Norman Shealy, MD, PhD discusses the history of mind/body approaches to managing stress-related illnesses.
by C. Norman Shealy, MD, PhD
Today’s concept of Mind-Body Medicine evolved in the early 1970s from the Humanistic Psychology Movement; the earliest biofeedback work of Dr. Elmer Green and his wife, Alyce; the meditation and relaxation studies of Dr. Herb Benson; and the psychoneuroimmunology work of Dr. George Solomon and Dr. Candace Pert. Mind-Body Medicine is a term that demonstrates physical, chemical, mental and spiritual interconnectedness, and currently encompasses a wide variety of techniques. These include: biofeedback, relaxation training, autogenic training, psychosynthesis, meditation, guided imagery, spiritual healing, prayer, Logotherapy, Gestalt therapy and many other short-term psychotherapeutic interventions, often called Energy medicine.
Mesmerism may well have been the forerunner of mind/body medicine The first known western book dealing with the subject of Mind-Body was written by Daniel Hack Tuke, M.D. in 1872. He emphasized that the Mind acts upon the Body through Intellect, Emotions and Volition. Interestingly, he considered that both special and general sensations were influenced by Mind, Intellect and Volition, so he excluded these from his discussion! On the other hand, he quotes Unser who in 1771 wrote, “ Expectation of the action of a remedy often causes us to experience its operation beforehand. (Vol 1, page 3). John Hunter, of syphilis fame had observed Mesmeric ‘magnetism’ and come to the conclusion that Attention and Expectation played a major role in evoking Imagination to influence virtually every sensation and movement. Braid of course took mesmerism to its more rational explanation, hypnosis. And early in the 20th century, Emil Coue emphasized that Imagination always wins in a conflict between Imagination and Will. Coue was famous for his :Every day in every way I am getting better and better: statement, with which he was reported to cure thousands of people.
HISTORY, PHILOSOPHY, AND METHODS
The “separation” of mind and body is often said to have originated with Rene Descartes. Prior to his contributions, medicine, science, philosophy and spirituality were commonly considered aspects of the whole person. With his influence in the 1600’s, the separation of mind and body occurred with mind being the purview of religion and metaphysics and body being the purview of science and medicine. In the late 18th century, Franz Anton Mesmer began the trend to re-examine the connection of body and mind. Although rejected by most of his contemporaries, Mesmer’s work, said by Benjamin Franklin to be only a suggestion of the effect of the mind, spawned the concept of hypnosis, which was introduced by James Braid and James Eisdale after Dr. John Elliotson demonstrated in the 1840’s that surgery could be performed on mesmerized patients.
In 1872, Dr. Daniel Hack Tuke published the first major treatise on Mind-Body Medicine in London. The second edition from 1884 is available as a reprint and is of great importance. Tuke emphasized that the Mind acts upon the Body through Intellect, Emotions and Volition. Interestingly he considered that both special and general sensations were influenced by Mind, Intellect and Volition, so he excluded these from his discussion! On the other hand, he quotes Unser who in 1771 wrote “Expectation of the action of a remedy often causes us to experience its operation beforehand. (Vol 1, page 3). John Hunter, of syphilis fame had observed Mesmeric ‘magnetism’ and come to the conclusion that Attention and Expectation played a major role” in outcomes. Braid of course took mesmerism to its more rational explanation, hypnosis.
Hypnosis was highly controversial for over 100 years but led to the beginning of modern psychiatry. Sigmund Freud is said to have been such a poor hypnotist that he retreated to psychoanalysis. In the early 20th century, the French pharmacist, Emil Coue, was reported by physicians to have cured thousands of patients with his famous statement, “Every day in every way I am getting better and better.” He was ridiculed by the American Medical Association when he visited this country.
Jan Smuts, former Prime Minister of South Africa, wrote in the 1920s the most elegant integration of all aspects of science, philosophy, and psychology in his book, Holism and Evolution. This was essentially the foundation of what is now called Holistic. William James discussed ‘Mind Cures’ extensively in his landmark book, The Varieties of Religious Experience, perhaps still the most in-depth study of religion and spirituality.
In 1929, Dr. Edmund Jacobson published his landmark book, Progressive Relaxation, in which he demonstrated physiological homeostasis with his practical technique of focused systematic muscle contraction and relaxation. He demonstrated that 80% of patients with “psychosomatic illness” were cured with this approach. It was never embraced by the medical profession.
Meanwhile, Dr. Johannes Heinrich Schultz of Germany had begun in 1912 a specific form of self-hypnosis called autogenic training. His first book was published in 1932. By 1969, the six volumes on autogenic therapy were published by Schultz and Luthe. With some 2800 scientific references, they reported that 80% of “psychosomatic” illnesses were adequately treated with autogenic training.
Meanwhile, Dr. Hans Selye had demonstrated the major effect of stress on health in general and maladaptation to stress as the basis of most disease. He emphasized the physiologic similarities of physical, chemical, and emotional stress.
In 1954, the American Society of Psychosomatic Medicine was founded. It was, and remains, primarily a psychiatrically oriented concept. Unfortunately, the term psychosomatic, which could be called mind-body, has been considered by most patients and physicians to mean “all in the head.” Meanwhile placebo, which has been the standard since the beginning of modern scientific medicine, has been both used and abused and is poorly understood by both physicians and the public. Interestingly, the vast majority of drugs are only a few percent better than placebo, which in most controlled studies averages 35% efficacy. Almost no drugs are 70% efficacious.
In the 1960s, Dr. Abraham Maslow and Dr. Carl Rogers began the reintegration of spirit and mind, founding Humanistic Psychology. Dr. Roberto Assagioli meanwhile had integrated all of his concepts, as well as Carl Jung’s concepts of symbology, into his technique of psychosynthesis.
In 1970, Dr. Elmer Green and his wife, Alyce, introduced the concept of autogenic feedback training, which became biofeedback. Their earliest work proved that 84% of migraineurs and 80% of patients with hypertension were remarkably improved and adequately controlled with temperature biofeedback training. Since that time, it has been demonstrated that every physiological response, which can be measured and fed back to the patient visually or audibly, is capable of being brought under voluntary control.
In the 1970s, Dr. Herbert Benson first reported on the physiologic homeostatic benefits of meditation and later recognized that the basic benefit was deep relaxation, soon to become known as the Relaxation Response. Benson’s work proved what Jacobson had shown fifty years earlier. Most striking was Benson’s demonstration that individuals who did 20 minutes of deep relaxation twice a day had a 50% decrease of both catecholamine production and insulin requirement for the entire 24-hour period.
In the early 1980s, Dr. George F. Solomon introduced the major field of psychoneuroimmunology, which has provided the greatest evidence of the complete interconnectedness of body, mind and attitude. Most remarkable is the finding that virtually every neurochemical produced in the brain is also produced in white blood cells and usually in the intestines. To some extent, the field of psychoneuroimmunology has suggested that the “mind” is part of every cell. Dr. Candace Pert’s discovery of beta-endorphin, the natural opiod, was the first major step in demonstrating what Buryl Payne had introduced in Getting There Without Drugs in the 1970s. It now appears that the mind can produce a wide variety of mind-altering chemicals, ranging from anandamide to neurotensin with analgesic, neuroleptic, and hallucinogenic effects. Ultimately, mind-body medicine is the foundation for virtually all CAM modalities.
MAJOR CLINICAL APPLICATIONS
The wide array of mind-body therapies have been reported to be effective in pain control, migraine, rheumatoid arthritis, ADHD, epilepsy, hypertension, peptic ulcer, anxiety, depression, PTSD, and diabetes. For instance, 84% of migraineurs can control their headaches when they learn temperature control of the index finger, the least difficult biofeedback technique. In many chronic disorders mind-body medicine is the approach of choice in stress illnesses and at the very least, a major adjunct even when pharmaceuticals are necessary.
Evidence-based approaches include relaxation for GERD, hypnosis for irritable bowel syndrome, biofeedback and guided imagery for headaches, meditation and guided imagery for pain, and prayer for coronary artery disease.
The most complex stress disorders include fibromyalgia, chronic fatigue and Post Traumatic Stress Disorder. These patients fit into a syndrome I have called Electromagnetic Dysthymia.
ELECTROMAGNETIC DYSTHYMIA (CHRONIC FATIGUE; FIBROMYALGIA, PTSD)
EMD is a generalized disorder of chronic fatigue, anxiety, depression and a significantly weakened immune system. In its most severe form it is called Post Traumatic Stress Disorder. It is often mis-diagnosed and goes under the rubric of environmental allergies, candidiasis, chronic fatigue, M-E (in England), REDD syndrome, etc. All these problems are associated with deficiency in DHEA, magnesium, and essential amino acids, especially Tryptophan and Taurine. Indeed all significantly depressed patients have:
• Magnesium deficiency
• Deficiency of one to seven essential amino acids, especially taurine
• Low or deficient DHEA
• Excess or deficient levels of norepinephrine, melatonin, serotonin, beta endorphin and/or cholinesterase
• Abnormal computerized EEG’s or brain maps with asymmetry. Most often there is excess activity in the right frontal area but it may be in any lobe of the brain
• Failure to respond appropriately to photostimulation. For instance, instead of increasing 10 cycle photostimulation, they may respond with 2 Hz or 20 Hz.
In general, at least 85% of patients will all these disorders respond well to:
• Transcranial stimulation with the Liss Cranial Electrical Stimulator, applied 40 to 60 minutes each morning. Liss output is 1 to 2 milliamps of current at 15,000 Hz, modulated 15 and 500 Hz. Used alone it brings 50% of patients out of depression within two weeks. It is useful also in anxiety, insomnia and jet lag.
• Photostimulation at 1 to 7 Hz. The Shealy RelaxMate™ has been used in over 30,000 chronically depressed patients who also suffer from anxiety. Used alone, it helps 58% of depressed patients. When combined with the Liss, 85% of over 30,000 chronically depressed patients have been markedly improved, without drugs.
• Magnesium chloride—for the most rapid improvement, IV’s of 2 grams magnesium chloride daily for 10 days, given in 500 cc IV fluid with 2 grams of vitamin C, 1 cc of B complex 100, 250 mg of Dex-Panthenol, 100 mg of B 6, 100 mcg of B 12 and 1 gram of calcium chloride. The same benefit can be obtained in 4 weeks with transdermal 25% magnesium chloride lotion.
• Lithium orotate, 15 to 40 mg daily. This is particularly essential for those with bipolar depression but may expedite recovery in almost all mood disorders
• Vitamin D deficiency. 50,000 units of D 3 and 100 mcg of K 2 may help almost all these individuals
• Adequate protein intake. In the most severe cases, supplements of taurine, 3000 mg, or Tryptophan, 2000 to 4000 mg, may be helpful, with adequate B complex
• Education: Although brief counseling intervention may be essential, education appears most effective. The book 90 DAYS TO STRESS-FREE LIVING by C. Norman Shealy provides a 3 month daily program which has proven to be remarkably effective in those who will do it
For those with ADHD, just lithium orotate and photostimulation may be adequate.For migraine, temperature biofeedback is effective 84% of the time. These individuals also may respond well to stimulation with the Liss CES, or to avoiding wheat, corn, eggs, milk, citrus, peanuts and wine. They should always avoid aspartame.
For rheumatoid arthritis patients the entire protocol may be helpful. Additionally, stimulation with human DNA frequencies of 54 to 78GHz applied with the SheLi TENS™ to 12 specific acupuncture points, called the Ring of Fire, has relieved the symptoms inn 70% of RA patients who have failed conventional approaches. This approach has also bee 80% effective in diabetic neuropathy.
Epileptics are commonly deficient in magnesium and taurine and may respond to these. EEG biofeedback training is also useful.
Hypertension is often controlled with training in temperature biofeedback. Timed release L-arginine and magnesium may also be of benefit.
INTERFACE WITH OTHER CAM MODALITIES
Ultimately, as Sir William Osler said over 100 years ago, “More important than what the physician does, is the patient’s belief and the physician’s belief in what the physician does.” Benson, for instance, demonstrated that every 20th century treatment for angina pectoris, when subjected to double blind controls was no better than placebo. The recent article “The Emperor’s New Drugs” has emphasized the remarkably minimal effect of antidepressants, compared with placebo. Faith and belief appear to be key elements in all therapy. A positive attitude not only improves outcome but also positively affects quality of life. Even outcome of surgery is positively influenced by proper mental preparation. Ultimately, to a significant degree, the mind-body connection influences all therapy.
There are well over 100,000 scientific articles emphasizing the effects of mind on body and of body on mind. The fields of hypnosis, biofeedback, relaxation training, psychoneuroimmunology, faith and prayer and spirituality have solid scientific studies at this time.
DESCRIPTION OF LANDMARK STUDIES/BOOKS
1. Jacobson, Edmund. Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice. University of Chicago Press, 1974. Original Copyright 1929.
This study was done in 1929 and is considered by experts to be of Nobel prize quality because it established the physiological foundation of muscle and mental tension as major determinants of a majority of illnesses. The chapters on emotions, psychological factors, tone and nervous regulation and the concept of neuromuscular hypertension make this an essential foundation for understanding the effects of muscle tension on the mind and the body.
2. Luthe W, Schultz JH. Autogenic Therapies Volumes 1-6. New York: Grune and Stratton, 1969.
Volumes 1 and 4 are the most critical in this remarkable collection. There are some 2800 scientific articles with only 200 in English. Using a simple self-hypnotic technique, the authors demonstrated that 80% of what today is called stress illnesses could be well controlled with this approach.
3. Selye, Hans. The Physiology and Pathology of Exposure to Stress: A Treatise Based on the Concepts of the General Adaptation Syndrome and the Diseases of Adaptation. Montreal, Canada: ACTA Inc. Medical Publishers,1950.
Again, this is one of the best scientific studies ever reported in a book and is considered by some experts to be of Nobel Prize quality. The book covers the physiology and pathology of stress on every known physiological, hormonal, and metabolic system, as well as effects on various organs. The most critical aspect of Selye’s work is that he demonstrated that emotional and nervous stress produce the same biochemical physiological responses as do chemical and physical stress.
4. White, Leonard; Tursky, Bernard; Schwartz, Gary E. Theory, Research and Mechanisms. New York: Gilford Press, 1985.
This is the classic and best overall book on placebo and introduces the concept of nocebo. Essentially, every symptom and illness that can be triggered by disease, injury, or dysfunction can become a negative conditioned response. These nocebo responses can elicit the same adversive reaction as the disease itself and the conditioned or learned response becomes a “nocebo.”
5. Pavlov IP. Conditioned Reflexes. Translated by GV Anrap. Oxford University Press, 1927.
Again, the classic Pavlovian conditioning work is extremely important in understanding totally unconscious reflex physiological and psychological experiences, which can be initially imprinted by a single strong physical, chemical or emotional stress.
6. Benson H, Beary J, Carol M. The relaxation response. Psychiatry 1974, 37: 37-46.
This classic paper describes physiological changes elicited by common mind-body practices such as meditation, yoga, autogenic training, and hypnosis. Evidence demonstrates that these learned techniques decrease oxygen consumption, respiratory and cardiac rate, and muscle tone, while increasing alpha rhythm brain activity and skin resistance. Opposite the ‘flight-or-fight’ response of the sympathetic nervous system, the relaxation response, properly elicited in controlled conditions, has subsequently been shown to reduce post-op anxiety and pain, decrease muscle tension in TMJ and other stress-related disorders, and positively effect many other disease states and health outcomes.
7. Goleman, Daniel; Gurin, Joel. Mind-Body Medicine. Yonkers, New York: Consumer Reports Books, 1993.
This is another book prepared for the public and has an excellent overview of the connections between mind, body, stress, emotions and health.
8. Reich, Wilhelm. The Discovery of the Orgone. Translated by Theodore P. Wolfe. New York: The Noonday Press: A Division of Farrar, Straus, and Giroux, 1971.
Reich’s concepts of body armoring and the physiological and pathological effects of muscle tension induced by mental distress is essential to understanding the remarkable breadth of possibilities in mind-body medicine.
9. Tuke, Daniel Hack. Illustrations of the influence of the mind upon the body in health and disease. Elibron Classics. Adamant Media Corporation. www.elibron.com, 2003.
Recognized as the first major book in the field of Mind-Body Medicine, this classic is a most valuable resource.
10. Damasio, Antonio. Looking for spinoza: joy, sorrow and the feeling brain. Harcourt, Inc., New York, 2003
A brilliant discussion of brain, body and mind in the context of history, art, music and philosophy.
Current Studies: PubMed, the public-accessible version of the NIH National Library of Medicine medical database, MedLine, has 539 scientific references to mind-body medicine. When one considers many of the cross-references from this particular context, it is perhaps the best single source of scientific references. A PubMed search for psychoneuroimmunology yields at least 662 references, with many scientific potential cross-references.
There are thousands of books and scientific articles that emphasize the mind-body connection. The following are suggested resources by mind-body medicine experts.
Benor, Daniel J. Spiritual Healing: Scientific Validation of a Healing Revolution—Professional Supplement. Southfield, Michigan: Vision Publications, 2002.
Davis J. Endorphins. Garden City, New York: Dial, 1984.
Green E, Green A. Beyond Biofeedback, Knoll Publishing, 1977
Ornstein R, Thompson RF. The Amazing Brain. Boston: Houghton Mifflin, 1984.
Assagioli, Roberto. Psychosynthesis. New York: Penguin Books, 1965.
Ballantine, Rudolph. Radical Healing, Integrating the World’s Great Therapeutic Traditions to Create a New Transformed Medicine. New York: Harmony Books, 1997.
Benson, Herbert. The Relaxation Response. New York: Avon Books, 1975.
Brown, Barbara B. New Mind, New Body: Biofeedback: New Directions for the Mind. Harper Rowe, 1974.
Coulter, Harris L. Divided Legacy: A History of the Schism in Medical Thoughts, Vol. I, II, III. Washington, DC: Wehawken Book Company, 1975.
Hanno, Kirk; Weisbrod, Jo; Ericson, Kay. Psychosocial and Behavioral Aspects of Medicine. Baltimore: Lippincott, Williams and Wilkins, 2003.
Harris, Thomas A. I’m Okay-You’re Okay: A Practical Guide to Transactional Analysis. New York : Harper and Rowe, 1969.
Hastings, Arthur C; Fadiman, James; Gordon, James. Health for the Whole Person: The Complete Guide to Holistic Medicine. Boulder, Colorado: West View Press, Inc., 1980.
James, William. The Varieties of Religious Experience: A Study in Human Nature. New York: The Modern Library, 1936.
Louis H, Martha E. Psychosomatics: How Your Emotions Can Damage Your Health. New York : Viking Press, 1972.
Lynch, James. The Language of the Heart. New York : Basic Books, 1985.
Justice, Blair. Who Gets Sick: Thinking and Health. Houston : Peak Press, 1987.
McKeown, Thomas. The Role of Medicine: Dream, Mirage or Nemesis. London: The Nuffield Provincial Hospitals Trust, 1976.
Shealy, C. Norman. Life Beyond 100—Secrets of the Fountain, Tarcher, N.Y., 2006
Siegel BS. Love, Medicine, and Miracles. New York: Harper and Row, 1986.
Smuts JC. Holism and Evolution. New York : McMillan Company, 1926.
Tart, Charles. Open Mind, Discriminating Mind: Reflections on Human Possibilities. San Francisco: Harper and Rowe, 1989.
ARTICLES AND EVIDENCE-BASED REFERENCES
Achterberg J, Lawliss GF, Simonton OC, Simonton S. Psychological factors and blood chemistries as disease outcome predictors for cancer patients. Multivariant Experimental Clinical Research 1977; 3: 107-22.
Angell M. Disease as a reflection of the psyche. New England Journal of Medicine 1985; 312: 1570-72.
Cunningham AJ. Mind, body, and immune response. In: Adey R (ed.). Psychoneuroimmunology. New York: Academic Press, 1981; 609-617.
Goldstein A, Grevert P. Placebo, analgesia, endorphins, and naloxone. Lancet 1985; 2: 8204-5.
Inglefinger F. Health: A matter of statistics or feeling. New England Journal of Medicine 1977; 296: 448-449.
Wallace LM. Psychological preparation as a method of reducing the stress of surgery. Journal of Human Stress 1984; 10: 62-77.
PubMed, the public-accessible version of the NIH National Library of Medicine medical database, MedLine, has 539 scientific references to mind-body medicine. When one considers many of the cross references from this particular context, it is perhaps the best single source of scientific references. A PubMed search for psychoneuroimmunology yields at least 662 references, with many scientific potential cross-references.
Advances: The Journal of Mind-Body Medicine
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The International Journal of Stress Management
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Journal of Behavioral Medicine
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Journal of Personality and Social Psychology
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Journal of Psychosomatic Research
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Stress and Health
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Health and Stress
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AUDIO/VISUAL AND WEB-BASED REFERENCES
Basic Relaxation/Mindfulness Meditation (Olivia Hoblitzelle)
Carolyn Myss Audio
Self-Empathy/Nurturing Change (Peg Baim, RN, MS, NP)
Sound Body, Sound Mind (Andrew Weil, MD)
Tuning in to Your Body, Tuning Up Your Mind (Margaret Ennis, MA)
An Introduction to the Mind/Body Medical Institute (Herbert Benson, MD)
The Biophysiology of Stress (Richard Friedman)
Introduction to Mind/Body Medicine Including the Relaxation Response and How to Teach it (Herbert Benson, MD)
Medical Renaissance—The Secret Code, C. Norman Shealy, DVD,
Mind/Body Stress: The Scientific Basis of Stress and Relaxation (Dr. Kradin)
Recovering the Soul: A Scientific and Spiritual Search (Larry Dossey, MD)
Relaxing My Body, Calming My Mind with Education Initiative Staff
The American Institute of Stress
Center for Mind-Body Medicine
James Gordon, MD, President
Center for Mindfulness in Medicine, Healthcare and Society
Mind/Body Medicine Webpage
The Mind/Body Medical Institute
National Institute for Clinical Applications of Behavioral Medicine
PO Box 523
6D Ledgebrook Drive
Mansfield Center, CT 06250