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Review: Cure, by Jo Marchant

700x373Cure: A Journey into the Science of Mind Over Body, is an excellent new book by science journalist Jo Marchant, which explores the healing (and harming) power of the mind and emotions over the body. It succintly brings together a lot of recent evidence in areas sometimes dismissed as ‘pseudoscience’, such as the placebo response and hypnotherapy, to argue for their medical efficacy and the need for a medical model which better incoporates the mind.

Marchant argues: ‘Conventional science and medicine tend to ignore or downplay the effect of the mind on the body. It’s accepted that negative mental states such as stress or anxiety can damage health long-term…But the idea that the opposite might happen, that our emotional state might be important in warding off disease, or that our minds might have ‘healing powers’, is seen as flaky in the extreme.’  Her book succeeds in its aim of rescuing this area ‘from the clutches of pseudoscience’. 

The book is very much in line with a new research project I’m involved with at the Centre for the History of Emotions, calling Living with Feeling, which also explores the interaction between emotions and health. I’m going to summarise the main points from each chapter of Marchant’s book.

Brain scans from Benedetti’s research

Chapter One looks at the placebo response, in which fake or dummy medicine still has real healing effects on patients. Mainstream science has tended to dismiss the placebo effect as a trick or mental anomaly that mainly works for ‘unintelligent or inadequate patients’, as The Lancet put it in 1954. In fact, the placebo response has been shown by researchers such as Fabrizio Benedetti to have powerful physiological effects. For example, Jan Stoessl, a neurologist at the University of British Columbia, found that dopamine levels tripled when patients with Parkinson’s were given placebo pills. Fabrizio Benedetti has used brain scans to identify the effect of placebo – the effect of belief – on motor neuron cells, which fire more slowly in Parkinson’s sufferers following a placebo. The power of belief and suggestion appears to release natural healing chemicals in the brain such as endorphins, which help counteract some illnesses like Parkinson’s and MS, as well as psychiatric illnesses like depression. Indeed, another placebo researcher, Irving Kirsch, has suggested wonderdrugs like Prozac work mainly through the placebo effect – his book The Emperor’s New Drugs explores this. Benedetti has also found that valium ‘has no effect unless patients know they are taking it’, which surprised me.

Chapter Two explores how placebos even work when patients know they are taking a placebo. A 2010 study by Harvard’s Ted Kaptchuk – a leading researcher in this field – gave placebos to patients with Irritable Bowel Syndrome (which affects 10-15% of the population) and told them  ‘that although the capsules contained no active ingredient, they might work through mind-body self-healing processes’. They did significantly better than those who received no treatment. Marchant highlights the market in ‘open-label placebos’ like Placebo World, Universal Placebos and Aplacebo – the latter set up by Simon Bolingbroke, who manages his own pain from Lyme disease using placebos. ‘It sort of started as a joke’, Bolingbroke says. ‘But it’s a joke that’s real.’

Marchant deepens her analysis of the placebo effect in this chapter, exploring the power of ‘feeling cared for’ – patients who receive their drugs when their doctor is present apparently get 50% more pain relief. She suggests that placebos tap into ‘ancient evolved pathways’ in our brain which persuade our brain ‘that we are loved, safe and getting well’. She also begins to explore the connection between placebo, ritual and symbols – bigger placebo do better than smaller ones, two pills work better than one, coloured pills work better than white, blue helps us sleep, red is better at relieving pain, green is better for anxiety. ‘We are symbolic animals’, says Benedetti. We’re also ritualized animals, and the ritual interaction between healer and patient affects the placebo response. ‘Words, gaze, silence, body language, all are important’, says Kaptchuk.

In Chapter Three, Marchant explores another mechanism for the placebo effect – physiological conditioning. She writes about the relatively new field of psychoimmuneology (which includes QMUL’s Fulvio D’Aquisto), which has proved that our autonomic nervous system is connected to our immune system, and that the placebo effect (or beliefs) can impact immune cells through neurotransmitters. She writes about a new medical intervention called Placebo Controlled Drug Reduction, where patients are given a drug in combination with a placebo, and then subsequently the drug is reduced while the placebo remains. The physiological association between the drug’s effects and the placebo’s effects means the placebo keeps working  – a 2010 study by Adrian Sandler found PCDR to be effective in treating children with ADHD.

Chapter Four covers the highly contentious area of fatigue and Chronic Fatigue Syndrome. Marchant explores how fatigue used to be understood as an automatic physiological response, but which some researchers argue is actually more like an emotion. Sports psychologist Tim Noakes of the University of Cape Town has ‘proposed that the feeling of fatigue is imposed centrally, by the brain’. A ‘central governor’ in the brain makes us feel tired before our body gets damaged, as an early-warning system, Noakes argues. However, the central governor can get it wrong, and can be modulated through training, and through belief – Chris Beedie at Aberystwyth University found cyclists given a pill they believed was performance-enhancing could cycle 2-3% faster.

Marchant then highlights the research of QMUL’s Peter White on Chronic Fatigue Syndrome. White’s research argues that CFS can be treated with a combination of Cognitive Behavioural Therapy and Graded Exercise Therapy. A 2011 study found that 22% of patients recovered after a year of CBT and GET, while patients trying ‘adaptive pacing therapy’ (in which you adapt to the new circumstances of having CFS) did no better. CBT and GET appears to be a way to re-train the ‘central governor’ of your brain when it gives you the false information that your body has reached its fatigue limit. The suggestion that CFS involves the mind is, however, hugely unpopular with some sufferers of ME (Myalgic Encephalopathy, patients’ preferred name for the condition) , who have been stigmatized for decades as suffering from ‘yuppie flu’ or ‘Raggedy Ann syndrome’. A Guardian article by Marchant on CFS has already attracted the ire of ME groups. Perhaps it’s the mind / body paradigm that’s at fault – it’s rarely just the mind or just the body, but a complex interaction between the two.

Franz Mesmer

Chapter Five looks at hypnosis, a medical intervention with a chequered history ever since Benjamin Franklin’s 1784 trial of Mesmer’s animal magnetism dismissed it as ‘imagination’. The Lancet was initially a fan of John Elliotson’s early research into animal magnetism in the mid-19th century, but then rapidly and publicly dismissed it as mere ‘suggestion’. But can suggestion still be very healing? Part of the problem is there is still argument over what hypnosis actually is and what it does. On one side are those who argue it induces a hypnotic ‘state’ in the brain – a trance or altered state. On the other side are those who argue it is simply role-play, people going along with suggestions, particularly if given by a high-status figure. It’s probably both. In support of the ‘state’ theory, neuroscientist David Spiegel has found that brain scans of people hypnotized to see black and white as colour show the colour-processing parts of their brain are activated – if this is just ‘make-believe’, then it’s make-believe at a neurological level.

Marchant highlights the research into the healing power of hypnotherapy visualization for sufferers of Irritable Bowel Syndrome, which helps 70-80% of IBS sufferers, according to the research of Peter Whorwell. Visualizing and imagining apparently affects our physiology – a study by Karen Olness found that children who imagined heat going to their hands really did heat up their hands. I find that fascinating, considering the importance of ‘warm healing hands’ in charismatic Christianity and alternative medicine. It also reminds me of how people using Tibetan Tummo meditation manage to heat up their body, and even endure ice baths for long periods, by visualizing a candle burning in their chest.

Chapter Six takes this idea of the healing power of visualization into the realm of virtual reality, by exploring a VR programme called Snow World, which has been found to help burn victims to cope with pain, apparently by distracting them with an interesting immersive world. VR can also be used to manipulate people’s body awareness, mitigating the symptoms of phantom limb syndrome, and even inducing out-of-body experiences. Below is a video on Snow World:

Chaper Seven deepens the analysis into the importance of caring relationships in healing, showing how mothers giving birth who have the same care-giver helping them throughout the birthing process tend to have less complications and easier births – an important finding when one third of women feel traumatized by birth. Marchant also looks at the use of Comfort Talk by medical practitioners. She takes up the importance of caring relationships in Chapter Ten as well, highlighting the Tecumseh research project, which explored the importance of social connections to the immune system.

Chapter Eight looks at how stress is bad for our immune systems and even ages us, and how growing up in poor, rough neighbourhoods affects our bodies. Stress is apparently connected to our imaginations too – we remember past adverse events and expect them in the future, so our bodies are stuck in defense mode. Chapter Nine looks at how we can counteract this with mindfulness, bringing our mind back to the present moment rather than worrying about the past and future. Marchant also discusses the Relaxation Response, first highlighted by Herbert Benson, who looked at how chanting a mantra (or any word, it doesn’t have to be Hindu) helps kick in the parasympathetic nervous system response, enabling our bodies to relax and heal.

In Chapter Eleven, Marchant looks at the role of the vagus nerve as an important transmitter between our mind and body, particularly through Heart-Rate Variability (HRV). Those with higher HRVs are apparently better able to adapt and respond to adverse events. We can modulate the HRV through techniques like meditation, and train our response through biofeedback mechanisms – in one app, for example, as your HRV goes up, you see on an image change and the sun rise over a tree! That kind of live feedback makes training much easier. Marchant also looks at the ground-breaking research of Kevin Tracey into Vagal Nerve Stimulation, using implanted electric nerve stimulators which are controlled via iPad.  It’s been found to be helpful in treating arthitis, MS, depression and other disorders. Is electric healing the future? One more device to charge!

The faithful at Lourdes

Finally, Chapter Twelve brings these various strands together to look at the role of ritual, care, belief and faith in healing at Lourdes. Marchant visits Lourdes and takes part in the healing ceremonies. Despite her atheism and skepticism, she is struck by the physical power of the ritual, and the deep caring connections that visitors feel. ‘Quite unexpectedly, I feel a powerful sense of connectedness, as if I’m at the centre of something much, much bigger’, she writes. Exeter’s Paul Dieppe, another key researcher in this field, has also studied the Lourdes effect – I interview him here.

But do visitors to Lourdes experience  ‘miracles’? Maybe, maybe not, but it certainly unlocks many of the healing responses Marchant’s explored throughout the book. She also highlights the healing power of spiritual beliefs in HIV patients – a 2006 study of HIV patients found 50% throught their religion / spirituality was helping them live longer. Another study found that 45% of HIV patients became more religious after their diagnosis, and those who did ‘lost CD4 cells much more slowly’ over the four years of the study than those who didn’t. Religious belief isn’t always healing – those who believe in an angry or judgemental God are more stressed and heal less well.

Marchant concludes by noting the scientific community’s ‘ingrained resistance’ to much of the research she has explored, how difficult it is for the researchers to get funding, how the NHS website still says ‘there is no strong evidence’ for hypnotherapy’s effectiveness for IBS, when there actually is. She puts this down to the success of the materialist paradigm in giving rise to modern medicine, in which the physical is taken as real and measurable, while the mental / emotional / subjective is seen as slippery, hard to measure, and best ignored. As a result, we put much more faith and funding into surgical or chemical interventions than mental ones, despite the huge cost of drugs which may work mainly through the placebo effect, and despite the sad fact that half a million people die each year in the western world accidentally through psychiatric drugs. We have replaced spiritual healing with chemical healing, even though the latter is still, to some extent, a faith-system.

We need to go beyond the mind / body split and find new terms, like ‘psyche’, or mind-body continuum, or even the dreaded ‘holistic medicine’, particularly in the treatment of chronic conditions like IBS, CFS, MS, and depression. It reminds me of meeting Professor Qasim Aziz, head of QMUL’s gastroenterology unit and an expert on IBS, last month. He told me that, although it is now official NHS policy to combine mental and physical care within hospitals, in reality this isn’t yet the case at all, and many IBS sufferers are passed from department to department without proper treatment, until around 40% contemplate suicide, and some go through with it. I hope this changes, and we can reincoporate the mind into medical care. This excellent book is a hopeful step towards that change, and essential reading for those interested in the medical humanities and the fascinating interplay between belief, meaning, imagination, emotion, ritual, relationships, and our material bodies.

The Big Dream survey

Over 500 people filled in my survey about their dreams. The results suggest people have ‘big dreams’ which they find insightful and adaptive, but such dreams are rare, and usually in times of crisis. Big dreams sometimes involve a visit from a deceased loved one.

et-moon-560Colin Ludlow was a successful TV writer in his 50s, when he went into hospital to have a tumour removed from his bowel. After the operation, he contracted pneumonia and MSRA. He spent the next month in intensive care, close to death. During that time, he had a series of very vivid dreams. He never used to recall his dreams, but he can still remember these dreams today, and felt compelled to write a book about them, Twenty Four Dreams Before Dying.

The 24 dreams were quite cinematic, slightly flowery and romantic (several of the dreams involve medieval knights or World War II heroes), and often centre around a voyage (in one, he rides a tricycle to heaven), a great undertaking, a battle. In the last dreams in the series, the battle is won and he returns home, across the sea, to the land of the living. He’s not sure what to make of the dreams, but feels they helped him to face death, and that he’s less afraid of death, more open to the possibility of an afterlife, as a result. They helped prepare him for the journey, like a pre-flight safety video.

I went to the launch of Colin’s book, and was struck by his story. Personally, I rarely remember my dreams, or find them particularly significant, except for one period of my life, when I was traumatized and my psyche was quite dissociated (ie there were traumatic memories I struggled to integrate). I had a series of dreams in which I was pursued by a terrifying tramp-figure, who was trying to kill me. In the final dream, I was in a lorry with the tramp driving, and we crashed through the side of a barrier on a cliff. I manage to pull the tramp to safety just before the lorry crashes over. I feel those dreams helped me through a crisis, by helping me recognize and accept the dissociated parts of me, which is what I take the tramp to symbolize. I also think the dreams were prophetic – a few months later, I crashed through a barrier on a cliff, while skiing, and had a near-death experience which helped to heal me of PTSD.

At Colin’s book launch, I asked the neuroscientist Chris Frith (a friend of Colin’s) whether neuroscience presently believed there is any meaning to our dreams. He said no. In fact, this is not quite true. While the old, rigid psychoanalytic interpretation of dreams is not widely accepted anymore, there are several ‘dream labs’ in universities, who have arrived at various conclusions as to why we and other animals dream. They’re now considered a form of ‘threat rehearsal‘, and also a way of solving problems and consolidating memories – when I was taking my finals, I dreamt my essay plans were assault courses over which I had to clamber.

Big Dreams

I’m still curious about the phenomenon of ‘big dreams’. Carl Jung came up with the phrase. He wrote: ‘Unlike ordinary dreams, such a dream is highly impressive, numinous, and its imagery frequently makes use of motifs analagous to or even identical with mythology.’ And a big dream may not be just about you, it could be a ‘collective mythological dream’ for your tribe.

The ‘big dream’ fits with what was known in ancient culture as ephiphany dreams, in which a god or dead person visits you and tells you some important information. Epiphany dreams were rare, and the examples passed down to us usually occur to famous leaders, with gods telling them to invade a country or establish a city. But there was a democratic culture of epiohany dreams too – you could spend the night in a dream-cave to get advice from the god Aesculapius. Galen, the great medic, says he became a doctor after Aesculapius appeared to him and also to his father in a dream.

Sebastiano Ricci’s Dream of Aesculapius (1710)

However, the ancients and medieval Christians thought that most dreams were ‘mundane’, ie caused by the body and basically meaningless, and some could come from the ivory gate of false dreams. In any case, they were not considered easy to interpret, so dream interpretation manuals were always popular, like the Atharva Veda, which is full of such pearls of wisdom as ‘If, in a dream a flat-nosed, dark, naked monk urinates, there will be rain.’

Survey results

I thought it would be interesting to ask you about your dreams. I wanted to test the hypothesis (1) that there are ‘big dreams’, ie dreams that seem unusually vivid, significant, and insightful, (2) that such dreams are rare, and (3) that they particularly occur in times of crisis and transition – like Colin in intensive care, or me struggling with PTSD, when the psyche has a lot of work to do to adapt. I would suggest that in times of crisis, particularly confrontation with death, our subconscious ‘wakes up’ and communication with the dream-world becomes more vivid.

I made a SurveyMonkey survey and sent it out via my newsletter, Facebook and Twitter, and to the members of the London Philosophy Club. I received 508 responses – thank you! Obviously there are methodological problems with this survey – the pool of respondents are probably mainly middle-class British and Americans in their 30s-70s. However, the results are still interesting.

Firstly, it’s clear that people do have dreams which they find significant and insightful (79.5% do), and that such dreams are rare – 27.8% have had less than 10 such dreams in their life, 18% said they’d had such dreams more than 10 but less than 100 times, and only 17% say they have such dreams very often.

Chart_Q1_151218(1)

Secondly, as I hoped, such dreams particularly seem to occur at ‘crisis / transition / deep change’:

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And thirdly, 62% of people felt that these ‘big dreams’ had helped them adapt to that crisis:

Chart_Q3_151218What were the contents of these significant ‘big dreams’? Well, some of the replies suggest the sort of collective mythological content which Jung predicted (one lady dreamt she was a male martyr being impaled on a tree while vikings rode round her on bisons, which is…kind of mythological). A few of the ‘big dreams’ were about collective political situations – responding to the Paris attacks, for example. But not many. Most of the ‘big dreams’ people reported were about personal relationships, sometimes indicating subconscious feelings and bringing the insight that the relationship is not a goer:

Once in a relationship I was dissatisfied with, I had a dream it was the wedding day, I was at the end of the aisle with my dad about to walk down it, turned to him and said “I just can’t do it dad” and ran out of the church! Ended relationship soon after!

I would very often dream of my partner who had in the dreams the face of one of my male friends who has a more suited personality for me. It was like I couldn’t even be happy with my boyfriend in my dreams! I knew It had to stop… I broke up and immediately I felt a shift in my life and regained my joy and confidence.

Dreams about stressful work relationships and work crises were also quite common:

I was having issues at work with two people, I dreamt I was locked in a cell and they were throwing poo at me. Summed up the situation and scared me if I’m honest

Rather than the alchemical or mythological symbols Jung predicted, dreams seem to be pragmatic in their symbolism – they’ll use whatever metaphor or symbol seems to fit the situation.

In my dream I was operating on my boyfriend, taking his organs out one by one (like in operation game) and studying them to see what they told me about him. this was painful for him. when I woke up I realised this was what I was doing to him by asking questions I felt I needed the answer to (about previous relationships). I realised this was hurting him & that it wouldn’t tell me anything. this realisation enabled me to let go of this need – and helped save our relationship (for a while).

Dreams also seem to help people become aware of (and potentially change) their relationship to themselves. They will often use the metaphor of exploring a big house:

“I was in my house, and came across a door that led into a part of the house, with more rooms, that I hadn’t known was there. It was when my marriage was breaking down, and I was facing life as a single parent. I had the dream three or four times, and when I woke, it was with a sense of awareness that there were new places in my life to discover and live in, and where I would be safe and at home.”
“At times when I feel insecure, I often dream about my house being broken into. This is a recurring dream. Having done lots of research down the years, I understand that the house is symbolic, in that it represents the ‘mansion of the soul’ and or a play on words as has been my experience, where the question could be – ‘Is your house in order?'”

Another recurring metaphor is water / swimming pools / drowning / facing a storm or tsunami / crossing a river:

I dreamt I was trying to swim across the river Mersey with my friends with all my clothes on, so this made it difficult, my friends were helping he along. It was around the time I was going through an acrimonious divorce. I knew that everything would eventually turn out “all right” as my friends gave me support in my dreams and in real life.

Dreams, death and bereavement

One of the most common types of ‘big dreams’ people remembered involved meeting loved ones who have passed away –  43% of respondents said they’d met a deceased loved one in a dream, of which two thirds think this was their memory, and one third believed this was the actual loved one’s spirit visiting them:

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These spirit visitations helped people adapt to the crisis of bereavement

my father had died and I vividly met him in a dream where I felt that he was acknowledging me as a person and showing his acceptance and deep love for me 🙂

Or to adapt to an upcoming bereavement:

When my toddler nephew was dying, I had a dream of him as an infant, and there was a group of relatives / ancesters standing along a river some on one side and me and others one the other side of this very nerrow river maybe stream. On my side of the river we passed infant Mike down the row of relatives till he came to me I then gave Mikey to an ancester on the other side of this river with the understanding he was “with us now, and we will take care of him.” I woke up and I heard a disembodied voice saying “he is no longer of this earth and will be at peace now.” I knew then he wasn’t going to make it through his cancer treatment and would die. He died one or two days later.

Or sometimes the visit was simply an ancestor spirit offering support in a later crisis:

my late dad giving me a hug & telling me everything would be alright because i’m strong. This was a very bad time as i had just been diagnosed with ms. the dream was very vivid – i could see, hear & sense my dad very clearly & it left me feeling calm & comforted.

The anthropologist Edward Burnett Tylor thought that dreams were the origin of religion and belief in the soul – because it feels like the soul leaves the body (33% of you say you’ve had an out of body experience while dreaming), meets the dead, and receives messages from some other dimension. People are more secular in their interpretation of dreams today, but interestingly, 47% of respondents still believed that some dreams come from God or a higher spirit:

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I also asked people if they’d ever had ‘prophetic dreams’, ie dreams about events which subsequently happened. I only thought of this question after the initial release of the survey, so the data pool is smaller (138 people), but the results are still interesting – 38.2% said they’d experienced prophetic dreams, also often about relationships:

“Soon after a new man came into my life I had a series of vivid dreams with a common theme: he was driving to pick me up and I noticed someone sitting in the rear of the car; we were in his flat and he wouldn’t listen when I said I thought someone was in the kitchen…reader, he was married and playing away from home. My dreams quite often warn me of things that I don’t want to admit consciously”

“I kept on dreaming my partner was cheating (he was)”

“Dreamt would be broken into over Christmas. Was so vivid could see their faces. Put extra locks on front door. Got robbed anyway.”

“I dreamed my late father told me I was pregnant. I took a test the following day and I was!”

“I have twice dreamt the result of a sports event, taking place the following day. One was a 5-4 win in a football penalty shootout and the other a Six Nations game. Both were correct and I won money on the second one!”

Before you jump out of bed and accuse your partner of infidelity or put £100 on Manchester City, remember the warning of the ancients – it may be a false dream from the gate of ivory!

Lucid dreaming experiences were common among respondents:

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And clearly we’re not embarrassed to discuss our dreams with others:

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Around 30% of respondents said they had some sort of ‘dream practice’ – usually trying to remember their dreams in the morning, often writing them down in a journal, and sometimes discussing them with a therapist. One person with tinnitus says she uses her dreams to manage her physical condition, while another said they can tell from their dreams when their iron level is getting too low!

What about sex? Well, Freud would say all your dreams are about sex (Jung would say they’re all about alchemy). That doesn’t seem to be the case. But there’s some transgressive sex in there – 50% of you who describe yourself as either heterosexual or homosexual said you’d dreamt of a sex experience contrary to your usual preference, which makes me wonder if we’re all bisexual or trisexual in our subconscious self. We’re not that faithful in our dreams either – according to the Montreal dream lab, women only dream of having sex with their partner 25% of the time, the rest of the time it’s sex with someone else; with men, only one sixth of their sex dreams involve their partner.

Conclusion

So, to return to my initial hypothesis, it does seem that people have ‘big dreams’ which strike them as unusually significant and insightful. Such dreams are not common for most people. They usually happen in moments of crisis and transition. They are pragmatic in their use of metaphor and symbol, using symbols that fit your situation, although there are symbols and metaphors that reoccur quite often. People find them relatively transparent in their meaning. They seem to help people adapt to the crisis. They particularly give people insights into relationships – to oneself, to loved ones, to people at work. And they quite often involve a visit from a dead loved one, which helps people adapt to loss and bereavement. Hooray for dreams!

Here, by the by, is a New York Times article looking at how dream-labs are now studying such ‘big dreams’, particularly dreams of visits by dead loved ones.