Posts Tagged ‘Stanforsd University Medical School’

Mind and Medicine

March 19, 2018

The title of this post is identical to the title of the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” There are two extreme views regarding the mind and medicine. One view, and it is unfortunate that there are physicians who hold this view, is that there is no relationship between the mind and medicine. The other extreme is that the mind controls all and medicine is unnecessary. Actually, this extreme view is the view adopted by some religions such as Christian Scientists, that prayer and meditation, not the mind, provides the basis for treating all illnesses. As the reader will see, the truth lies somewhere in between.

The truth is that there are links between the immune system and the central nervous system, and the field that studies this, psychoneuroimmunology (PNI) is a leading-edge medical science. It’s name acknowledges the links: psycho, or mind; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

Some surgeons will cancel scheduled surgeries for people who are panicked by the prospect of surgery. Every surgeon knows that people who are extremely scared do terribly in surgery. They bleed too much, they have more infections and complications, and they have a harder time recovering. Patients do much better if they are calm.

A study of anger in heart patients was done at Stanford University Medical School. All the patients in the study had suffered a first heart attack, and the question was whether anger might have a significant impact of some kind on their heart function. While the patients recounted incidents that made them mad, the pumping efficiency of their hearts dropped by 5 percentage points. Some patients showed a drop in pumping efficiency of 7% or greater. This is a range that cardiologists regard as a sign of myocardial ischemia, a dangerous drop in blood to the heart itself.

Another study by Dr. Redford Williams of Duke University found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores. This is a stronger predictor of dying your than were other risk factors such as smoking, high blood pressure, and high cholesterol.

Anxiety, the distress evoked by life’s pressures, is perhaps the emotion with the greatest weight of scientific evidence connecting it to the onset of sickness and course of recovery. Yale psychologist Bruce McEwen noted a broad spectrum of effects: compromising immune functions to the point that it can speed the metastasis of cancer; increasing vulnerability to viral infections; exacerbating plaque formation leading to atherosclerosis and blood clotting leading to myocardial infarction; accelerating the onset of Type 1 diabetes and the course of Type II diabetes; and worsening or triggering an asthma attack. Stress can also lead to ulceration of the gastrointestinal tract, triggering symptoms in ulcerative colitis and in inflammatory bowel disease. The brain itself is susceptible to the long-term effects of sustained stress, including damage to the hippocampus, and so to memory.

There are also medical costs of depression. In patients with chronic kidney failures who were receiving dialysis, those who were diagnosed with major depression were most likely to die within the following two years; depression was a stronger predictor of death than any medical sign.

Heart disease is also exacerbated by depression. A study of 2832 middle-aged men and women tracked for twelve years, those who felt a sense of nagging despair and hopelessness had a heightened rate of death from heart disease. For the 3% who were most severely depressed, the death rate from heart disease compared to those with no feelings of depression was four times greater.

As there are medical costs to pessimism, there are medical advantages to optimism. For example, 122 men who had their first heart attack were evaluated on their degree of optimism or pessimism. Eight years later, of the 25 most pessimistic men, 21 had died; of the 25 most optimistic, just 6 had died.

There is medical value from relationships. Two decades of research involving more than 37,000 people show that social isolation, the sense that you have nobody with whom you can share your private feelings or have close contact—doubles the chance of sickness or death. A 1987 report in “Science” concluded that isolation is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and and lack of physical exercise. Goleman takes care to note that solitude is not the same as isolation; many people who live on their own or see few friends are content and healthy. Rather, it is the subjective sense of being cut of from people and having no one to turn to that is a medical risk.

Goleman argues that for medicine to enlarge its vision to embrace the impact of emotions, two large implications of the scientific findings must be taken to heart:

HELPING PEOPLE BETTER MANAGE THEIR UPSETTING FEELINGS—ANGER, ANXIETY, DEPRESSION, PESSIMISM, AND LONELINESS IS A FORM OF DISEASE PREVENTION. The data show that the toxicity of these emotions, when chronic, is on a par with smoking cigarettes, helping people handle them better could potentially have a medical payoff as great as getting heavy smokers to quit. One way to do this that could have broad public-health effects would be to impart most basic emotional intelligence skills to children, so that they become lifelong habits. Another high-payoff preventive strategy would be to teach emotion management to people reaching retirement age, since emotional well-being is one factor that determines whether an older person declines rapidly or thrives. A third target group might be so-called at-risk populations—the very poor, single working mothers, residents of high-crime neighborhoods, and the like—who live under extraordinary pressure day in and day out, and so might do better medically with help in handing the emotional toll of these stresses.
MANY PATIENTS CAN BENEFIT MEASURABLY WHEN THEIR PSYCHOLOGICAL NEEDS ARE ATTENDED TO ALONG WITH THEIR PURELY MEDICAL ONES. While it is a step toward more humane care when a physician or nurse offers a distressed patient comfort and consolation, more can be done. But emotional care is an opportunity too often out of the way medicine is practiced today; it is a blind spot for medicine. Despite mounting data on the medical usefulness of attending to emotional needs, as well as supporting evidence for connecting between the brain’s emotional center and the immune system, many physicians remain skeptical that their patients’ emotions matter clinically, dismissing the evidence of this as trivial and anecdotal, as “fringe, or worse as the exaggerations of a self-promoting few.

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