Sunday Times, 07 February 2016
Cure: A Journey into the Science of Mind over Body
by Jo Marchant
Church attendance increases your life expectancy by 7-14 years. Fake drugs (placebos) work even if you know they are fake. Hypnosis cures IBS (irritable bowel syndrome). Mindfulness slows the progress of multiple sclerosis. Meditation thickens your prefrontal cortex. Psychiatric drugs kill half a million people in the West annually.
That, roughly, is the territory covered by this book: the landscape between the strong evidence that the state of your mind affects the state of your body and the hard truth that current medicine, in choosing to ignore this evidence, might be harming us. It is, of course, a landscape littered with as many hucksters as healers. We must tread carefully.
Jo Marchant is a sceptically inclined science journalist. “I believe passionately in the scientific method,” she writes. But science might have been misled by its own history. In the 17th century, Descartes’s division of the world into the physical and the God-supported mental created a dualism that continues to haunt science. When God dropped out of the picture, scientists were seduced into discounting the mental as an irrelevant add-on, only of interest to the superstitious. Now even neuroscientists, who claim to be studying the mind, like to say the human self is a delusion.
In medicine, hard physicalists tended to ignore the patient entirely as anything other than a control system for the body machine. This was comprehensively disproved by the effectiveness of placebos, which seemed to work as well as, or better than, the real thing. The physicalists were contemptuous. Placebos, said an article in The Lancet in 1954, only work for “unintelligent or inadequate patients”.
But it was the writer in The Lancet, not the patients, who had succumbed to superstition. The story of placebos, with which Marchant begins her book, provides incontrovertible evidence that the body can be profoundly affected by the mind. This does not simply mean that placebos lull the patient into feeling less pain, actual physical changes occur. Placebos, for example, can trigger the release of endorphins, natural painkillers. Or there is the astounding story of acutely autistic children being cured by the hormone secretin, which double-blind trials seemed to show had no effect. Then there was the antidepressant Prozac that worked for millions, even though tests showed it shouldn’t.
The point is, as one doctor puts it, that “the active ingredient is meaning”. If a treatment signifies care and hope to the patient, then it may work. Extraordinarily, this works even when the patient knows a treatment is a placebo — Marchant even claims to have cured her own headache with a fake drug. Now there are companies selling placebos online, capsules whose only ingredient is air. Clearly the subconscious can still be activated in spite of the doubts of the conscious.
Placebos indicate that patients’ minds can be conscripted in almost any treatment regime. This insight can be extended far beyond fake drugs. Chronic fatigue syndrome (CFS), for example, can be relieved by cognitive behavioural therapy. Oddly, some CFS sufferers don’t want to hear this because it implies their affliction is “all in the mind”. Perhaps they should realise that “all in the mind” is rapidly becoming an obsolete or even meaningless diagnosis. In this context, hypnosis (which appears to be effective in treating IBS) should, perhaps, be seen as a much more commonplace treatment.
So should a high quality of care. A startling study in 2012 showed that pain and complications in childbirth could be reduced if the mother had a single caregiver throughout labour. It can even reduce the likelihood of caesarian sections, which are now far too common in Britain and America, apparently because they are convenient. The long-term effects of all these c-sections have yet to be assessed.
Good care also helps in dying. Contemporary squeamishness about death means that we tend to ignore the dying, wishing them away before their time is due. Care becomes rudimentary, dominated by futile or, in some high-profile cases, cruel treatments. A mind-body view should change all this. Marchant reports a study that showed that well-cared-for patients survived 11.6 months as opposed to 8.9 months for a control group.
The point was human contact. This, above all else, gives people, even in extremis, a reason to live. Social ties save lives and their absence is toxic. Why do Costa Ricans live longer than their much wealthier American neighbours? Because they have much richer and broader social networks. Their supreme sociability can, it seems, be detected at the level of their chromosomes.
In spite of all this, Marchant’s conclusion is bleak. A mind-body revolution in medicine will be held back by the way research is funded: in America, 75% of the money comes from drug companies whose only interest is in selling us chemical compounds. Only 0.2% of America’s National Institutes of Health’s $30bn budget goes on mind-body research. This is really bad news for us; the NHS could save a fortune if mind-body procedures were implemented.
Marchant’s book is amiably badly written. She suffers the common science writer’s tic of adding, without integrating, reportage. So when I am suddenly told that one of her interviewees “is dipping a strip of pitta bread into her hummus” as she speaks, I die a little inside and, more important, take her less seriously.
It is, nevertheless, a diligent and useful work that makes the case for “holistic” medicine while warning against the snake-oil salesmen who have annexed that word for profit.
In the end, Wittgenstein was right when he said that the best picture of the human soul is the human body. We are indivisible entities whose most serious afflictions are neither real nor imagined, but both. This can be hard to understand, but it is the price we pay for being human.