Open Book

Looking for ‘There’ There

Making sense of the claims for mind-body medicine

Magazine Issue
November/December 2008
Looking for ‘There’ There

The Cure Within: A History of Mind-Body Medicine

Anne Harrington

W. W. Norton. 336 pp. ISBN: 978-0-393-06563-3

A centerpiece of Anne Harrington’s The Cure Within: A History of Mind-Body Medicine is a story from a 1957 psychiatric journal that radiates questions and puzzles. It concerns a certain “Mr. Wright,” who had a diagnosis of lymphosarcoma—cancer of the lymph nodes. According to Harrington, “Tumors, some the size of oranges, infested his neck, groin and armpits.” He’d ceased to respond to conventional therapies, but in the hospital, he’d learned of a new experimental drug called Krebiozen and was “persuaded that it would be his miracle cure.” He begged his doctor for an injection, which was administered on a Friday. On Monday, the doctor was greeted by Mr. Wright “walking around the ward, chatting happily.” The tumors had “melted like snow balls on a hot stove.”

Was this surprising reversal due to the powerful new drug? Blind luck? A miracle?

Mr. Wright continued his stunning recovery until he read conflicting stories about Krebiozen’s effectiveness in the newspaper. His confidence undermined, he relapsed, but his crafty doctor convinced him that the original injection had been defective, and administered another one. This time, however, it was distilled water. Thinking he’d gotten the real thing, Mr. Wright recovered even more dramatically than after the first injection. He was sent home, a “picture of health.”

Some time later, while convalescing, Mr. Wright read in the paper that the august American Medical Association had denounced Krebiozen as a worthless drug. He relapsed once again, was admitted to the hospital, and died two days later.

This story underscores some of the fundamental questions underlying mind-body medicine: how much control do our minds have over our physical well-being? How can we best marshal our emotional resources to help us prevent and recover from disease?

We’ve all experienced the influence our minds have over our bodies. We’ve all seemingly held back a cold during an exam or project, only to get sick the day after, during the start of our vacation. We’ve all read accounts of husbands and wives dying of a broken heart following the death of the beloved partner. We all know that people, especially men, sometimes don’t live long after they retire and begin to feel bored, restless, and useless.

In self-help literature, we’re told that our minds have great power, as great as the doctors who lord it over us. When we’re in dire straights, we want miracles, whether self-generated or from some unseen power. Harrington, who teaches the history of medicine at Harvard, is well aware of this dilemma. She knows patients want to give meaning to their disorders, their illnesses, and, yes, their health. Who wants to believe that a dramatic, spontaneous remission is just an anomaly, a fluke?

Harrington is also well aware of how impersonal conventional medicine often is, and that 60 million Americans use complementary therapies and spend $40 billion annually in search of an alternative healing experience. Although traditionalists have long resisted giving these treatments legitimacy, increasingly a stamp of medical approval has been placed on once seemingly bizarre beliefs and practices.

The bridge between peoples’ attitudes and beliefs and their health has been explored by Bernie Siegel, a surgeon at Yale University. The notion that repressed or unpleasant emotions could cause cancer had been floating about for years in the cultural ether. Norman Mailer, a writer ever alert to the zeitgeist, even used this argument in 1960 after he stabbed his wife at a party. Had he repressed his rage, he claimed, he’d have developed cancer. Siegel added to this vague cultural notion the belief that some repressed people were “cancer prone.”

“Cancer might be called the disease of nice people,” he wrote in his 1986 bestseller, Love, Medicine, and Miracles. The ones who died were “emotionally repressed, nice but not authentic.” All told, “there were no incurable diseases,” he added, if only an individual had the right attitude. So who were the people best able to fight illness? Those who are “openhearted, feisty and in touch with their needs.”

As Siegel proclaimed: “It’s my main job as a doctor to help you develop into a new person, so you can resist the unwanted, uncontrolled development of illness.” No wonder the book sold two million copies and he became a New Age pinup, with his smiling face and shaven head.

According to Harrington, Siegel’s vision has been a lifeline for some patients; but for others, it’s been a recipe for horrible guilt. Although she bends over backward to remain dispassionate, she can’t hide her irritation with the good doctor. In at least one standard, randomized trial, she tells us, dealing with repressed issues made no difference to how long patients lived.

Still, Siegel’s message pervades both popular culture and the medical profession. Harrington still finds doctors who’ve come to believe it, despite scant empirical evidence. One clinician even told her that a certain woman was “too mean to have cancer.” For some medical practitioners, being repressed has become a scarlet-letter sin.

We can all understand the need to believe that our emotions can knock out rampaging, malignant cells. If we think we can manage our emotions and thereby fix our lives (the purpose of therapy), it isn’t much of stretch to think we might be able to control our tissue and organs. And we’ll pay good money to doctors, therapists, publishers, and coaches to help us entertain this possibility.

Faced with the need to meet strict standards of scientific proof, mind-body medicine is still struggling to establish its empirical foundation. The evidence for a mind-body connection sometimes comes to those who don’t anticipate it. Harrington cites the case of David Spiegel, a Stanford psychiatrist. Although Spiegel believed that open, frank talk about physical ailments was beneficial, and he taught simple self-hypnosis techniques to manage pain and anxiety, he disapproved of those like Bernie Siegel who peddled false hopes about the effects of positive and negative attitude on illness. He dismissed the “wish-away-your-cancer crowd.”

But then he got a surprise. In his own 1989 study, he discovered that not only did support groups improve mood and coping skills, but the women involved in them lived twice as long (37.6 months as opposed to 18.9 months) as women in the control group, who had no group counseling

So Spiegel found himself in the company of all sorts of alternative practitioners he distrusted. But then things began to unravel. A follow-up study failed to replicate his findings. As of now, Harrington writes, Spiegel remains unwilling to concede that support therapy doesn’t extend the life of women with cancer, and whatever its effect on longevity and survival may prove to be, he’s convinced that therapy can help cancer patients live more fully and authentically in the time they have left.

That’s where Harrington stands, with her good common sense. When she asked one patient in a support group whether it mattered whether she’d live longer, the patient told her no, it didn’t matter. She and her group had all learned to live better, and their painful feelings about dying had been eased. As one woman told Harrington, quite movingly, “If you eliminate the concept of time, I guess then you could say we live longer.”

One point Harrington underlines is that the history of mind-body medicine is full of spiritual and religious hopes and themes. It’s about the stories we tell ourselves to make meaning out of our sufferings. Once people believed their ills could be caused by demon possession. Since then, the vocabulary and metaphors have changed, and Harrington recounts this history in a thorough, vivid way. If people once believed they were possessed by evil spirits, Freud told his patients that repressed impulses caused their hysterical symptoms. You could say that Bernie Siegel’s fix on “cancer as character” follows in a tradition begun way before the origin of modern science.

Nevertheless, some approaches within mind-body medicine have a firm empirical foundation. Harrington reminds us of the growing scientific literature that has led to the acceptance of meditation (often by another name) in hospital and clinical programs around the world. Jon Kabat Zinn, the originator of “mindfulness-based stress reduction,” claims that without his Ph.D. in molecular biology from MIT, doctors would have been wary about accepting the possible value of Buddhist meditation techniques in a medical setting. Luckily, he was able to show through research trials that this ancient wisdom can help patients manage their pain.

So how do we separate pop fads from the more enduring contributions within mind-body medicine? As a disinterested scholar, Harrington is reluctant to judge, though she makes an exception for Bernie Siegel: if there’s a dart board in her office, I’d imagine his smiling picture is front and center. But I think it’s safe to say that The Cure Within will make many readers feel a certain humility. Like poor Mr. Wright, I suspect, however willing we may be to defer to the wisdom of various medical authorities (we do it every time we go into a hospital), we want to feel some control over our existence. We want to embrace a narrative that gives sense to our experience. And we wish for a certain amount of certainty about the best course to take, even when it isn’t forthcoming. We might first look to science for guidance; but if that doesn’t give us what we’re looking for, we hope for a miracle.

In the end, as Harrington might say, we want to make sense of our lives in the form of a good, comprehensive story we can tell ourselves. It may not protect us from a dread disease, but as meaning-making creatures, we resist the idea that ultimately our well-being depends on the impersonal whims of the universe.

Richard Handler

Richard Handler is a radio producer with the Canadian Broadcasting Corporation in Toronto, Canada.