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Part III
Philosophical Arguments
Chapter 8
Conclusions from the
Evidence
Although the evidence can tell us is that thinking significantly affects health, it cannot tell us how to interpret it philosophically. Accordingly, in drawing conclusions from the evidence, we must take leave of the empirical method and turn to philosophical argument. There are three major questions on the subject of what to do with the evidence. Because all of them are philosophical in nature, I have included them in Part III of this essay. One of them is whether the evidence is worth examining at all. If mental healing is, as materialist skeptics claim, a mere misinterpretation of the evidence, then the evidence is simply irrelevant. A second question is whether mental healing practices -- such as imagery, hypnosis, meditation, prayer, placebos, positive thinking, and good doctor-patient relationships -- do in fact work and have a proper place in scientifically-based health care. This is a critical issue for both health care providers and philosophers, in that good theories should also work in practice. Third, there is the question of what is really happening, when and if psychosomatic healing occurs. Is the healing "mental" in the Cartesian sense, i.e., a cause-effect relationship of a mental substance acting on a physical one? Or, is it merely a physical causal relationship between the central nervous system and the immune and other systems, in which case a mental substance, in the Cartesian, sense plays no effective role at all? Is it something else?
In this chapter, I make two arguments. First, I argue that the evidence definitely is worth examining, and that the major arguments against doing so are unsound. Second, I argue that the evidence does suggest that mental healing techniques have a place in scientifically based health care. The remaining philosophical issues are addressed in Chapters 9 - 11.
I. Merits of Examining the Evidence
Many reputable philosophers and health care practitioners dismiss the evidence of mental healing without review. The difficulty of persuading skeptics to examine the data has been one of the major obstacles to developing psychosomatic medicine. Therefore, it is necessary to show that the evidence itself merits examination before drawing conclusions from it.
The general argument against examining the evidence is that mental healing is "unscientific," that, although it may be an appropriate topic for supermarket tabloids, it is not one for reputable medical and scientific journals. The ultimate irony of this position is that the refusal to review the evidence is neither a skeptical nor a scientific position. A skeptic is one who suspends judgment. Refusing to examine the evidence, based on a priori opinions of its irrelevance, is certainly not that. Moreover, the act of refusing to look at the evidence is in itself an abdication of the scientific method. The predicament is similar to that of William James in defending the value of psychical research nearly a century ago. However, we do have one tactical advantage unavailable to James. He could not effectively argue that people were dying for lack of interest in psychical research. With respect to psychosomatic healing, one could argue that they are.
The claim that psychosomatic healing is "unscientific" seems to come from a combination of three sources:
I will examine these three objections in order.
Emotionally-based Prejudice and Unclear or Hasty Thinking
Historically, emotional prejudice has significantly obstructed the development of scientific medicine. For example, when Jenner first introduced the idea of smallpox vaccination in the eighteenth century, many objected to it because the idea of scratching someone with puss from a sick animal was simply repugnant. With respect to mental healing, the prejudice is a general aversion to anything that even sounds religious or spiritual. This kind of objection is more an emotional reaction than anything else.
Prejudice is not the only source of poorly formulated objections to examining the data. Mental healing is much easier to deny than to understand, especially if one's worldview demands an explanation formulated in purely physical terms. Not everybody has the time, acumen, or inclination to grasp the philosophical and scientific issues involved with mental healing, some of which have baffled the keenest of contemporary professional scientists and philosophers. It would be unrealistic to expect health care professionals to become first-rate philosophers and continue to perform operations and take office visits -- to say nothing of keeping abreast with the technological advancements in their own field. Instead, they derive their definition of "scientific" from what they believe to be a consensus of their peers and mentors.
In responding to these less-than-well-formulated objections, one must first understand the constraints upon those who make them. Professional philosophers and reputable theologians could not escape criticism by their colleagues, were they to make such objections. They are more likely to come from people in health care and its associated sciences, where there is no time to engage in lengthy philosophical debates. Because the objections themselves were formulated in haste, we can assume that our replies would be read just as hastily. Hence, we must be brief. Secondly, it would be helpful if the replies had emotional, as well as rational, appeal.
I would answer the objections of this kind with the following argument. We all agree that those who need health care should get it, provided that it is affordable and deliverable. What has brought Christian Scientists under fire is their refusal to accept or permit the delivery of medical care, even when it appears warranted, on account of their metaphysical beliefs. It is not their religiosity or even their philosophical idealism that is most objectionable, but their willingness to let people suffer and die when effective remedies are available. Because justice delayed is justice denied, health care should likewise not be delayed. To obstruct, delay, or misdirect the development of any treatment that shows promise is, in effect, to withhold it. If psychosomatic therapy has any real potential, then that potential merits exploration and development as quickly as possible. Moreover, its development should not be left to the quacks and charlatans. It needs the discipline and integrity of the scientific method. Therefore, to reject, on a priori grounds, all evidence suggesting that psychosomatic therapy might work, results in withholding treatment from those who need it. Yet, Christian Scientists are condemned for the same offense.
A Narrow View of What Properly Constitutes Science
Although mental healing definitely pertains to health, it is not normally part of a medical doctor's formal training. A doctor is far more likely to hear about it, especially in its psychokinetic form, in church than in medical school. Many of them see mental healing as a purely religious or psychological issue, as opposed to a medical or scientific one.
While I believe that this is an error, it is an understandable one. In his introduction to the anthology Quantum Questions, Ken Wilber explains why this sort of misclassification might happen. Wilber argues that modern "science" actually has two dimensions: the scientific method and the traditional scientific domain. The scientific method includes practices such as experimentation, observation, and verification. The scientific domain has traditionally been limited to the principles of mathematics and what we can observe via the five senses, with or without the aid of instruments.(170) The domain and method have been linked for so long that their conjunction has become confused with their identity. Mental healing is viewed as unscientific because mentality itself can neither be observed by the senses nor measured mathematically, even with the aid of the most sophisticated instruments. People therefore misclassify it as outside the domain of science.(171)
This problem surfaces in medicine in several ways. Doctors frequently distinguish the "science" from the "art" of medicine. The former is scientific knowledge and technical expertise. The latter, often called "bedside manner," is the ability to relate to patients in healing ways. When my pathologist father spoke of this distinction, he almost always regarded the "art" as less important. Never one to mince words, he made it very clear that the patient is much better off with an abrasive, insensitive, but technically competent physician, than with an "idiot with a nice bedside manner." When I asked him why a doctor could not have both the art and the science, he replied, "Ideally, they should, but such doctors are rare." However, this is exactly the kind of doctor that Siegel, Dossey, and Cousins would like to see come out of medical school. They believe what has traditionally been called the "art" of medicine should be included in the "science."
Siegel gives us more insight, in speculating why the medical journals tend to ignore studies on self-induced cures of cancer:
One problem with cancer statistics is that most self-induced cures don't get into the medical literature. A survey of the reports on colorectal cancer found only seven such cases described between 1900 and 1966, although there have certainly been many more than that. A person who gets well when he isn't supposed to doesn't go back to his doctor. If he does, many doctors automatically assume his case was an error in diagnosis. In addition, most physicians consider such cases too "mystical" to submit to a journal, or think they don't apply to the rest of their patients, the "hopeless" ones.(172)
A leading immunologist once told me over lunch that he deliberately omitted any discussion of psychoneuroimmunology from his immunology textbook. When I asked him why, he replied that it is not something medical doctors can use. Although we know that the nervous, endocrine, and immune systems all interact, the physiological processes are too complex and elusive to treat with either internal medicine or surgery, which are, after all, what medical schools must teach. Psychologists, ministers, priests, rabbis and other mental and spiritual counselors may be able to use psychoneuroimmunology, but it has little to do with practicing medicine. Hence, the domain of medicine, according to this immunologist, is the biochemistry of the body. Thinking habits and belief systems, which lie outside that domain, belong to psychologists and the clergy. This immunologist, evidently, did not see the "art" of medicine as having any legitimate place in an immunology text at all.
It is this narrow view of medicine as drugs and surgery that Cousins, Dossey, and Siegel are protesting. Cousins suggests that doctors originally become intimidated by, or prejudiced against, the so-called "soft" sciences while in medical school, and this fear persists into their professional life. Based on his own experience as a medical school professor, he gives the following explanation of why medical doctors would be reluctant to expand their domain:
Some of the students... seemed dubious about the role of psychological factors in causing disease or in contributing to a strategy of treatment.... They lived in a new world of technology designed to provide exact answers. The technology spewed out neat little numbers that all fitted together. The study of anatomy or physiology or biochemistry provided precise descriptions. Everything had a name and everything was in place.
References to the need for a patient-physician partnership, or to the communication skills of the doctor, or to medical ethics, or to the philosophy of medicine or even to the history of medicine, were regarded by some of the students as "soft," and therefore not really primary in medical education. By contrast, subjects such as physics, biochemistry, pharmacology, anatomy, etc., won the favored adjective "hard."
The reasons were not obscure. "Soft" subjects lacked precise answers. The grade-conscious student, therefore, could never be sure that the answers on examination papers would correspond to the professor's judgment. With the "hard" subjects, however, the correct number or fact was certain to lead to a predictable grade. The students therefore tended to steer away from the "soft" and gravitate to the "hard."(173)
Medical school survivors are understandably reluctant to expand the scope of their practice into areas in which they feel uncertain and incompetent. Few people, least of all those whose incompetence and uncertainty can lead to loss of life, embrace this kind of experience enthusiastically. I remember when my father took up the science of gemology as a hobby. One of the things he loved most about it was that there were always precise and definitive answers. Anatomy, he said, was his favorite subject in medical school, largely for the same reason. Pathology offers no such precision. Although he learned to tolerate the ambiguities and uncertainties of his professional life, he admitted that he would have preferred that they not be there -- especially when making the life-or-death decisions that were a routine part of his practice.
Other factors have also engendered opposition to psychosomatic medicine. For example, cynics say that the problem is that there is no money in it, i.e., the medical and pharmaceutical establishments oppose psychosomatic medicine precisely because it is inexpensive and would reduce their incomes and profits. I am not so naive as to believe that the health care industry is somehow exempt from the crass, sociopathic thinking that occurs in other businesses. Money is central in all business, including health care. However, as the son of two doctors, I do not believe it is the only issue under consideration. The vast majority of the doctors I know, as well as those I know who work in pharmaceutical companies, are deeply interested in their patients' health. Although quality of care is sometimes sacrificed for profit, I think it is unfair to accuse the health care industry of a deliberate, systematic campaign to make people sick in order to create markets for cures. Moreover, both the health insurance and managed care companies, potent economic and political forces within that industry, stand to gain much from inexpensive medicine. As the industry turns more to managed health care, prevention rather than cure will become increasingly profitable for these major players. It will be interesting to see how much the changing economic interests will change the attitude towards psychosomatic medicine. Be that as it may, the cynical, economic explanation by itself seems insufficient. I find Wilber's, Siegel's, and Cousins's explanations more adequate.
Adequate or not as explanations of why medical people have refused to review the evidence, the above explanations do not constitute valid objections against reviewing it. It is the intellectual integrity of the scientific method, not the limited nature of the scientific domain, that has led to the success of modern medicine. This method, which dictates that we experiment and verify before drawing conclusions, preserves intellectual integrity and keeps dogmatic excesses in check. There is no reason to limit intellectual integrity to mathematics and that which can be observed with the senses. The scientific method can be applied beyond its traditional domain. This is not to say that it will be easy. Psychosomatic medicine will have to deal with all the complexities of human thoughts and emotions, as well as the differences between individuals. The investigation is not likely to lead to solutions in the form simple or precise mathematical formulas. Moreover, contemporary philosophy has yet to provide a viable philosophical paradigm for psychosomatic healing. Nevertheless, the investigation may lead to the discovery (or, should I say rediscovery?) of some general maxims that could greatly improve the quality and lower the cost of health care. The first step in applying the scientific method to this new domain would be to review the existing evidence systematically and even critically.
An a Priori Commitment to Ontological Materialism
Materialists claim, as we have shown, that mental causation is impossible as a matter of principle. There can be, accordingly, no bona fide evidence for psychosomatic healing. When cited to prove the existence of mental healing, the supposed evidence is used to misinterpret the observed events.
This argument deserves some attention. Someone could easily conduct a study "proving" the earth was flat by showing that billiard balls do not roll on a level surface without being pushed. However, because the round earth theory has been demonstrated empirically, I would choose to ignore such "evidence" that "proves" the earth is flat. Why would anyone want to examine evidence for a discredited theory?
The theory that the materialist claims to have been scientifically refuted is that of mental causation. Only material forces can move material things. To use Gilbert Ryle's pejorative terminology, they reject the Cartesian dualist idea that a "ghost" can move a "machine." Materialists do not believe in ghosts at all -- not even ones that animate living organisms. Thus, the idea that ghosts can perform major repairs on machines seems especially preposterous.
One basis for this argument is that mental causation is scientifically impossible because it violates the law of conservation of energy, or of matter/energy. Mental causation supposedly violates this law, because it involves the influence of a substance that has no physical energy on physical things.
The argument, however, is fallacious for two reasons. As Griffin says, we do not know for certain that the amount of energy in the universe has remained constant since the big bang. Even if we are reasonably certain that it has, we are not more certain than we are about the reality of consciousness and mental causation.(174) The other reason is that what the materialist claims is violating the law of conservation of energy is not mental causation per se, but dualistic interactionism, i.e., the influence of a purely mental substance on a purely physical one. Something that is both mental and physical can exert physical influence, on account if its physical energy, but according to mental rules.
An example of such an entity is computer software. In one sense, the word processor I am now using is a physical entity. I purchased it as a compact disc, and it now resides in my computer's physical memory. Its ability to control the computer stems from its physical characteristics. However, the way in which it controls the computer, i.e., what it tells the computer to do, originates in the programmer's and the operator's thoughts. It can therefore make the computer, a purely physical entity, behave according to a mind's rules -- all without violating the law of conservation of energy in the least. As the power supply provides sufficient physical energy for the computer to run programs, so does the blood supply provide sufficient energy for the brain to sustain thoughts. The difference between the brain and the computer is that we know how the computer loads and runs programs. We do not know how the brain supports thoughts. Even so, there is no reason to believe that there is any violation of the law of conservation of energy involved, unless we arbitrarily presuppose that thoughts cannot also be physical things or activities. Mental causation may ultimately not involve ghosts moving machines at all. Cartesian dualism, which seems to be the focal point of the materialists' protest, is only one of several known theories of the mind-body relationship. There are others, such as personal idealism and panexperientialism, which have been with us at least since Berkeley and Leibniz.
However, let us suppose that materialism and dualism really are the only viable ontological worldviews. The materialists would still have no grounds for ignoring the evidence for mental healing on the grounds that mental causation itself is impossible. If the impossibility of mental causation is what renders mental healing impossible, then all forms of mental causation -- including that which is ostensibly involved in ordinary things such as waving a hand or speaking -- are impossible as well. At this point, the materialist's position is in danger of degenerating into absurdity, because these acts, being actual, are possible by definition. Of course, materialists usually do not deny that we can wave our hands or talk. What they do instead is either give wholly implausible, reductionist explanations of these activities or simply admit that these activities may be impossible to explain in materialist terms.
To be consistent, they should grant mental healing the same modal status as other forms of apparent mental causation, i.e., call it impossible to explain, not impossible to occur. The mental causation involved when thoughts stimulate the production of natural killer t-cells is probably the same kind of mental causation that occurs when my thoughts cause my fingers to type on this keyboard. In both cases, we have certain thoughts that lead to certain physiological responses. The only differences are in the particular thoughts and responses involved, and the fact that most of us have better conscious control over our voluntary muscles than our production of t-cells. If we could ever learn to control our t-cell production as well as we control our hands, we would have a powerful new cure for cancer, lupus, and a host of other diseases. However, the problem of mental causation is the same for both hand-waving and producing t-cells. (We presume that physiological processes handle the details in both cases.) Were we discussing psychokinetic healing, the mental causation might be different, because it involves action at a distance as well as mental causation. In this essay, however, we are dealing with psychosomatic healing only.
In order to be consistent, however, the materialist should classify psychosomatic healing, along with a host of other human activities, as inexplicable, not impossible. With this reformulation, the materialist position is more consistent internally, in that it treats all forms of mental causation alike. This reformulation, however, removes the basis for continuing to ignore the evidence. The fact that something is inexplicable does not justify ignoring it. On the contrary, the inexplicability of events only emphasizes the need to investigate them further.
Some materialists might object that mental healing does not belong in the same category as intentional bodily motion. The ability of a human being to move about is a matter of common knowledge. There is not nearly as much evidence for psychosomatic healing. This argument, however, is spurious. The amount of evidence for one phenomenon relative to the evidence for another is irrelevant. The fact that there is much more evidence for the existence of planets and stars than there is for black holes does not justify ignoring what evidence there is for black holes. The same holds for psychosomatic healing. One can argue that the evidence for either mental healing or black holes is insufficient to establish its existence, but only after examining the evidence itself first.
In summary, there is no justification for refusing to examine the evidence. In refusing to look at it, it is the self-styled scientific skeptics who are being unscientific. In obstructing the development of what could become a powerful set of therapies, the skeptics are committing the same offense for which we reproach Christian Scientists, i.e., denying treatment for those who need and could otherwise receive it. Furthermore, to insist that the scientific method be limited to its traditional domain is to be obstructionist. Science advances by moving to new domains. Finally, even the committed materialists, who embrace an ideology in which it is difficult if not impossible to explain mental causation, should still be willing to examine the data. Mental healing may not involve the kind of dualistic interaction they deem impossible. Moreover, even under the materialist paradigm, psychosomatic healing is not that much harder to explain than other, much more common manifestations of mental causation. It would therefore be more appropriate to classify mental healing as inexplicable, as opposed to impossible, and investigate it like any other mysterious phenomenon.
II. The Place of Psychosomatic Therapies in Scientifically Based Health Care
The evidence surveyed shows that psychosomatic therapies can and do work. Placebos, hypnosis, and imagery practice all have statistically significant, positive effects on health. Conversely, discouraging and depressive thoughts have been shown to make us sick. Heart disease and cancer, arguably the two most serious diseases in America today, can both be attributed at least in part to mental causes. Job dissatisfaction can lead to heart disease; the inability to express one's self emotionally can lead to cancer; and, stress, grief, depression, and loneliness can all lead to either, as well as to poor health in general. Furthermore, other studies have shown that the dire circumstances in themselves do not make us sick. The determining factor is our interpretation of these events. Anger, grief, loneliness, and sadness are natural human emotions, but they differ from despair and depression, in that the latter usually entail a belief that nothing can be done about the adverse conditions, at least for the foreseeable future. The cognitive factor is critical.
The evidence also suggests a tremendous, untapped potential for mental treatment of physical ailments. The works of spiritual adepts and holy people of many religions -- as well as the mentally ill -- have all shown the extraordinary extent to which thinking can affect physiology. Also, biofeedback studies have shown that we can systematically train the mind to control physiological processes previously believed to be automatic. However, biofeedback has also shown that much of the thinking that affects the body is subconscious. By making us aware of subconscious processes, biofeedback enables us to bring them under conscious control. A major element of psychosomatic therapy is helping patients become aware of subconscious thoughts and beliefs.
In summary, the evidence does suggest that thoughts can significantly affect health, either adversely or beneficially, although we may not yet fully understand how. It also indicates that psychosomatic therapy shows considerable promise. Mental therapies can often alleviate, and sometimes cure, illnesses for which there is no known conventional medical treatment. The potential health benefits of preventative mental therapies may be greater still. The arguments by Cousins, Dossey, Siegel and others, that our health care system should pay more attention to the mental element in both diseases and cures, are sound. In an era in which high-tech medicine is becoming increasingly unaffordable for more and more people, the neglect of this simple and usually inexpensive form of therapy is especially tragic.
III. The Evidence and the Philosophical Issues
Although the evidence is quite conclusive with respect to the potential for psychosomatic healing in health care, its philosophical implications are not so conclusive. Although the evidence tells us that psychosomatic healing occurs, it does not tell us how. Psychoneuroimmunology is beginning to tell us how the brain affects the immune system, but it does not tell us how the mind affects the brain. Prima facie, it would seem that the evidence favors some worldviews over others. Materialism, which denies mental causation altogether, is the ontology that is least compatible with the evidence. Explaining phenomena such as the placebo effect, feats performed under hypnosis, and the live burial of the Yogi Haridas is extremely difficult in materialist terms. However, the evidence itself does not prove conclusively that these phenomena cannot be attributed to the brain, because it does not address the mind-brain relationship. Dualism is somewhat more compatible, but not much. Mental healing involves mental causation, a form of mind-body interaction, and mind-body interaction is what dualism finds hardest to explain. Mental healing would seem to be more compatible with idealism and panexperientialism, but most contemporary philosophers assume that these ontologies have already been discredited.
The relationship between mind and matter is ultimately not an empirical question. Had it been one, some clever scientist would probably have devised a study, or series of studies, that would have solved the riddle. The issue is almost purely philosophical. Accordingly, the philosophical issues, if they are to be resolved at all, must be addressed by philosophical argument. In Chapter 9, I review the current debate on the mind-body problem of modern philosophy and attempt to explain how it has come to what seems to be an intractable stalemate. Once the nature of the stalemate is properly understood, we can begin to explore some of the alternatives to dualism and materialism, alternatives that might explain psychosomatic healing.
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Notes on Chapter 8
170 Ken Wilber, Quantum Questions: Mystical Writings of the World's Greatest Physicists, Ken Wilber, ed. (Boulder, Colo.: Shambhala Publications, 1969), 12-14. Return to text
171 The misclassification error here may be one made more by materialist philosophers than doctors or scientists. My physicist friend Anthony Smart accused me of maligning scientists in suggesting that they would make such an error. He contended that, among scientists, or at least among physicists, science is the scientific method -- and no more. Professor Fred Sontag of Pomona College, during my oral defense of this dissertation, echoed this sentiment in saying that most of the scientists he knew -- and most doctors, for that matter -- were quite open to the notion of psychosomatic healing. Return to text
172 Siegel, 21. Return to text
173 Cousins, Head First, 26-7. Return to text
174 Griffin, Unsnarling the World-Knot, 51. Return to text