Mind Body Disconnect
October 30, 2013
Mind over matter is a commonly used phrase, but what does it really mean? New age guru and alternative medicine proponents often talk about the mind-body connection, but what is it really? How much can our "Mind" directly affect our health? Is there a mind-body connection at all, and if so what are the limits? Most importantly is there any evidence that your brain can overcome the limits of your body's physiology?
Let's review broadly what is meant when people say mind-body connection. It is a diffuse statement that has no specific anatomical or physiologic definition. For the purposes of this discussion we will use Mind-Body Connection as defined by the alternative medicine community covering most of the bases. This simplified overview is that your; attitude, social network, community, and spiritual beliefs are the biggest factors controlling your overall health. The supposed effects of your mind are extrapolated to include how your body responds to specific diseases. Based on this assumption they conclude that the key to good health is in your head. There are a host of pseudo-scientific and poorly understood scientific concepts that are used to justify this ideology. Quantum mechanics, energy, naturalism, chi, meridians, aura, spiritual vitalism etc. Collectively, like most nonsense it has little basis in scientific thought. This is despite the use of scientific sounding terms like"quantum". It is considered to be a non-scientific approach to medical care. Like all really convincing pseudoscience there is a kernel of truth in this ideology. The Brain does manipulate hormonal controls, as well as the neurological and physiologic controls. Although in this ideology there is a great deal of glossing over the limits of the physiologic brain and an over estimation of the ability to change the brain's function.
If you believe hard enough that you will get well, then you will. This philosophy fails miserably in practice. The perspective that your "mind" can significantly affect the course of most diseases is unfortunately completely false. It has become a common public perception that a positive mental attitude is the key to defeating deadly diseases, this is disappointingly untrue.
Let's start with what is known about the mind body connection. If you ask a person on the street, what is your mind and what is your body, you may not get a quick answer. Realistically these terms have no definable physiologic meaning. In addition they are not truly separate entities. There is a mind-body connection physiologically. It is just impossible to separate them specifically as well defined structures. The mind or consciousness is a construct of your brain. Your brain is a hormonal and neurological control center. That center does have a great deal of sway over the other organs and tissues in the body. The body, in this context, is generally anything outside of the consciousness. The body is the metabolic, support and feedback system for your brain. The function of the brain and body are physiologic facts, and they are not in dispute.
The failures of the mind-body connection are in the extrapolation and exaggeration of these interactions. There is also a complete failure to understand the physiological limit of this interaction and its effect on the human body. Plus there is a belief that un-measurable or supernatural factors are involved.
Clearly the best evidence in support of the mind body connection is related to stress. Mostly because stress is not a well defined process and there are wide error bars in the definition of stress. Stress is a state of emotional and mental strain or tension resulting from adverse or very demanding circumstance. Medically it is an umbrella statement that encompasses many psychological and physiologic illnesses. Alternative medicine supporters will often point to stress as a key factor in many illnesses. This oft quoted statement "95% of illness and disease are affected by stress" is true. Stress does have a great deal of impact on a few illnesses. Stress has a minor impact on a much larger number of differing illnesses. Stress does cause problems; it consumes resources and elevates the inflamatory responses as well as fight or flight responses. There is no question that long-term release of certain stress related hormones, and stress related physiologic factors have a deleterious effect on the human body. Unfortunately you cannot just will stress away and the effects are vastly overblown by the mind-body connection advocates. The correct question is not "what diseases are affected by stress", rather "what is the degree of effect and in what direction". Meaning stress can have a negative impact, but absence of stress is not always a positive. Also in practice improving stress does not always result in better treatment outcomes. The actual curative effect of stress reduction on an illness is unclear and in research numbers are quite small.
My personal bugaboo for the mind body connection is Cancer. It fails miserably, and is in fact a detrimental concept related to cancer therapy. Portrayals of mind over cancer is commonly promoted in television and movies. It is a feel good story. "She fought hard and won", although it is "feel good", it is not accurate and has a significant downside to cancer patients and their families. Namely it is blaming the victim's emotional state for the illness or the failure of treatment.
Emotions and feelings are an important part of coping with a cancer diagnosis. When a person is told they have cancer, questions like these may come up:
Most of the study results on the subject tended to show no link between personality and cancer, but a few seemed to support the idea. These few published studies were smaller, poorly designed, or not very well controlled. This means that their results were more likely to be due to bias or random chance. Also, some journals tended to publish the studies that suggested there was a link and reject those that showed no link. Demonstrating significant publication bias. People are then more likely to read or hear about the few studies that seemed to show a link but not find out about those that didn't show any link.
In 2010, the largest and best-designed scientific study to date was published. It looked at nearly 60,000 people, who were followed over time for a minimum of 30 years. This careful study controlled for smoking, alcohol use, and other known cancer risk factors. The study showed no link between personality and overall cancer risk. There was also no link between personality traits and cancer survival.
People with cancer and their families may feel guilty about their emotional responses to the illness. They may feel pressure to keep a positive attitude at all times, which is unrealistic. This feeling of pressure can come from within themselves, from other people, or both. Sadness, depression, guilt, fear, and anxiety are all normal parts of learning to cope with major life changes, and a cancer diagnosis is a major life change. Trying to ignore these feelings or not talking with others about them can make the person with cancer feel lonely. It can also make the emotional pain worse. And some people feel guilty or blame themselves when they can't "stay positive," which only adds to their emotional burden.
Along these same lines, many people want to believe that the power of the mind can control serious diseases. This is a comforting belief that can make a person feel safer from the risk of serious illness. If it were true, you could use your mind to stop the cancer from growing. But the down side of such beliefs is that when people with cancer don't do well, they may blame themselves.
Researchers looked at the emotional well-being of more than 1,000 patients with head and neck cancer to find out whether it affected survival. Over time, those who scored high on emotional well-being showed no differences in cancer growth or length of life when compared to those with low scores. Based on what we know now about how cancer starts and grows, there is no reason to believe that emotions can cause cancer or help it grow.
Cancer is the best example of the Mind-Body connection downside. Not much benefit related to the disease and a significant downside. It is not the only one. There is a similar lack of supporting evidence for mind body treatment in Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Lupus, Cystic Fibrosis, Myasthenia gravis, et al. Promoting the idea that the patient's mental attitude is the primary driving factor behind success and failure is wrong and detrimental. In some cases families falsely blame failure of treatment on the patient. Thus making the situation drastically worse for the victim. Don't get me wrong, positive mental attitude does help the victim deal with the psychological problems and enduring the physical fatigue. It is not able to affect the course of these diseases.
If you look at the whole of Chronic, Debilitating, or deadly diseases (excluding somatoform and psychological disorders) there is no discernible effect on final morbidity and mortality. In poorly structured small studies there seem to be an small effect on final outcomes. In well structured large studies the small effect disappears. In my opinion this pattern in the literature is consistent with no effect at all. This is true even in purely neurological disorders like MS, dementia, ALS or Parkinson disease. Even some psychiatric disorders like Schizophrenia fail to improve with good positive mental attitude measures. Using your mind is not a magical panacea allowing you to will yourself better. There is no credible research showing that it can improve immune function, destroy cancer cells, unblock arteries, repair damaged organs, restore damaged nerves et Al, at any better rate than the mean would indicate. Meaning, some people, against all odds, get better despite good or bad mental attitudes.
Is the mind body connection complete bunk-o? No I am not proposing that at all. There is just no magic to your mind's control of the body. Stress does consume resources, it fatigues you and it can slow recovery. In research the greatest benefit from stress relief is seen in the stress related diseases. Hypertension for example, migraines or back pain are examples. Mind body therapy works wonderfully with anxiety, somatoform disorders, and minor depression. Anywhere where stress and anxiety are the biggest factors you see the biggest effect from the "Mind Body Therapies". It is not superior to treatments like message therapy, exercise therapy, and cognitive behavioral psychiatry. It is just as effective.
There is no evidence that your brain can radically diverge from it normal function by using your cognitive functions. There is a limit. You can hold your breath but when you pass out you start breathing again. There is no evidence that you can will away cancer, heart disease, tuberculosis, ALS, dementia, ADHD, Chronic Obstructive Pulmonary Disease, Asthma, the list goes on. There is no evidence that "willing" prevention of a disease will in fact prevent it. There is no deviation from standard incidence of those diseases with positive or poor mental attitudes.
In my opinion, mind body connection is a philosophy that is nothing more than wish fulfillment, and vitalism. Expecting people to believe that they have a supernatural ability to cure themselves is a terrible passive way of blaming a person for their misfortune. It can give them feelings of self loathing and inadequacy when they cannot maintain a "Positive Mental Attitude". When it becomes apparent that the disease is worsening it has a very real devastating effect on their psychology as well as relationships with family and friends. Creating scenarios of anger and dissension for the victims, sometimes in their last moments. When they improve they feel falsely that they are in control, but if the disease reverts they begin a cycle of self blame. Tragic really.
Take it for what it is, a self help stress relief modality nothing more.
For everyone who actually checked the references GO SOX.
Disclaimer: This post is my personal opinion it does not reflect the opinion of; my practice, my partners, hospital affiliations, Brian Dunning or my academic affiliations. It is for informational/educational purposes only. It is not intended to replace personal medical evaluation and discussion with your healthcare provider.
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