness whereas our western science implies that human consciousness is the result of the inner physical workings of the human brain. Further research into modern physics has found that the observer actually determines the nature of the subatomic matter and that when they look for them as particles they show up as particles and when looking for them as waves they show up as waves, which makes the role of consciousness even more implicit.
So how does all this relate to spiritual healing? What if on a subatomic level the healer is producing change via his interaction with the healed? What if there is a rearranging of matter at this subatomic level that is conducive to a healing state, or a state of enhanced well being? I throw all this out for conjecture because, like you, I am looking for answers.
8. Prayer:
The general discussion of prayer is an area that does not lend itself well to the scientific approach. Prayer in and of itself has always been in the domain of a variety of belief systems. In this area people feel that they are seeking communion with God, through prayer. This has been described as a communication between their mind and that of God. So how prevalent is prayer? According to Self magazine as reported in an April 1994 survey, 88% of people in the USA pray and 59% of them meditate, while 89% believed in some sort of God or a higher consciousness. Clearly prayer is not an isolated or rare event. But does prayer belong in medicine and does it make a difference?
A lot of the early research was anecdotal, due to the extreme difficulty in quantifying prayer in the field of scientific research. Rupert Sheldrake PhD, in his paper "Prayer-A Challenge for Science", discusses how since ancient times a strong belief exists that consciousness is not limited to the physical body and that prayer is an access point to this realm. Dr. Sheldrake gives insight into the mechanistic mindset of the scientist and the difficulty that science has in evaluating something that is not easily quantified. Many of the researchers have difficulty separating the mind from something that exists inside of the brain.
One of the first studies utilizing the scientific approach, the double blind study, the cardiologist Randolph Byrd M.D. looked at the use of prayer in a cardiac care unit(20). He found that the use of prayer had a statistically significant benefit for those that received prayer. This study was criticized by in mainstream medicine. The best assessment of this study from the perspective of a non-partial point of view was by a fellow cardiologist, the respected Larry Dossey, M.D., in his book "Healing Words", he explains the strengths and weaknesses of this study, but congratulates Dr. Byrd for the courage in both performing and bringing out this study. Dr. Dossey concludes that there have been no conclusive studies done on human subjects on the power of prayer that would meet the guidelines of double blind studies.
Does this mean that prayer does not work or does it indicate that we perhaps lack the means to study it adequately? There is a difference between something not existing and being incapable of proving the non-existence of a thing. From the standpoint of current scientific thinking if a thing cannot be proved it does not exist. To say that something does not exist because we cannot proves its existence represents a metaphysical position rather than a scientific one and it would be more scientific to continue to accumulate empirical data and to keep our minds open. In science we take our empirical data and form our conclusions. If we attempt to form a conclusion and them make the empirical data fit that conclusion then that would be like trying ro reform our feet to fit our shoes as the Dalai Lama so aptly stated.
Perhaps the answer to this will indeed come from the field of quantum mechanics. Dr. David Bohm makes a compelling argument in his book, "Wholeness and the Implicate Order" that all things are connected on a subatomic level. As we learned earlier the observer can have an effect on the observed simply by his conscious interaction and the actual nature of matter at the subatomic level would change by virtue of this interaction. Is prayer simply the insertion of a conscious stream of intention that alters the health state of the person being prayed on?
The thoughts of one of the greatest minds of the 20th century perhaps ring truer now than ever before: Albert Einstein stated; "Now, even though the realms of religion and science are clearly marked off from each other, nevertheless there exist between the two strong reciprocal relationships and dependencies. Though religion may be that which determines the goal, it has, nevertheless, learned from science, in the broader sense, what means will contribute to the attainment of the goals it has set up. But science can only be created by those who are thoroughly imbued with the aspiration towards truth and understanding. This source of feeling, however, springs from the sphere of religion....The situation may be expressed by an image: Science without religion is lame, religion without science is blind."
9. Logotherapy:
Logotherapy, according to it founder Dr. Viktor Frankl, is based on the belief that all life has meaning and the focus of therapy was to assist the patient in their quest to find meaning in life’s daily activities; as well as to help them live a responsible and meaningful life, irregardless of the circumstances they found themselves in. Dr. Frankl described logotherapy as "a psychology in spiritual terms"; however this was not intended to be a religious based endeavor. But rather that it was the spirit of the will of the human being which could affect health, the capacity for love, the imagination and even enhance personal religious faith at the same time. At the heart of this approach is the search for meaning, however, and not the search for God.
Dr. Frankl has espoused 3 basic tenets of his therapy:
1) Life has meaning under all circumstances or meaning of life
2) our main motivation for living is our will to find meaning in all things in life or will to meaning
3) we have freedom to find meaning in what we do and experience or free will.
Dr. Frankl believed that each person exists in 3 dimensions; the body, the mental or mind and the spiritual and that these 3 components comprise a totality or a unit and could not be broken down to their individual parts but must be treated as a whole. Dr Frankl believed that is was this spiritual component that was unbreakable and that it remained intact in even the worst of conditions, be they physical or mental.
The basic tenets of logotherapy were developed as early as the 1920's, while Viktor Frankl was still in his teens. Yet it was in the concentration camps of Nazi Germany that he got to see first hand how his theories were supported by his personal experience and observation. After spending 3 years total in Auschwitz and Dachau, he observed that those individuals whose focus was on the future and a meaning to life were the ones most apt to survive. This experience stands alone in the field of psychotherapy where the therapist had the opportunity to test his theories under such extreme circumstances.
Dr. Frankl believed that if this search for meaning was not at the heart of ones being that we would exist in a state of emptiness and that it would be evidenced as boredom. He believed that this was as a by product of industrialization, the breakdown in the family and the rampant dehumanization of individuals, as he personally experienced. This feeling of meaninglessness in today’s world in what Dr. Frankl called the mass neurotic triad, in other words depression-addiction-aggression.
The 4 main techniques are:
a) paradoxical intention - the patient is encouraged to do or wish to happen the very thing they fear
b) dereflection - patients are asked to redirect their attention away from what is bothering them to more positive things going on their lives. This method is used to help them transcend themselves as see themselves as being more creative
c) modification of attitudes - in this approach the patient is taught to reframe many of the negative attitudes to positive ones. Help them to see the beneficial aspects to whatever the current situation is.
d) The appealing technique - in this approach the actual appeal is to the human spirit inside of everyone and through the power of suggestion; the therapist expresses belief in the dignity, the ability to accept responsibility, the inner drive of the human spirit to seek meaning and the potential for change that the patient possesses.
In a study at Hamamatsu University(21), School of Medicine, Health Administration Center in 2003 both DHEA and cortisol were studied in conjunction logotherapy and loxoprofen sodium (a non-steroidal anti-inflammatory drug like aspirin). This study revolved around low back pain and it found that by utilizing logotherapy there was a discernable difference in the release of beneficial hormones in the body and there was an active mechanism in stimulating human brain function. Logotherapy has been found to be beneficial in the treatment of alcoholics(22), as well as new approaches are being utilized at Sloan-Kettering Cancer Center(23) in their psychotherapeutic interventions at the end of life. Further research on cancer and logotherapy was undertaken in Japan reported in 2006(24) and its role in spiritual care. In an article reported in Journal of Mental Health Counseling, Vol. 26, 2004 Robert G. Blair reported promising results using logotherapy in the treatment of depression in older adolescents.
Perhaps at its heart, logotherapy espouses the philosophy of its founder, Dr. Viktor Frankl. Dr Frankl argued that the spiritual dimension needed to be added to the physical and mental dimensions because ultimate meaning exists and is a unique to each person and experience. He believed that this meaning to life was accomplished through 3 ways:
1) Creativity, to give something to the world, by way of our talents, through the process of self expression, whether it is gifts or through the type of work we do.
2) Experiencing, through the process of receiving via relationships, our culture or various interactions with nature or the environment.
3) Change in attitude, we always have control over our attitude towards any situation and that it is up to us to develop a way of transcending ourselves to find the deeper meaning of things, even in the face of suffering.
He felt that meaning was meant to be discovered, recognized and fulfilled and that even in the worst of situations something meaningful could be found if one had the courage.
10. Gestalt Therapy:
Gestalt therapy was born out of the existential movement that sprang up in Germany in the 1920's. The collaboration of Frederick Perls M.D., and his work in the field of psychoanalysis under the direction of Wilhelm Reich studying brain injured soldiers from WWI, and his wife Laura Perls Ph.D. and her work with the noted existential philosopher Martin Heidegger were the beginnings of this approach. Existentialism focuses on the direct experience of relationships of pain, joys, suffering as experienced through our interaction with others and that through this process we are always discovering not only ourselves but are also capable of remaking ourselves in the process.
After having fled Nazi Germany to the safer confines of South Africa both of the Perl's were exposed to Jan Smuts who later became the prime minister of South Africa and started to espouse what Mr. Smuts called "holism". This blending of Gestalt psychology, existential philosophy and psychoanalysis helped Dr.'s Perl to formulate a new approach to the field of psychiatry and psychology that embodied a holistic approach that they termed Gestalt Therapy. Dr. Perls was trained as a Freudian psychoanalyst but he felt that Dr. Freud was too dogmatic in his approach and that a much larger picture would emerge through the patients acknowledgement of personal responsibility for their actions, through an understanding that there are choices that everyone has in creating their personal existence and through forming what he called an existential dialogue. He felt that the emotions and feelings that were present in every moment needed to be dealt with and that only through gaining an awareness of these processes could true mental health be achieved.
In an elaborate book by Gary Yontef, Ph.D. "Awareness, Dialogue and Process" and later in his collaboration with James S. Simkin, Gestalt therapy was described as a process where enhanced awareness was the goal. This was not to be accomplished through the interpretation of an analyst, but rather through the perceptions and feelings of the actual patient. Through enhanced awareness, insight is gleaned and this type of awareness could only be achieved through a present-centered approach, or living in the moment, not in the past or the future. Gestalt therapists believe that through this awareness, and the insight that is garnered, patients can not only change those things about themselves that are harming them in some ways, but that they can learn to accept and value themselves in the process.
Awareness has 5 distinct qualities:
a) Contact - Where are we in relation to the world we live in or relative to our environment. This describes not only our interaction with other people but anything that is different from what we may think, feel or experience as being from ourselves or us.
b) Sensing - Includes a variety of things like body sensations, emotions, thoughts or even dreams, but is essentially the very nature of awareness. This process involves being aware of ourselves, our environment and how we are interacting within that environment.
c) Excitement - This covers both the physiological as well as the emotional response we may go through when we encounter something in our environment. This may involve an increased heart rate, a flush of memories or a rush of anxiety or dread or any of a myriad of things.
d) Figure formation - This describes the very way that awareness is both shaped and developed. Figure formation is the process whereby we give shape and organization to the things we interact with, or contact, in our environment. With figure formation we use every part of ourselves be it the mind, the heart, the body, the soul, the intellect or the mind. This is what is known as a gestalt formation.
e) Wholeness - "The whole is greater than the sum of its parts" is in the most famous phrase of Gestalt psychology and embodies the thinking of current Gestalt therapy to this day.
At the Los Angeles Jewish AIDS Service(25) this approach was found to be of benefit in HIV - related therapy and in a study in Japan (26) general neurotic symptoms were found to be reduced by this approach. Researchers have found that using this approach also helps in the field of nursing (27) by allowing nurses to explore their creativity and to improve the professional practice. In an interesting article(28) discussing chronic or life-threatening illnesses, Gestalt therapy was found to be of benefit and in the field of schizophrenia(29) Gestalt theory was felt to be a viable therapy and underutilized if not forgotten.
Perhaps one of the most exciting things to come out of Gestalt therapy is Neurolinguistic Programming (NLP). In NLP, communication impacts and is impacted by sensory experience. NLP is a model for how language influences mental states, and was developed by John Grinder and Richard Bandler in the 1970's. NLP utilizes the work of Fritz Perls and others to construct a model for communication and how thinking and mental states are related to physiology. NLP stresses how important our mind is as a healing tool, how powerful our subconscious is as an engine that powers our lives and how intimately they are involved with health and well being. This field of endeavor has been utilized in Russia on people with acute coronary syndrome with excellent results (30).
Gestalt therapy believes that it is through the integration of all the various aspects of our essence and through conscious awareness of ourselves that we will be best able to function in a healthy manner. The practitioners in this field believe that there is a constant element of change within us and that by staying in the moment and staying aware, we are best suited to fully participate in life and all it has to bring.
Conclusion:
As the reader can appreciate the field of Mind-Body Medicine is wide ranging and encompasses many theories and disciplines. This body of knowledge and experience has engaged some of the best minds of many generations from the fields of philosophy, science and spirituality. Each of these areas alone comprise a rich body of knowledge and insight gleaned from some of the best thinkers of the last 100 years, however, it is through the integration of these various approaches that we will come to understand how to improve and maintain our health.
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