Chapter 6
Controlled Statistical Studies of Mental Healing

For most of the twentieth century, mainstream medical research never addressed a phenomenon that many practicing clinicians routinely observed: Attitudes, beliefs, and ideation all play a significant role in health. Since the 1970s, however, this has changed, and the research over this relatively short period has produced a gush, not a trickle, of evidence in support of psychosomatic healing. To reduce the job of reviewing these studies to a manageable size, I have chosen to focus on cancer and heart disease. Although cancer may be the more frightening of the two diseases, heart disease alone kills more Americans than all other diseases combined.(38) I will also cite an account of remission from acquired immune deficiency syndrome, or AIDS, primarily for the sake of public interest in the disease. However, we will first review some of the some of the studies relating to the overall effect of thinking on health, as well as evidence of the effectiveness of imagery practice, the best-known mental healing technique.

I. General Effects of Thinking on Health

The great Hasidic sage Rebbe Nachman of Breslov (1722 - 1810) once made this generalization about disease and health: "All the illness that afflicts people comes only because of a lack of joy.... And joy is the great healer."(39) Dr. Bernie Siegel offers a more contemporary perspective in referring to the "contentment factor." Siegel cites a long-term study dealing with the death rate among Harvard graduates, in which:

Those who were extremely satisfied with their lives had one-tenth the rate of serious illness and death suffered by their thoroughly dissatisfied peers even after the effects of alcohol, tobacco, obesity, and ancestral longevity were statistically eliminated.(40)

The two best-known mental and emotional factors that adversely affect health are stress and grief, especially if the latter is accompanied by loneliness. In the first half of this century, Walter Cannon discovered that heightened emotional states could stimulate the spleen, an organ that was later found to play a major role in the immune system.(41)

One study showed that medical students have diminished immune system functioning at exam time. Activities of natural killer T-cells and levels of interferon were both found do be lower during that period. Students also reported higher incidents of coughs and colds.(42)

According to Larry Dossey, grief, especially when accompanied by loneliness, can also adversely affect the immune system. In a 1977 study of the immune systems of widowed people in Sydney, Australia, researchers found that the bereaved showed significantly less immune activity than the control group. Another study, conducted at Ohio State University, found that medical students who had the highest scores on tests for loneliness and stress also had the lowest levels of natural killer T-cells.(43)

Of course, illness itself can lead to the same loneliness that aggravates the disease. In one study, conducted over nine years in Alameda County, California, death rates in a group of 7,000 people were correlated with indicators of social interaction, such as church membership, marital status, and other indicators of social activity. Death rates were found to be highest among those who had the fewest relationships -- even when factors such as socioeconomic status, cigarette smoking, and other health-related factors were taken into consideration. Isolation was linked to higher death rates from heart disease, cancer, and all other illnesses, as well as suicide and accidental death. Of course, the study naturally raises the question of whether the diseases caused the isolation, or vice versa. According to Dossey, the cause was the loneliness. Another study, conducted in Tecumseh, Michigan, "confirmed that increased loneliness and absence of social networks were the cause and not the result of disease and illness."(44) Dossey is quick to point out that nonetheless the culprit is not the experience of being alone per se, but the meaning ascribed to the isolation. Other researchers performed a follow-up of the Alameda County study, in which:

Women who had many social contacts but felt isolated had 2.4 times the normal risk of dying from hormone-related cancers (breast, uterine, and ovarian). And those women who had few social contacts and felt isolated were five times as likely to die from such cancers.

Interestingly, social ties did not seem to affect whether men got cancer in general, but among those who developed cancer, death was sooner in those who were socially isolated.(45)

If, as recent breakthroughs in psychoneuroimmunology suggest, the immune, nervous, and endocrine systems are all highly interrelated, then it would follow that tampering with the immune system might have emotional side effects. One study has corroborated this theory:

If the approach to treating cancer involves the immune system, the brain should manifest alterations as well. In support of this hypothesis, it was pointed out that scientists are now finding that the administration of interferon (an immune regulator that also inhibits viral cell growth) promotes severe depression in AIDS patients.(46)

Given some of the studies cited earlier, one has to wonder if the side effects of the cure could actually exacerbate the disease.

Finally, we cannot ignore the effect of doctor-patient relationships, a subject that has been the focus of three of the most commonly cited authors in this essay, Cousins, Dossey, and Siegel. Cousins, arguing that "a very simple effort to improve patient-physician interactions can result in significant improvement in a patient's condition," cites a series of four studies of ulcer, hypertension, diabetes, and breast cancer patients, conducted by Drs. Sheldon Greenfield and Sherrie Kaplan of the UCLA School of Public Health. In these studies, the control group was given only general information on self-observation and care, while the experimental group was given a full, twenty-minute training session on how to be more active in their treatment. The researchers found that the increased level of patient control, as well as the greater interest shown by physicians towards their patients, both positively correlated with improved health. Cousins infers that:

Research such as Drs. Kaplan and Greenfleld's project suggests that a more active patient role helps to foster a greater sense of control over illness, better health outcome, more rapid recovery, and greater compliance with treatment. Dr. Rose Maly of the UCLA School of Public Health utilized a simple technique to improve patient interactions with their physicians. The study observed corresponding attitudinal, behavioral, and health status changes in patients, as well as attitudinal changes in physicians....

Preliminary results indicate a significant improvement in the functional status of those who experienced the enhanced interaction with their physician -- the benefits having their greatest impact on individuals over age sixty.(47)

These studies all suggest that physicians should encourage their patients to take a more active role in their treatment, which has two important implications. The first is that patients have an opportunity to take a more active role in their own healing by monitoring and directing their thinking. The second is that the very sense of being more in control is in itself conducive to better health. Studies dealing with heart disease and cancer, to which we now turn, corroborate this theory.

II. The Effectiveness of Mental Healing Techniques

As interest in the subject of mental healing grows, a variety of different techniques may evolve. As of today, however, the technique of imagery, or visualization, stands out as the most prominent. It actually consists of nothing more than rehearsing the experience you want to have in the imagination -- with the express purpose of directing the subconscious mind to bring the experience into reality. Siegel, who used visualization extensively with cancer patients, explains how it works with respect to healing in analyzing its effectiveness in training the highly-successful athletic teams of the former Soviet bloc:

Visualization takes advantage of what might almost be called a "weakness" of the body: it cannot distinguish between a vivid mental experience and an actual physical experience....

Eastern European trainers often have their students and athletes lie down and listen to calming music Then the athlete visualizes, in full color and complete detail, a winning performance. This is repeated until the physical act becomes merely a duplication of a mental act that has already been successfully visualized. Soviet research indicates that athletes who spend as much as three-fourths of their time on mental training do better than those who place more emphasis on physical preparation.(48)

If mental rehearsal can train the body in athletics, it can at least theoretically train it to fight disease. (If this seems farfetched now, our upcoming discussion of biofeedback may render it less so.) Dossey cites the following documented success story:

Dr. G. Richard Smith and his colleagues at the University of Arkansas College of Medicine reported what is perhaps the first fully documented case of a human being intentionally changing the immune system. It involved a thirty-nine-year-old woman who was able to change her positive skin test for varicella zoster (the chicken pox virus) at will -- from positive toward negative, and then toward positive, a feat she repeated six months later. She used a rather specific form of imagery, imagining the redness and swelling surrounding the skin test getting smaller and smaller, while sending "healing energy" to the area.(49)

Dossey elaborates, citing the Achterberg and Lawlis studies and others as evidence of the effectiveness of visualization in altering the immune system. Achterberg collaborated with Mark S. Rider in an experiment that measured the effects of visualization in white blood cell count. The subjects were divided into two groups. Each group was asked to visualize images of the shape, location, and movement of one of two types of white blood cells, neutrophils or lymphocytes. Blood counts were taken both before and after each twenty-minute visualization sessions:

Results showed that the neutrophils (but not the lymphocytes) decreased significantly in the neutrophil group, while the lymphocytes (but not the neutrophils) decreased significantly in the lymphocyte group. The authors concluded that the highly directed imagery was cell-specific; that is, it affected the cells toward which it was intended or directed, and not others.(50)

Siegel cites a study in which imagery increased the count of platelets, a third kind of white blood cell.

In 1980 psychologist Alberto Villoldo of San Francisco State College showed that regular meditation and self-healing visualization improved white-blood-cell response and improved the efficiency of hormone response to a standard test of physical stress -- immersing one arm in ice water. The subjects trained in meditation withstood the pain of the test far better than those who did not meditate, and two-thirds of them were able to stop bleeding immediately after a blood test merely by focusing their minds on the vein after the needle was removed.(51)

Finally, Siegel cites a 1976 study, conducted by Gurucharan Singh Khalsa, founder of Boston's Kundalini Research Institute, showing that: "[R]egular yoga and meditation increased blood levels of three important immune-system hormones by 100 percent."(52)

The proven effectiveness of imagery in healing the body has two important implications. The first is that it corroborates other evidence that thinking can heal. The second is that mental healing is not a process entirely out of reach for most of us. Although people may vary in their ability to visualize, most can apply this technique to some degree. Effective mental therapy already exists and is available to just about anyone who wants to use it.

III. Heart Disease

We turn now to the leading cause of death by disease in twentieth-century America, heart disease. Before we look at the mental factors that might be involved with it, we must look at the physical factors. With heart disease, there are both long- and short-term causes. The long-term causes deal with the general deterioration of the circulatory system in and around the heart, which usually consists of some sort of constriction (commonly called "hardening") of the coronary and associated arteries. This restriction of the blood flow weakens the heart and sometimes causes infarction, necrosis, or death of heart tissue. Short-term causes, such as anger, excitement, or excessive physical activity, place demands on the weakened heart that it cannot accommodate. In the case of infarction, the heart can rupture, causing instant death. Or, it can fibrillate, i.e., simply vibrate instead of pumping blood. Fibrillation can also be fatal, but it can sometimes be arrested with cardiopulmonary resuscitation (CPR). Milder heart attacks result in simple spasms, with symptoms such as dizziness, nausea, and chest pains (angina pectoris). Vigorous physical exercise can therefore be fatal to a person with an already weakened heart -- even though in the long run it can also prevent heart disease by improving circulation. Exercise is therefore both a short-term cause of, as well as a long-term check against, heart disease.

There are, correspondingly, both long- and short-term mental causes of heart attacks. The short-term cause is the fight-or-flight syndrome, i.e., panic, extreme excitement, rage, or other forms of autonomic arousal. The long-term causes are persistent mental attitudes. The short-term causes are easier to understand from a commonsense point of view. Both folklore and fiction are filled with tales of death by "heart failure," but can an individual in otherwise good cardiac health succumb? Norman Cousins argues that it is indeed possible, citing numerous studies in the medical literature to support his position. The heart, he argues, is a muscle, and all muscles can spasm. A sudden heart spasm can result in fibrillation and near-instantaneous death, if not arrested by CPR.(53)

An interesting and relevant statistic is that people are more prone to die of heart attacks on certain days of the year and during certain times of the day. For example, if you are Christian, you are most likely to die of a heart attack the day after Christmas, but if you are Chinese, the day after the Chinese New Year.(54) Even better documented is the "Black Monday syndrome," the fact that both heart attacks and strokes occur most frequently on Monday morning at about 9:00 a.m. According to Dossey, researchers had originally attributed these finding to biochemical factors, such as circadian rhythms, bodily cycles that occur over a twenty-four-hour period. However, circadian rhythms did not account for the greater occurrences of these maladies on Monday. Dossey attributes the Black Monday syndrome more to emotional factors:

Emotions can trigger biochemical changes of their own, which might act in concert with circadian flows. Studies of subordinate primates -- for example, male baboons forced by dominant males into inferior roles -- show that chronically stressed animals indeed have higher elevations of certain stress hormones that can have negative effects on heart function. Platelet aggregation or stickiness also is known to increase in persons under psychological stress, which might be more pronounced on Monday in someone returning to a job they dread.(55)

From personal experience, I have generally found that the stress of returning to work is greater than the stress of remaining at work. Any problems, such as mechanical breakdowns, the failure of co-workers, employees or vendors to come through, or a boss having a temper tantrum or making impossible demands, all seem to be more painful when they hit early Monday morning. Like a loud noise on a quiet night, the sudden surge of irritation and anxiety are exacerbated by a sense of shock.

Machines, too, are subject to a kind of Black Monday syndrome. Light bulbs are far more likely to go out when you first hit the switch. In delving into this topic, I asked a co-worker, a former mechanical engineer who designed gears, if machines also tended to break down more frequently on Monday morning. Although he himself could cite no statistics in this area, he did speak of the "80-20 rule" of engineering, which says that 80% of mechanical failures will occur during a 20% time segment of a machine's life, i.e., during peak loads or whatever time period when the machine is subject to maximum stress. Two known laws of physics can explain why there might be greater stress on machines during start-up. The first is the law of inertia. It requires more energy to move something at rest than something already in motion. The second is that the friction of rest is greater the friction of motion. Both of these principles suggest that there is more stress involved in getting things moving than in keeping them moving.

The same holds true for the human body. Athletes in training will always take time to do "warm-up" exercises before beginning their more rigorous training. Failure to do so can result in serious injuries. The same may also hold true for the body-mind in general. That sudden jolt of reality that hits when one returns to a stressful job after a relaxing weekend can put the body into a fight-or-flight state of emergency when it is not ready for it. Heart rates go up before blood vessels dilate. Muscles tighten before circulation rates increase, forcing them to work anaerobically. People may tend to get heart attacks and strokes Monday morning for the same reason that athletes tend to injure themselves when they train without warming up.

Dossey attributes Black Monday syndrome to the meaning, or lack of it, involved in the contemporary work place:

What does one's job mean to the patient -- satisfaction, loathing, dread, a challenge, or something else; and how do these perceived meanings affect the body to contribute to heart attacks on Monday morning? Another valid question is, What does the heart attack that occurs on Black Monday mean? What does it symbolize or represent -- job dissatisfaction, unhappiness, "something physical," or perhaps nothing at all? However meaning is approached, the answers are almost always laden with emotion.(56)

The meaninglessness and long-term dissatisfaction experienced at the workplace, however, pertains to the short-term causes of heart attacks as well as the long-term ones. Although the meaninglessness of one's work is often a chronic condition, the very context of that condition can exacerbate the experience of shock described above. If one's job is a private hell, the return to it from a period of respite becomes that much more traumatic.

The correlation between mental attitude and the long-term causes of heart disease is even stronger. One of the best-known predictors of heart disease is the "Type-A" personality.(57) Type-A personalities are driven to succeed and are prone to perfectionism. They also tend to be irritable and aggressive when frustrated. Although their ambition often drives them to positions of power and wealth, it also renders them more susceptible to heart disease.

Occupation can also be a predictor of heart disease. However, contrary to the stereotype, the high-powered executive or professional worker is not the most susceptible. According to Dossey, some of the more susceptible workers are "waiters, gasoline station attendants, and certain data processors." Dossey elaborates:

In these jobs, the worker is powerless to control the work load. No matter how high the volume, one can only struggle harder to cope with it. If the work load is excessive and protracted, the situation begins to resemble the "learned helplessness" situation described by researchers in animal behavior.

It is not difficult to understand how any employee could develop an indwelling sense of entrapment and helplessness in a similar situation, especially if controlled by supervisors who are insensitive to these issues.(58)

Dossey goes on to suggest that it is the sense of helplessness in the face of responsibility, as opposed to the position of responsibility itself, that causes the heart disease. It is not the situation itself, but our reaction to it, that kills us. Dossey cites a study of executives during the AT & T breakup, in which those who developed heart problems were compared with those who did not:

Those who stayed healthy judged their stresses differently and responded to them differently than the illness-prone group. The healthy individuals possessed what the psychologists called a capacity for "optimistic cognitive appraisal," meaning that they had a way of "seeing the cup half-full rather than half-empty." When stressful events occurred, they did not regard them as the end of the world but as a natural and inevitable part of their lives. This allowed their bodies to respond to stress differently, averting injurious biochemical responses. In effect these people could control their body's reaction to stress. They also interpreted stress differently by regarding it as a challenge, an opportunity to learn, grow, and become a wiser, better manager. Not only were the healthy executives deeply involved in their work, they had a strong commitment to their families and to life in general off the job.(59)

In other words, the healthy ones were those who confronted their problems with the belief that they could be solved, that what they were facing was an adventure, not imminent doom. Their bodies responded accordingly, reacting more as though they were competing in an athletic event than engaging in mortal combat. The results were lower blood pressure and less likelihood of heart spasm.

Stress is not the only important factor in job-related heart disease. Citing a 1972 study by the U.S. Dept. of Health, Education, and Welfare, Dossey argues that:

[T]he best predictor for heart disease was not any of the major physical risk factors (smoking, high blood pressure, elevated cholesterol, and diabetes mellitus) but job dissatisfaction. And the second best predictor was what the researchers called "overall happiness." This finding fits with the fact that most persons below the age of fifty in this country who have their first heart attack have none of the major physical risk factors for coronary artery disease.(60)

Dossey's argument here is reminiscent of Rebbe Nachman's cited above. It seems, for example, that although job dissatisfaction and overall unhappiness may themselves cause heart attacks, these factors, in turn, stem from a deeper cause, the sense of helplessness and powerlessness over one's destiny. However, we must be careful not to oversimplify the matter. Neither unhappiness nor job dissatisfaction is a simple phenomenon; each can stem from many different and often concurrent causes. What is important here is that both can be profoundly connected to the way one thinks about one's job or overall position in life.

There may also be a mental-emotional component to some of the physical causes of heart disease, e.g., atherosclerosis and blood cholesterol levels. A 1979 study showed that "tender loving care" could reduce atherosclerosis and the corresponding risk of heart attacks by 50% among rabbits fed large amounts of cholesterol.(61) Dossey cites other studies suggesting that cholesterol levels themselves can be affected by the way we think about stress and by applying mental disciplines:

Dr. Herbert Benson of Harvard Medical School has shown that the ability to maintain a healthy cholesterol level is directly related to the ability to handle stress through relaxation.... Studies of people who meditate regularly have shown that their physiological age is much lower than their chronological age.(62)

Dossey suggests here that, with a properly-designed program of meditation and exercise, we can teach hard-driving, success-oriented (Type A) persons to avoid heart attacks -- without losing their achievement-oriented behavior. In fact, he cites another study, this one taken over five years, in which "Type A" heart patients were divided into three groups. The first group received advice on diet and exercise, as well as a comprehensive program of psychological counseling, biofeedback training, and individual and group education, on how to alter their Type A behavior. What the experimenters found was that:

During this time some of the subjects had recurrent heart attacks, some of which were fatal. Others died suddenly, 'dropping dead" from cardiac arrest presumably due to their heart disease. It was found that the circumstances most often preceding these events were emotional crises, excessive physical activity, consumption of a large fatty meal, or some combination of these circumstances.

When the statistics were examined at the end of one year, the rates of nonfatal heart attacks were lowest in the group given in-depth instruction on modifying their Type A behavior. In contrast, the group receiving the typical advice about diet, weight, and exercise had three times, and the control group four times, as many nonfatal heart attacks. In addition, the in-depth group had less than half the number of fatal heart attacks as the control group.(63)

In interpreting the study, Dossey concludes that the patients had undergone a kind of "meaning therapy," a means of re-evaluating the unpleasant or traumatic events in their life in ways that reduced their physical and emotional impact:

With the creation of new meanings, the body responds in healthier ways. The "adrenaline rush" that is felt in a crisis is blunted, along with the rise in heart rate and blood pressure. The diffuse anxiety and hostility Type As feel throughout the day abates, and the body's "emergency" apparatus, the sympathetic nervous system, is quieted. One of the primary benefactors of these changes is the heart. This important study shows that meanings can be changed, the significance that life events hold for us is not absolute, and as the meanings change to a more positive outlook, the rate of recurrent heart attack declines.(64)

To support his argument, Dossey cites another study by cardiologist Dean Ornish, who taught stress management techniques such as meditation, imagery, and relaxation exercises to cardiac patients. The participants in his stress management training were able to increase the duration of their exercise by 44 percent, and the total work performed, as measured by heart function, by 55 percent. Moreover, cholesterol levels dropped by 20 percent and angina attacks were reduced by 90%.(65) This study strongly suggests that mental activities, such as meditation and visualization, can have a positive effect in alleviating the physical causes of heart disease.

Heart disease has been positively correlated to emotional states. Dossey cites a survey that showed that men who experienced their wives as loving and supporting had 50 percent fewer episodes of angina pectoris than men who did not.(66) He cites other studies correlating heart disease and social isolation -- even among non-human primates:

[I]n groups of baboons living in the wild, life for low-ranking, low-status animals is often miserable. It consists of hard-earned, stolen meals and harassment by dominant males that can be life-threatening. The low-ranking male, even if he never picks a fight, is in constant danger of being assaulted and must always be on guard. In short, his entire life is spent with little control. These social stresses correlate with pathological biochemical changes internally. Subordinate baboon males have the type of physiology found in stress-related diseases. Their blood level of hydrocortisone, a hormone secreted during stress, is high and remains elevated even after a stressful event is over. Low-ranking males have lower concentrations of high-density lipoproteins (HDL), which are known to carry the "good" type of cholesterol and protect against heart disease. They have weaker immune systems, with fewer circulating lymphocytes to detect invading pathogens. And during stress they cannot maintain adequate levels of testosterone, the sex hormone that is valuable for muscle metabolism and aggression.(67)

Dossey speculates that humans in similar predicaments have similar health problems:

This scenario is similar to the experience of poorly educated or illiterate persons.... They have little autonomy or control over what happens to them, which often leads to a chronic and debilitating sense of despair, futility, and anger.... When an illiterate person resigns himself or herself to never learning to read and write, an authentic "no exit" or impasse situation is in place.(68)

Other studies have shown that heart disease, especially when fatal, tends to correlate inversely to education levels. Dossey argues that it does so only indirectly, via its direct bearing on isolation and stress, factors that we have already shown to affect adversely health in general and heart disease in particular. He cites two studies in support of this view. In a 1984 study of 2,320 male heart attack survivors, Dr. William Ruberman and colleagues found that those participants who were isolated and stressed had four times the risk of death than those with lower levels of isolation and stress. Ruberman was careful to control for extraneous factors such as smoking, hypertension, cholesterol, diabetes and other factors. Ruberman also found an inverse correlation between education levels and heart attacks. This led Dossey to another chicken-or-the-egg question: Was the controlling factor the education level or the isolation and stress? Again the researchers were able to "tease apart" these factors:

They concluded that poor education was only a stand-in or "proxy" for stress and loneliness -- that is, low education actually did its damage through the stress and social isolation to which it led....(69)

However, there is one point here that Dossey seems to neglect: A chicken-or-the-egg question may also exist with respect to education levels and social skills. People with poor social skills, for whatever reason, may also do poorly at school, becoming easily discouraged and dropping out early. Both the education levels and the levels of loneliness and stress could be attributed to a general inability and lack of confidence in coping with life. For our purposes, the ultimate question raised here is not whether the lack of education causes loneliness and stress, but the extent to which beliefs and attitudes cause loneliness and stress. The studies cited above do not address this question.

However, there are other studies that do, one of which was the study of executives during the AT & T breakup cited by Dossey above. In the findings in that case, it was the attitude towards the stressful situation, as opposed to the situation itself, that caused the health problems.

Some studies have shown that maintaining a positive mental attitude is healthy even if it entails engaging in what most of us would call an intellectual (and possibly moral) vice: denial. However, denial is only beneficial in the short-term. Like avoiding exercise, avoiding the truth is a short-term cure, not long-term prevention. Says Dossey:

Nowhere is the value of denial more apparent than in the coronary care unit following heart attack, where it has been shown that the higher the denial, the lower the mortality. Persons who deny being frightened, who minimize the seriousness of their illness, and who give the appearance of generally being unruffled tend to survive the CCU experience in larger numbers than those who are appropriately worried or who are unable to deny their distress. These findings led Dr. Thomas P. Hackett of Harvard Medical School, a pioneer in this research, to observe that "While denial can play the role of the enemy to the myocardial infarction victim in delaying his arrival in the emergency ward, it can also serve as an ally in the CCU."

However, Dossey adds that the denial must be genuine:

[W]e cannot consciously fool ourselves into not believing something exists, once the belief is already lodged in consciousness. Thus it is useless for the heart attack victim who finds himself in the coronary care unit to say to himself, "Statistics show that if I deny my heart attack, I'll have a better chance of surviving. So I'm going to close my eyes, lie back, and start denying!"(70)

Evidently, the self-deceit involved in denial is effective under the same circumstances as the deceit involved with placebos: It works only when the patient really believes the falsehood. Once again, this underscores a basic principle of mental and spiritual healing that dates back at least to Jesus and is strongly emphasized in New Thought: Sincere belief is a critical element in the power of thought to heal.

IV. Cancer

With respect to this dreaded disease, I have divided the topic into two subtopics: the role of the mental in causing cancer and the role of the mental in curing it.

The Role of the Mental in Causing Cancer

With respect to cancer, many physicians believe that the disease itself is caused by a breakdown in the immune system. Under this theory, anything that adversely affects the immune system -- including some kinds of brain activity -- can be carcinogenic. In Bernie Siegel's words:

One of the most widely accepted explanations of cancer, the "surveillance" theory, states that cancer cells are developing in our bodies all the time but are normally destroyed by white blood cells before they can develop into dangerous tumors. Cancer appears when the immune system becomes suppressed and can no longer deal with this routine threat. It follows that whatever upsets the brain's control of the immune system will foster malignancy.(71)

This theory could explain why so many substances have been linked to cancer. Anything that interferes with the functioning of the immune system can be carcinogenic.(72) A study conducted at the Albert Einstein College of Medicine in the Bronx found that children with cancer had had twice as many recent crises as other children, who were similar except for their disease. Another study showed that 31 of 33 children with leukemia had suffered traumatic losses within two years of the onset of the disease.(73)

Mental and emotional factors have been tied to cancer in several important ways. Like heart disease, cancer correlates positively with stress. Siegel cites two studies. In the 1970s, a study of mice bred to develop breast cancer, the cancer rate varied from 92 percent, for mice that were subject to stress, to 7 percent, for those that were not. In another experiment, in which rats injected with tumor cells and then given electric shock, 73 percent of the rats that could not escape the shock developed cancer. Of those that could, only 37 percent developed the disease, doing slightly better than the rats that received no shocks at all.(74)

Although it might be argued that stress itself is not due to thinking and beliefs, but to external circumstances, Siegel argues otherwise. Referring to a 1961 study by L. E. Hinkle, he concludes that stress comes not from events but in the way in which we interpret them. Situations such as poverty, bereavement, and alcoholism in the family, which might seem to be incredibly stressful to the observer, were not associated with the illnesses by the patients who did not report them as stressful. Conversely, events one would ordinarily consider to be not very stressful can be experienced as traumatic, especially in the case of children, who have been known to commit suicide for having received a B on a report card.(75)

Cousins cites a study by David M. Kissen indicating similar results. In this study of cancer patients, Kissen's research "suggested that an individual's emotional response to a life event was more critical than an event itself in the genesis of cancer."(76) This evidence is consistent with that found in similar studies cited above, with respect to heart disease.

Dossey cites one example of a researcher who found that mental factors are heavily involved in cancer -- even though he was trying to prove otherwise.

Professor David Spiegel, a psychiatrist and researcher at Stanford University Medical School, set out to refute the idea that mental factors were important in the course of diseases. Like many clinicians, he felt that assigning a role to the mind in cancer was not only erroneous but potentially destructive as well. (Many believe this idea generates guilt on the part of the cancer patient because it suggests that he or she was somehow responsible for causing the disease.) Spiegel followed eighty-six women with breast cancer for a period of ten years. Those who received group therapy and lessons in self-hypnosis lived an average of twice as long as those who were given only traditional medical treatment. Spiegel described himself as "stunned" at this finding, which contradicted his expectations.(77)

One of the more striking discoveries in the research of mental factors in causing cancer is that, "When combined with other psychological tests, mental imagery often is more useful than laboratory tests in assessing the patient's prospects." Siegel describes a study suggesting this:

Work done by the Simontons, Jeanne Achterberg and G. Frank Lawlis compared the predictive value of psychological factors and blood chemistry in 126 patients with extensive cancer. Virtually every psychological test showed a statistical relationship to one or more blood components. The patients who did most poorly were those who were very dependent on others -- such as the doctor -- for motivation and esteem, who used psychological defenses to deny their condition, and who visualized their bodies as having little power to fight the disease. Compared with patients who did well, those whose disease progressed fastest were more conformist to sex-role stereotypes and developed images that were more concrete and less creative or symbolic. The researchers concluded that "blood chemistries offer information only about the current state of the disease, whereas the psychological variables offer future insights" and that "the imagery was found to be the most important in predicting subsequent disease states." By analyzing drawings made by two hundred patients, Achterberg later achieved 95 percent accuracy in predicting who would die within two months and who would be in remission.(78)

One of the best-known mental predictors of cancer is the "cancer personality type." Cousins cites the work of psychologist Lawrence LeShan, an early pioneer in this field:

LeShan..., research psychologist of the Institute of Applied Biology in New York, conducted extensive pioneering work regarding the cancer-prone personality that led him to identify several psychological characteristics that seemed to typify cancer patients (including such factors as the inability to express aggression and disruption of a parental relationship in early childhood). He concluded that personality factors have some bearing on the observed association between traumatic life events (most notably, the loss of a significant emotional relationship) and the development of cancer, and he speculated that specific psychological attributes could be linked to particular types and locations of cancer.(79)

One of the more important traits of the cancer personality type is an inability to express emotions. Siegel, who calls it an inability to "be your own person," says:

As Elida Evans observed in her groundbreaking 1926 study of the cancer personality, "Development of individuality is a safeguard to life and health. It lifts a person out of the collective authority." I find in rural or rugged areas the percentage of exceptional patients is higher. They are independent, self-reliant people to begin with. Becoming your own person releases your creativity.(80)

Cancer patients tend to be "nice" people possessing low self-esteem and an exaggerated desire to please others. Several studies have shown that cancer patients can often be identified by their psychological profile. Siegel cites several:

By using a simple psychological test on a large group of women, some of whom had cervical cancer, Arthur Schmale was able to pick out 36 of the 51 who had malignancies (already diagnosed but unknown to him), by looking for hopelessness and a recent emotional loss. Other research groups have since gotten even better results. Marjorie and Claus Bahnson have developed a questionnaire that is 88 percent accurate in identifying those who turn out to have a biopsy-confirmed cancer. Most of these psychological tests are now more accurate than physicians' physical exams....

Some of the most valuable work has been done by Dr. Caroline Bedell Thomas of Johns Hopkins University Medical School. Beginning in 1946, she took personality profiles of 1,337 medical students, then surveyed their mental and physical health every year for decades after graduation. Her goal was to find psychological antecedents of heart disease, high blood pressure, mental illness, and suicide. She included cancer in the study for the sake of comparison, because she originally thought it would have no psychological component. However, the data showed a "striking and unexpected" result: the traits of those who developed cancer were almost identical to those of the students who later committed suicide. Almost all the cancer patients had throughout their lives been restricted in expressing emotion, especially aggressive emotions related to their own needs. She also found that, using only the drawings they made as one of the tests, she could predict what parts of their bodies would develop cancer.(81)

Dr. Fawzy Fawzy at the UCLA medical school conducted a study about the role of emotions in the levels of Leu-7 cells, one of the "natural-killer" T-cells. The study, which lasted over a year, compared levels of Leu-7 cells of an "experimental group" that had been able to "reduce anxiety about their illness and cope with life stresses more effectively" with a control group that had not. Cousins quotes Fawzy's account of the results:

The mean change scores showed that the control group's cells had actually decreased while the experimental group showed the desired increase in these cells at six weeks. By six months the control group had managed to return to close to baseline while the experimental group had continued to increase their Leu-seven cells. This trend continues in many of the other important cell categories.(82)

Grief also can have a profound impact on the development of cancer-fighting immune cells. Dossey cites the following study:

Steven J. Schleifer and his colleagues at New York's Mount Sinai Hospital... studied the immune function of fifteen men whose wives had terminal breast cancer. Of interest were the T- and B-lymphocytes, the body's two main immune cells. Prior to the death of the wife, the researchers found that these cells functioned normally. But beginning shortly after the wife's death, and extending for many months in the period of grief, the cells, though normal in number, stopped working. They could not even be made to work when extracted from the blood of the men and exposed in test tubes to chemicals that ordinarily "turn them on."(83)

Divorce has even worse effects, according to Siegel, because "...it's harder to accept that the relationship is really over."

Indeed, divorced people have higher rates of cancer, heart disease, pneumonia, high blood pressure, and accidental death than married, single, or widowed persons. Married men also have one-third the lung-cancer incidence of single men and can smoke three times as much with the same cancer incidence as single men.(84)

Depression can also suppress immune cell activity, as well as the production of antibodies, which can both aid in the suppression of cancer. What is equally important is that some of these deleterious effects can be mitigated with relaxation and creative imagination exercises. Cousins cites a series of studies:

Drs. Sandra M. Levy and Ronald B. Herberman of the University of Pittsburgh and the Pittsburgh Cancer Institute observed that depressive behavior (fatigue, listlessness, apathy) was associated with diminished natural-killer (NK) cell activity and accelerated tumor spread in breast cancer patients. [Cousins then cites the Schlieffer study mentioned above.] To confirm the relationship between severity of depression and suppressed immunity, the investigators conducted a series of studies comparing individuals hospitalized for depression with those not hospitalized and those hospitalized for other reasons. They concluded that the severity of depression was associated with reduction of T and B cells and their activity. This conclusion was strengthened by their observation that relief from depression is paralleled by changes in the immune system.

Drs. Janice Kiecolt-Glaser and Ronald Glaser, of Ohio State University, found that highly depressed nonpsychotic psychiatric in-patients had significantly poorer DNA (genetic) repair in immune cells exposed to irradiation than did less depressed patients; and that both depressed groups fared significantly worse with regard to DNA repair than the psychologically healthy, nonpsychotic group. All group differences were sustained through the final measurement point, five hours after irradiations time period in which DNA repair is expected to recover to pre-irradiation levels. This finding suggests... that emotional stress may contribute to the incidence of cancer by directly causing abnormal cell development or by indirectly diminishing immune surveillance or competence.

By the same mental processes, however, the immune response can be strengthened or restored. Use of relaxation exercises and creative imagination were found to be helpful in a study of cancer patients by Dr. Barry L. Gruber of the Medical Illness Counseling Center in Chevy Chase, Maryland, in collaboration with Dr. Nicholas R. Hall of George Washington University and later of the University of South Florida. For one year, the patients were asked to imagine the forces in their immune systems being fully engaged in a war against the cancer cells.

The investigators found that these exercises had the effect of stimulating lymphocytes and increasing the production of antibodies and interleukin-2 cells, enhancing NK-cell activity and augmenting the effectiveness of the cytotoxic T cells. The pattern of immune changes corresponded to the level of relaxation and imagery. Equally interesting was the fact that the patients clearly showed intense determination to overcome their disease.(85)

With respect to the same study, Siegel adds the following comments:

[The exercises also affected] the levels of thymosin-alpha-1, a hormone especially important to the auxiliary white cells called T helper cells. Thymosin-alpha-I also helps produce feelings of well-being, showing that the immune system can directly affect one's state of mind, as well as vice versa.(86)

Cousins elaborates on these studies, with respect to the problem of emotional inhibitions:

Both Dr. Temoshok's and Dr. Levy's studies linked emotional inhibitions to impairment in immune activity. This may explain the link between emotional suppression, such as passivity or stoicism, and the progression of cancer.(87)

Evidently, the adverse effects on the immune system brought about by depression are worse when the depression is coupled with the lack of an emotional outlet. LeShan drew the distinction between the psychological condition of "depression" and that of "despair."

LeShan conducted personality studies of 455 cancer patients and in-depth therapy of 71 "terminal" cases. He found that this condition of "despair" (so named to distinguish it from the more commonly recognized form of depression) was reported as predating the disease by 68 of his 71 cancer patients in therapy, but by only 3 of 88 other clients who did not have cancer.(88)

While both depression and despair are unhappy emotional states, despair entails the sense of helplessness that we found was so important in the link between stress and heart disease. That sense of helplessness may in fact be mitigated for those who can express emotions. Siegel cites two more studies:

[O]ver thirty years ago... internist D. M. Kissen studied a group of smokers, comparing those who had lung cancer with those having other diseases. Based on personality tests, Kissen found the cancer patients had poorer "outlets for emotional discharge," and concluded that, the more repressed a person was, the fewer cigarettes were needed to cause cancer.

Working with breast-cancer patients, Mogens Jensen of the Yale psychology department showed that "defensive-repressors " die faster than patients with a more realistic outlook. These are the smiling ones who don't acknowledge their desperation, who say, "I'm fine," even though you know they have cancer, their spouses have run off, their children are drug addicts, and the house just burned down. Jensen feels this behavior "disregulates" and exhausts the immune system because it is confused by the mixed messages.(89)

In his conversations with Bill Moyers, Michael Lerner, co-founder of the Commonweal Cancer Help Program, cites a study by Lydia Temoshek, whose work was also cited by Cousins earlier, of patients with malignant melanoma:

Temoshek looked at the difference between patients who expressed their feelings and those who didn't, and discovered that the ones who expressed their feelings had more immune activity at the site of their lesions. They also had thinner lesions than the people who did not express their feelings.(90)

As with heart disease, denial can also have a healing influence on cancer. According to Dossey, there are definitely times when deluding one's self can in fact heal, because it can help maintain a more positive mental attitude. Tactics such as denial, making excuses, and comparing one's self to only the worst off among other victims, in order to look good by comparison, all tend to promote healing:

Researcher Keith W. Pettingale and his colleagues at King's College School of Medicine and Dentistry in London studied the psychological response of women three months after mastectomy. At a five-year follow-up, they found that the rate of recurrence-free survival was significantly higher among patients who had reacted to their cancer either with a fighting spirit or with denial than among those who had reacted with stoic acceptance or feelings of hopelessness and helplessness.... After a follow-up period of ten years, the outcome was the same: those patients demonstrating a fighting spirit or denial did better and had higher rates of survival....

Another strategy used by most cancer patients, [psychologist Shelley E.] Taylor found, is to make selective comparisons with other persons with the same disease. Women with breast cancer tended to compare themselves with other women with cancer who were doing poorly, which enhanced their estimation of their own strengths.... Summing up, Taylor states, "The effective individual in the face of threat... seems to be one who permits the development of illusions, nurtures those illusions, and is ultimately restored by those illusions."

Another device used by the secret helper is excuses.... Research by psychologists C. R. Snyder and Raymond Higgins at the University of Kansas has shown that persons who offer themselves plausible excuses have greater self-esteem, better health, and perform better on all sorts of cognitive, social, and physical tasks than people who put the blame on themselves when things go wrong.... They help preserve a sense of self-worth and personal integrity -- as when we say that we flunked a test because we didn't study hard enough, not because we weren't intelligent enough.... Excuses give them time to marshal additional psychological resources for the next challenge.... Snyder and Higgins conclude that excuses are far from the "simple, silly and ineffective ploys" most people consider them to be and are, in fact, necessary illusions.'(91)

Dossey may well have exposed a conflict between moral and physical health here.

If intellectual dishonesty is sometimes helpful, emotional dishonesty is not. People who express their negative emotions tend to do better. Being ornery and cantankerous pays more often than not. Siegel, who calls this expression "fighting spirit," says:

Psychologist Leonard Derogatis, in a study of thirty-five women with metastatic breast cancer, found that the long-term survivors had poor relationships with their physicians -- as judged by the physicians. They asked a lot of questions and expressed their emotions freely. Likewise, National Cancer Institute psychologist Sandra Levy has shown that seriously ill breast-cancer patients who expressed high levels of depression, anxiety, and hostility survived longer than those who showed little distress. Levy and other researchers have also found that aggressive "bad" patients tend to have more killer T cells, white cells that seek and destroy cancer cells, than docile "good" patients. A group of London researchers under Keith Pettingale recently reported a ten-year survival rate of 75 percent among cancer patients who reacted to the diagnosis with a "fighting spirit," compared with a 22-percent survival rate among those who responded with "stoic acceptance" or feelings of helplessness or hopelessness.(92)

Siegel elaborates on fighting spirit, with respect to the Derogatis study:

His work stands as excellent scientific support for a group of researchers nearly three decades earlier, who were "impressed by the polite, apologetic, almost painful acquiescence of patients with rapidly progressive disease as contrasted to the more expressive and sometimes bizarre personalities" of those who lived longer.(93)

Cousins cites another study that supports Siegel's contention:

Dr. G. Nicholas Rogentine, Jr., and colleagues of the National Cancer Institute recruited patients who had been successfully treated for malignant melanoma. The patients were asked to rate the amount of "adjustment" they required in order to cope with their illness. Participants who reported that they reconciled themselves to their illness were more prone to recurrence than those who resisted the idea of adapting to cancer.(94)

Anything seems to work better than resignation. Cousins, citing the Temoshok study mentioned earlier, argues that "passive" emotional states are the most dangerous:

[Lydia Temoshok's] structured interview with patients measured emotional, behavioral, physical, and mental reactions to events. These measurements revealed that malignant melanoma patients whose attitudes and emotions were active instead of passive exhibited better immune function and slower tumor growth.(95)

Dossey is more specific. According to his interpretation, the following studies indicate some specific thoughts that are associated with both defeatism and suppressed immune system activity:

When people learn... to be genuinely helpless, they tend chronically to react to their problems with the classic triad of "I caused it," "It'll always be this way," and "This is going to spoil everything else I do." This point of view seems actually to be channeled into the body. It creates physiological changes that set the stage for bad health. When Seligman and his colleagues rated 172 undergraduates for the presence or absence of this explanatory style, they accurately predicted which students would be sick the most; the predictions held both one month and one year later. In another study involving 13 patients who had malignant melanoma, absence of this style of explanation was a better predictor of survival than even the level of activity of natural killer cells, a type of white blood cell crucial in the immune response.(96)

In sum, the studies indicate that despair, a profound feeling of sadness coupled with a sense of resignation to conditions, is the attitude that is least healthy when attempting to recover from cancer. Secondly, the social style of not expressing one's negative emotions, especially if it stems from an exaggerated fear of others' disapproval, seems to describe the personality profile of those most likely to get cancer in the first place.

The Role of the Mental in Curing Cancer

Having seen how thinking patterns can exacerbate or lead to cancer, we can now turn to the various forms of mental therapy that seem to work. Without advocating specific techniques, Siegel cites five characteristics, outlined by Dr. Kenneth Pelletier, that are typical of cancer patients who survive against the odds;

1. Profound intrapsychic change through meditation, prayer, or other spiritual practice.
2. Profound interpersonal changes, as a result: Their relations with other people had been placed on a more solid footing.
3. Alterations in diet: These people no longer took their food for granted. They chose their food carefully for optimum nutrition.
4. A deep sense of the spiritual as well as material aspects of life.
5. A feeling that their recovery was not a gift nor spontaneous remission, but rather a long, hard struggle that they had won for themselves.

Then, Siegel adds:

In 1977 a research group led by Dr. Edward Gilbert of Denver's Presbyterian Medical Center completed one of the first controlled tests of psychological treatment of cancer patients. Gilbert and his co-workers asked independent physicians to examine a group of forty-eight patients and predict how long they could expect to live using standard medical treatments. The patients entered an eight-week program of individual and group therapy, biofeedback, and training in meditation and visualization. Then the patients were tested by independent psychiatrists to see which ones had made the most positive changes in their lives. Five patients were graded as having changed most significantly and four of these far exceeded medical expectations. Of the other twenty-five then remaining in the group, only one outlived the initial prognosis by a similar margin.(97)

Siegel cites the techniques of "individual and group therapy, biofeedback, and training in meditation and visualization," but he also notes that these methods are most effective when, coupled with the experience of the disease itself, they result in profound transformation in the afflicted individual's character.

For me, the diagnosis of cancer was a terrifying experience -- and mine was one of the more readily "curable" varieties. Moreover, the primary weapons modern medicine uses to fight cancer, surgery, radiation and chemotherapy (or as some have put it, "slash, burn, and poison") often cause more discomfort than the actual disease itself. It is, therefore, understandable, why a protracted battle with cancer can in itself bring about depression, the very mental condition that tends to bring on cancer or make it worse. Recognizing this, Cousins decided to look for ways to combat the depression, with the aim of improving the physical condition as a result. He organized and led a group of cancer patients called the "Society of Challengers," who met weekly for a six-week period. During that time they received "education information about their cancer and about nutrition" and were "taught various relaxation techniques as well as positive coping strategies and problem-solving techniques."(98) As one might expect from Cousins, the therapy also included healthy doses of humor.(99) There was, of course, a control group that received nothing but standard medical therapy.

To measure the potential effectiveness of his techniques, Cousins used two standard psychological tests to measure levels of depression: the Profile of Mood States (POMS) and the psychosocial adjustment to illness (PAIS) test. Standard medical tests (LEU 7 and LEU II) were used to measure the immune system. When comparing the scores of both kinds of tests, in both the Challengers and control groups, Cousins found that not only did the Challengers group fare better than the control, but also that the measures of mental well-being correlated positively with the levels of immune system activity.

After six weeks, Cousins found that the experimental group showed a significant decrease in depression (as measured by the POMS), while the control group showed only a slight decline. The trend continued. After six months, the decline in depression accelerated for the Challengers group and actually increased for the control. Moreover, a dramatic difference in PAIS scores between the two groups had appeared, with the control group showing a slight decrease in distress and the experimental group showing a more marked decrease. Says Cousins:

The reeducation of the patients, apparently, was having its effects. The growth in confidence; the increasing knowledge by patients about the nature of their own resources; the enhancement of life-style; the decline in feelings of helplessness -- all these were reflected in the POMS and PAIS measurements of the research group.

Most exciting of all, however, was that the decline in depression was accompanied by an increase in certain immune cells, or activating forces, within the immune system. The conclusion was inescapable: If you can reduce the depression that almost invariably affects cancer patients, you can increase the body's own capacity for combating malignancies. This becomes especially important in view of the fact that chemotherapy, which is often used in the treatment of cancer, can have deleterious effects on the immune system.

The data on which his conclusions are based appear on the next page:

How Depression and Quality of Life Affect the Immune System

PROFILE OF MOOD STATES (POMS)
Mean Change Scores

SIX MONTHS
TENSION-ANXIETY POST-TREATMENT POST-TREATMENT

Control 0.15 0.04

P<.012* P<.007*

Experimental -4.06 -4.34

DEPRESSION-DEJECTION

Control -0.58 0.04

P<.049* P<.003*

Experimental -3.89 -4.71

PSYCHOSOCIAL ADJUSTMENT TO ILLNESS (PAIS)
Mean Change Scores

PSYCHOLOGICAL DISTRESS

Control (PAIS test not -1.46
administered P<.043*
Experimental at this point) - 5.77

TOTAL PAIS
Control -1.35

P<.007*

Experimental -6.91

QUALITY OF LIFE
Mean Change Scores

Control -1.65 -0.23

P<.024* P<.035*

Experimental 7.60 8.34

IMMUNE CELLS (in the NK cell family)
Mean Change Scores

LEU 7
Control -0.85 0.04

P<.032* P<.044*

Experimental 1.06 2.09

LEU II
Control 0.50 0.12

P<.740 P<.014*

Experimental 0.80 2.89

*P is the level of statistical significance between the experimental and control groups. P<0.05 is considered to be statistically significant. All statistically significant figures have been asterisked.(100)

The results of Cousins's own study would seem to indicate that the psychotherapeutic techniques used produced statistically significant differences in both the patients' emotional sense of well-being and their immune system responses.

Cousins cites another study, conducted by Dr. Herbert Benson of the Harvard Medical School, whose work was also previously cited by Dossey, in which "relaxation response" training had a positive effect on cancer patients. Benson found that patients undergoing meditation, relaxation, and guided imagery therapy

reported significant improvements in quality of life, including increased vigor and fighting spirit, along with a decrease in hopelessness, tension, depression, anxiety, and somatization. Dr. Benson also found relaxation response training effective in moderating the adverse physical effects of chemotherapy.

Preliminary results have shown that the gains made as a result of participation in the relaxation response group endure over time and that patients with more advanced cancer who rated highly on "fighting spirit" survived significantly longer.

Cousins's concludes that intelligence and free will can both combat existing diseases and help prevent future ones.(101)

Other studies support his view. Two of the early pioneers among mainstream physicians in applying mental healing techniques with cancer patients were physician O. Carl Simonton and psychologist Stephanie Matthews (Simonton's wife at the time). Siegel describes their initial studies on the effectiveness of imaging techniques on "terminal" cancer patients as follows:

Of their first 159 patients, none of whom was expected to live more than a year, 19 percent had gotten rid of their cancer completely, and the disease was regressing in another 22 percent. Those who eventually did succumb had, on the average, doubled their predicted survival time.(102)

Dossey makes a similar point in citing two other studies, including the Achterberg and Lawlis studies cited earlier.

[T]here is ample solid scientific evidence that directed, highly specific imagery can bring about changes in the body. For instance, Dr. Howard Hall of Pennsylvania State University has shown that subjects, using hypnosis, can generate a more active immune response when they imagine their white blood cells as "strong and powerful sharks." Working with 126 cancer patients, psychophysiologist Jeanne Achterberg and psychologist G. Frank Lawlis demonstrated that the patients' clinical response -- future tumor growth or remission -- was directly related to the specificity, vividness, strength, and clarity of their mental imagery. The work of Achterberg and Lawlis, pioneers in the clinical use of imagery, thus offers another side to the debate over whether directed or nondirected imagery and prayer strategies work best.(103)

Hypnosis too has been beneficial in treating cancer patients, especially in the area of relieving pain. Murphy cites two studies:

In a series of articles published during the 1950s, physician Byron Butler reported the successful reduction of pain in cancer patients and gave a history of cancer treatment by hypnosis going back to 1980. More recently, V. W. Cangello gave posthypnotic suggestions for pain reduction to 73 cancer patients and found that 30 of them reported excellent to good results. His deeply hypnotizable patients generally experienced more relief than the others, though about half of his less susceptible subjects were also helped. The results of these studies, wrote Ernest and Josephine Hilgard, "show a relationship between hypnotic responsiveness and success in pain reduction. The figure that commonly emerges -- about 50 percent of the cases showing substantial improvement -- is close to that reported by other clinicians.(104)

Though Murphy cites no similar studies with respect to hypnosis curing cancer, Siegel makes a qualified argument that cancer can be cured by mental activities. Apparently the tabloid The Midnight Globe ran a headline quoting him as saying the mind can cure cancer. Siegel describes his reaction as follows:

I thought it [the headline] was simplistic and misleading. The more I worked with patients, however, the more I came to see that the statement was correct. Now I consider those omnipresent supermarket newspapers to be important medical journals. (I say this tongue mostly in cheek.) The mind can cure cancer, but that doesn't mean it's easy.(105)

Later, he describes some of the hurdles involved:

I have collected 57 extremely well documented so-called cancer miracles. A cancer miracle is when a person didn't die when they absolutely, positively were supposed to. At a certain particular moment in time they decided that the anger and the depression were probably not the best way to go, since they had such a little bit of time left, and so they went from that to being loving, caring, no longer angry, no longer depressed, and able to talk to the people they loved. These 57 people had the same pattern. They gave up, totally, their anger, and they gave up, totally, their depression, by specifically a decision to do so. And at that point the tumors started to shrink.(106)

The "cancer miracles" mentioned by Siegel here are called "spontaneous regression of cancer" or SRC in medical jargon. SRC does occur, but according to Dossey it is "uncommon, to say the least." Opinions as to how rare vary, but he cites one study in which the researchers simply concluded that when it did occur, it was a fluke:

Researchers T. C. Everson and W. H. Cole collected 176 case reports from various countries around the world on spontaneous regression of cancer (SRC), and concluded that SRC occurs in one out of 100,000 cases of cancer. Other authorities believe the incidence may be higher, perhaps one in 80,000 cases.

These researchers concluded that, since almost any treatment seemed to work occasionally but not consistently, all these measures were equally worthless and that SRC is purely a random event entirely beyond the control of an individual patient. According to this point of view, the disappearance of St. Peregrine's cancer had nothing to do with prayer; it would have happened anyway for reasons that are essentially obscure and unpredictable. The saint was simply one of the lucky ones. And in any case, these events are too rare to hold out as hope to people suffering from cancer, especially since they cannot control them.(107)

Dossey, however, does not concur with this conclusion. Citing five carefully controlled case studies conducted in 1975 by physician Yujiro Ikemi at Kyushu University's medical school in Fukuoka, Japan, Dossey maintains that that attitudes such as "prayerfulness" can make a significant difference:

Ikemi and his co-workers did not "skim off the top," picking only cases that conformed to their expectations and preconceived ideas. The reports are scientifically precise and include biopsy confirmation of all the cancers in question. On balance these remarkable cases seem to contradict the idea that SRC is accidental, random, and beyond the effects of a patient's thoughts, attitudes, and feelings. They strongly suggest that there is a profound effect of prayerfulness and an indwelling spiritual sense on the cancer process.(108)

Dossey believes, evidently, that "spontaneous" regression of cancer, although rare and apparently random, may be less "spontaneous" than it might seem. However, he is somewhat more cautious than Siegel in his position on whether we can call prayer an outright "cure" for cancer. Citing a study by Michael Lerner, special consultant to the U. S. Office of Technology Assessment, in preparing a report on unconventional cancer treatments, Dossey expresses the following reservation:

So far no one has been able to demonstrate that cancer or any other disease will predictably disappear by using prayer, meditation, or any psychological or spiritual method whatever. Lerner has concluded that although there is plenty of anecdotal evidence that many such therapies improve the quality of life, he has not found any cure for cancer among the many unconventional methods he examined, and little scientific evidence that such methods extend life beyond what could be achieved with conventional treatments.(109)

The exact extent to which prayer or mental therapy can work with cancer is not yet known. Cousins unexpectedly found himself under attack by people in the news media, when physician Barrie Cassileth published a paper, "Psychosocial Correlates of Survival in Advanced Malignant Disease," in the New England Journal of Medicine, in June 1985.(110) In spite of the controversy in the news media that ensued, Cassileth had no intention of discrediting Cousins's work. Her intent was to prevent people from misinterpreting it to mean that anybody could simply laugh their cancer away. Cousins's and Cassileth's subsequent discussion of the matter resulted in the following joint statement:

Some of the reports and comments incorrectly interpreted the [Cassileth] study's results to mean that positive attitudes have no value in a strategy for effective treatment of illness.

Cassileth's study, however, was not concerned with disease in general but with advanced cancer in particular. Cassileth wrote: "Our study of patients with advanced, high-risk malignant diseases suggests that the inherent biology of the disease alone determines the prognosis, overriding the potentially mitigating influence of psychosocial factors."

This means that in advanced cancer, biology overwhelms psychology. It does not mean that emotions and health are unrelated. It does not mean that emotions and attitudes play no role in the treatment or well-being of ill people.

The reciprocal mind/body relationship is complex. We must be aware equally of both the potential power and the limitations of attitudes in their effects on health and disease.(111)

This statement probably best sums up the clinical aspects of applying mental therapy to the disease called cancer.

V. Acquired Immune Deficiency Syndrome (AIDS)

Due the highly charged political and social controversy surrounding AIDS, no discussion of healing in the 1990s is complete without some investigation into it. Siegel gives the following account of an individual who experienced a "spontaneous" regression of the disease, which is generally regarded as always fatal:

Hope instilled that kind of courage in William Calderon, who achieved the first documented recovery from Acquired Immune Deficiency Syndrome (AIDS). Calderon was diagnosed in December 1982. His doctors told him he would probably be dead in six months. Understandably, he became depressed and hopeless. Almost immediately Kaposi's sarcoma, the type of cancer that most often accompanies AIDS, appeared and began spreading rapidly on all areas of his skin and throughout his gastrointestinal tract. Soon Judith Skutch, co-founder with astronaut Edgar Mitchell of the Institute of Noetic Sciences and now President of the Foundation for Inner Peace, arrived at Calderon's hair-styling salon for her regular appointment. Noticing by his eyes that he had been weeping, she got him to tell her the reason. Her next words turned out to be the key to saving his life. She said, "William, you don't have to die. You can get well."

Skutch described the Simontons' work with cancer patients. With unwavering love and support from her and from his lover, Calderon came to believe in his own survival. By continuing at the job he loved, he refused to give in to the disease. Instead he began meditating and using mental imagery to combat it. He worked to restore strained relationships with his family and achieved peace of mind by forgiving people he felt had hurt him. He loved his body with exercise, good nutrition, and vitamin supplements. And from that point on his immune system showed increased response and his tumors began to shrink. Two years after the diagnosis, Calderon showed no signs of AIDS.(112)

While this is only a single instance, it is, to use William James's terminology, the one white crow that refutes the proposition that all crows are black. Moreover, practitioners of Religious Science, some of whom I knew personally when I was active in the church in the 1980s, reported witnessing similar accounts. However, the medical doctors involved in the cases dismissed them all, saying simply that the original HIV positive test results for these patients must have been false. That conclusion, however, is debatable. We simply do not know enough about AIDS to know that it is always fatal.

VI. Summary and Conclusion

The evidence for psychosomatic healing is not merely anecdotal. Reputable researchers have systematically investigated psychosomatic disease and healing using controlled statistical studies. The fact that a significant psychosomatic element was found in the genesis and treatment of both heart disease and cancer, the leading causes of death by disease in contemporary America, underscores the importance of these findings.

Notes on Chapter 6

³⁸ Dossey, Meaning and Medicine, 167. Return to text

³⁹ R. Nachman of Breslov, Likutey Moharan II, 24, in Avraham Greenbaum, The Wings of the Sun: Traditional Jewish Healing in Theory and Practice (Jerusalem, Israel and Monsey, N.Y.: Breslov Research Institute, 1995), 5. Return to text

⁴⁰ Siegel, 76. Return to text

⁴¹ Cousins, Head First, 76-7. Return to text

⁴² Dossey, Meaning and Medicine, 84. Return to text

⁴³ Dossey, Meaning and Medicine, 94. Return to text

⁴⁴ Dossey, Meaning and Medicine, 70. Return to text

⁴⁵ Dossey, Meaning and Medicine, 94. Return to text

⁴⁶ Cousins, Head First, 200. Return to text

⁴⁷ Cousins, Head First, 234-5. Return to text

⁴⁸ Siegel, 153-4. Return to text

⁴⁹ Dossey, Healing Words, 106. Return to text

⁵⁰ Dossey, Healing Words, 105-6. Return to text

⁵¹ Siegel, Love, Medicine and Miracles, 150-1. Return to text

⁵² Siegel, 150-1. Return to text

⁵³ Cousins, The Healing Heart, 52-4. Return to text

⁵⁴ Moyers, 191, quoted from Candace Pert. Return to text

⁵⁵ Dossey, Meaning and Medicine, 63-4. Return to text

⁵⁶ Dossey, Meaning and Medicine, 14. Return to text

⁵⁷ Moyers, 206, quoted from Margaret Kemeny. Return to text

⁵⁸ Dossey, Meaning and Medicine, 65-6. Return to text

⁵⁹ Dossey, Meaning and Medicine, 67. Return to text

⁶⁰ Dossey, Meaning and Medicine, 63. Return to text

⁶¹ Siegel, 183. Return to text

⁶² Siegel, 74. Return to text

⁶³ Dossey, Meaning and Medicine, 168. Return to text

⁶⁴ Dossey, Meaning and Medicine, 168-9. Return to text

⁶⁵ Dossey, Meaning and Medicine, 167-9. Return to text

⁶⁶ Dossey, Healing Words, 109. Return to text

⁶⁷ Dossey, Meaning and Medicine, 72. Return to text

⁶⁸ Dossey, Meaning and Medicine, 72. Return to text

⁶⁹ Dossey, Meaning and Medicine, 70-1. Return to text

⁷⁰ Dossey, Meaning and Medicine, 220-1. Return to text

⁷¹ Siegel, 68. Return to text

⁷² It also suggests that studies testing various substances for carcinogenic effects, specifically those that involve the injection, ingestion, or other form of exposure to massive quantities of the substance, might not be reliable with respect to more moderate amounts. Moderate exposure may well not adversely affect the immune system, while exposure to the massive quantities used in the tests does. Claims concerning the carcinogenic effect of "second hand smoke" have come under attack for precisely this reason. Return to text

⁷³ Siegel, 75. Return to text

⁷⁴ Siegel, 72-3. Return to text

⁷⁵ Siegel, 72. Return to text

⁷⁶ Cousins, Head First, 291. Return to text

⁷⁷ Dossey, Meaning and Medicine, 131-2. Return to text

⁷⁸ Siegel, 116-7.79. Return to text

⁷⁹ Cousins, Head First, 291. Return to text

⁸⁰ Siegel, 167. Return to text

⁸¹ Siegel, 94-5. Return to text

⁸² Cousins, Head First, 264-5. Return to text

⁸³ Dossey, Meaning and Medicine, 93. Return to text

⁸⁴ Siegel, 74-5. Return to text

⁸⁵ Cousins, Head First, 85-7. Return to text

⁸⁶ Siegel, 152. Return to text

⁸⁷ Cousins, Head First, 216. Return to text

⁸⁸ Siegel, 80. Return to text

⁸⁹ Siegel, 80. Return to text

⁹⁰ Moyers, 332. Return to text

⁹¹ Dossey, Meaning and Medicine, 221-4. Return to text

⁹² Siegel, 25. Return to text

⁹³ Siegel, 104-5. Return to text

⁹⁴ Cousins, Head First, 217. Return to text

⁹⁵ Cousins, Head First, 216. The spelling of the researcher's last name is different here (Temoshok) from that in Moyers (Temoshek) cited earlier. I am not sure which spelling is correct, but the two citations appear to refer to the same work. Return to text

⁹⁶ Dossey, Meaning and Medicine, 30. Return to text

⁹⁷ Siegel, 184-6. Return to text

⁹⁸ Cousins, Head First, 254. Return to text

⁹⁹ Cousins, Head First, 258. Return to text

¹⁰⁰ Cousins, Head First, 259-261. Return to text

¹⁰¹ Cousins, Head First, 235-6. Return to text

¹⁰² Siegel, 18. Return to text

¹⁰³ Dossey, Healing Words, 105. Return to text

¹⁰⁴ Murphy, 325. Return to text

¹⁰⁵ Siegel, 98-9. Return to text

¹⁰⁶ Siegel, 202 Return to text

¹⁰⁷ Dossey, Healing Words, 29. Return to text

¹⁰⁸ Dossey, Healing Words, 30. Return to text

¹⁰⁹ Dossey, Healing Words, 35. Return to text

¹¹⁰ Cousins, Head First, 210 - 213. Return to text

¹¹¹ Cousins, Head First, 213 - 215. Return to text

¹¹² Siegel, 39-40. Return to text