Mind-body medicine is a concept with a 20-30 year history in Western medicine. There have been rapid and important developments in this ...
Mind-body medicine is a concept with a 20-30 year history in Western medicine. There have been rapid and important developments in this field in recent years. Concepts are implemented through practical applications and applications are becoming increasingly widespread.
The emergence and development of new concepts in medicine in recent years is related to the changing balances in medicine. Over time, the balance between the science and art aspects of medicine and the balance between technological and humanistic approaches rapidly shifted towards science and technology. So much so that it has begun to be forgotten that medicine is an art as well as a science. Technology, which should be a tool that serves people, has become human-managed.
After World War II, there was a sudden leap in scientific and technological developments. Penicillin went into mass production. I can say that my generation did not know what antibiotics were in their childhood. There were sulfamides at that time. Then came penicillin injections, followed by other antibiotics. So much so that, after I became a physician, I encountered the classical pneumonia picture that I learned when I was a student, several times. I recently learned that typhoid and cholera vaccines are no longer available in Turkey. Because their treatments are cheaper than vaccines.
Medicine can work miracles in acute and infectious diseases (as in malaria). However, various problems have arisen as a result of these developments, which allow life to be extended at all costs and prioritize life span over quality of life. Serious patients and their relatives began to experience painful experiences, and palliative care became a branch of expertise.
The old doctors who went to the patient's home and knew the family closely are left behind. The progress of science necessitated a high level of specialization. The old understanding of medicine, which saw the human being as a whole, has been lost. The human body began to be seen as consisting of independent parts, and each part was understood by a different physician. For example, a person visiting a gastroenterologist is reduced to an endoscopic view. Although it is possible to see the ulcer in all its details thanks to endoscopy, the social, cultural, psychic and economic conditions that cause ulcers remain outside the field of view of endoscopy. Another effect of specialization was that it provided physicians with great power and privilege. Physician authority has become much stronger. Patients became hesitant to even ask questions, and eventually, especially those with a chronic disease, felt uncomfortable with this authoritarian relationship.
Chronic degenerative diseases (rheumatic diseases, heart and brain diseases due to atherosclerosis, cancer, etc.) are the diseases that cause the most deaths today. The physician and hospital experiences of people suffering from these diseases can be as devastating as the disease itself. The patient, who cannot have a say in his life, becomes passive and needy and feels helpless. Often, they are forced to implement decisions made without taking into account their preferences and values and suffer the consequences of these decisions. This condition is as painful as the physical discomfort and limitations caused by the disease. This mood created by being sick makes it difficult to cope with physical complaints, and as physical complaints increase, helplessness and depression increase. In other words, a vicious circle occurs. Modern medicine has had a hard time breaking this vicious circle. Eventually, physicians began to question both the approach of medicine and their own approaches. Because doctors as well as patients complain about this situation. Modern medicine has not paid much attention to the philosophical approach that forms the basis of medicine for centuries, but it has become clear that it is not possible to get out of the vicious circle we are in today without the help of the philosophical approach. Thus, issues ignored by the technical approach, such as illness as a life experience, the meanings people attach to diseases, and the effects of these meanings on the healing process, have begun to be discussed and examined.
Mind-body medicine developed in this new era of medicine. It is difficult to define it as it is still developing and taking shape conceptually. It can be defined as "becoming aware of the relationship between the mind and the body and reflecting this awareness on medical practice", "accepting that thoughts affect health and acting accordingly", or even "accepting that there is no distinction between mind and body". These are not just philosophical approaches, but definitions that are examined within the framework of scientific understanding and based on as much material basis as possible. Since the definition is not yet established, the applications offered under this name may show some differences.
In daily life, we use expressions such as “my heart is broken”, “my heart is torn”, “my lungs are on fire”. We get cold sores on our lips because of fear, and we break out in hives because of boredom. We used to get tuberculosis because of our troubles, but now we get cancer. These expressions, which we all hear and use, show that we know the mind-body interaction. It is a concept familiar enough to enter our daily speaking language. We know but we are not aware that we know.
However, realizing that our thoughts affect our health can save our lives. This awareness saved Norman Cousins' life. Author and editor Norman Cousins told the extraordinary story of his illness in his book Anatomy of an Illness[1] . In 1964, at the age of 49, Cousins contracted an unnamed rheumatic disease. He is hospitalized with high fever and severe pain in his joints. He can hardly move any of his joints due to pain. When the doctors told him that there was no going back, that is, he would never be as active as he was before, he started to take control of his illness; In his own words, he decides that he “needs to do more than just be a passive observer.” He remembers the book The Stress of Life by Hans Selye, which he read about 10 years ago . In this book, Selye explained the negative effects of anger and resentment on body chemistry. Cousins thinks the opposite of Selye's observations is possible. In other words, it assumes that positive emotions such as love, hope, faith, laughter, and the desire to live can change body chemistry to cope with diseases. He decides that laughing is the easiest method. With the approval of his doctor, whom he has known for years and is a good friend, he settles into a hotel room, watches funny movies, listens to funny stories and laughs out loud. He sees that his pain, which can only be controlled with 38 various painkillers a day, goes away after laughing for 10 minutes, and he can sleep comfortably for at least 2 hours. After 8 days, the pain is almost gone. He compiled this experience into a book in 1979. Anatomy of a Disease quickly became a bestseller. In addition to writing, he begins teaching at UCLA (University of California, Los Angeles) as a biobehavioral sciences instructor. Cousins said the following about what he went through:
“As for what I conclude from all this: First, the desire to live is not an abstract concept, but a physiological reality with therapeutic properties. Secondly, his main duty is to support the patient's desire to live to the fullest; “I was very lucky to have a doctor who knew how to activate all the natural healing powers of the mind and body.”
Cousins goes to Africa and meets Dr. He interviewed Albert Schweitzer and later published a book about Schweitzer. He also mentioned Schweitzer in Anatomy of a Disease . Schweitzer, who introduced a witch doctor in Africa as his "colleague", stated that there is not much difference between his and the witch doctor's working styles and said: "Every patient carries his doctor inside him, but he is not aware of it. “The best thing we can do is to allow the doctor inside the patient to take action.”
The development of the mind-body interaction, which forms the basis of mind-body medicine, in the history of modern medicine is as follows: When our ancestors, that is, the people of the cave age, faced a danger, they had to attack, fight or flee to save their lives. Therefore, it has become vital for the body to prepare itself to attack or flee in case of danger. The changes that occur in the body in situations of danger have been shaped throughout evolution and carried down to the present day. These changes that occur in the body in response to stress were first drawn to attention in the 1910s by Harvard physiologist Walter Cannon (1871-1945), who is considered one of the pioneers of modern psychosomatic medicine. While conducting animal experiments on the digestive system, Cannon observed that the movements in the digestive system slow down and stop with emotional stimuli such as fear and tension, and start again after the animal calms down. He thought this might be due to a type of “attack or flight response.” When there is a matter of life or death, the body puts on hold activities that are not essential at the moment, such as digestive movements, and directs the blood it uses to areas of immediate importance, such as muscles. Cannon focused his research on this issue and determined what changes the body shows in response to stress.
Even though we do not encounter wild animals in our daily lives, other stresses we experience continue to cause changes that Cannon calls "emergency reaction". These changes prepare people to attack and escape. The tension of the muscles increases, the amount of blood flowing to the arms and legs increases so that they can work harder, the heart pumps blood faster, blood pressure increases, the respiratory rate increases to meet the body's increasing need for oxygen, and as a result, the metabolism accelerates, that is, the body works faster and consumes fuel faster. The nervous system and hormones work together to bring about these changes.
Another important contribution of Cannon to our subject is the concept of "homeostasis". This concept indicates that the body is always working towards finding its normal balance. This balance is constantly disrupted and reestablished by various internal and external elements. For example, our body temperature can remain constant regardless of external conditions. We shiver in the cold because our body narrows our veins to prevent heat loss and reduces contact with the external environment. When we run, we sweat because our body has overworked and overheated and gets rid of excess heat through sweat. Homeostasis refers to the internal communication of the body, that is, the cooperation of all systems. The balanced state of the body is the healthy state. The body tries to maintain this healthy state. In the 1930s, Cannon talked about the mind and wisdom of the body in his book The Wisdom of the Body, in which he explained the concept of homeostasis . The body's internal communication is one of the building blocks of mind-body medicine.
Another scientist who made significant contributions to the subject of mind-body interaction is Dr. who introduced us to the concept of "stress" in the 1930s. Hans Selye (1907-1982). He was the first to say that diseases such as high blood pressure, stomach and duodenal ulcers are caused by stress. As a result of his research, he decided that stress or tension plays an important role in the emergence of diseases. According to Selye, all kinds of stress constantly affect our daily lives, and our emotional reactions to the problems we encounter throughout life determine whether we become sick or not. Selye said that what makes us sick is not actually stress, but distress (negative emotions such as fear, anxiety, unhappiness in the face of stress). Selye, an endocrinologist, stated that neuroendocrine factors, that is, the nervous system and hormones, play an important role in many diseases, and that signals from the brain can change the functioning of the body by affecting hormones. Half a century after Selye's discovery, scientific developments regarding the functioning of the immune system and new discoveries in brain and receptor chemistry have shown how right he was.
In 1943, Swiss physiologist Dr. Walter Hess observed that when he stimulated a certain part of the brain in the cat, the attack or flight response occurred, and when he stimulated a different part, a physiological response opposite to the first occurred. Hess suggested that this second response is a protective mechanism against excessive stress and mobilizes the body's reparative powers. These studies earned him the 1949 Nobel Prize in Medicine.
It was understood in the 1970s that the anti-stress physiological response detected by Walter Hess in cats could also occur in humans. Dr. from Harvard Medical School While investigating the relationship between hypertension and stress, Herbert Benson found that blood pressure and heart rate decreased in people who meditated (deep relaxation), and oxygen consumption and therefore basal metabolism slowed down. This slowdown occurs more quickly than during sleep and may decrease to lower levels than during sleep. Unlike sleep, while REM is not observed during deep relaxation, alpha waves become evident in the brain and their intensity and frequency increase. It has been found that blood lactate levels also decrease significantly during deep relaxation. While the skin's resistance to electrical current decreases in cases of anxiety and tension, it increases significantly with deep relaxation. In conclusion, it can be said that deep relaxation has a unique physiology. Benson called this special physiological state the "relaxation response". Seeing that easy learning to elicit the relaxation response is important in the treatment of many diseases, Benson focused his studies in this field and became a pioneer of mind-body medicine with his clinical research. The book The Relaxation Response , written by Benson in 1975 , has sold more than 4 million copies in the past 25 years and has been translated into 13 languages. In the foreword to the 25th anniversary edition of the book, it is stated: “30 years ago, it was considered a blasphemy of science when a Harvard doctor and researcher suggested that stress could contribute to health problems and published studies showing that mental focus techniques were beneficial for the body. Today, no one doubts the existence of a multifaceted and close relationship between mind and body.”
Important discoveries regarding brain chemistry and receptors in the 1970s provided a partial understanding of how mind-body interaction occurs. In order to understand the subject better, it is necessary to briefly talk about receptors and neurotransmitters.
A stimulus is needed for the cell to activate. This is a chemical stimulus. A trigger molecule combines with another molecule in the cell membrane, called a "receptor". This event has been likened to a key entering a lock. When the appropriate key enters the appropriate lock, a series of chemical events begin within the cell and enable the cell to do work. Nerve cell triggers are called “neurotransmitters”. Nerve cells come into contact with each other and other cells through neurotransmitters.
For years, it has been thought and researched that in order for morphine and similar substances to be effective in the body, there must be a specific receptor in the cell for these substances. Finally, in 1972, as a result of the work of Pert and Snyder from Johns Hopkins University, this receptor called the "opioid receptor" was discovered. Since there is an opioid receptor in the body, the body should naturally be secreting a morphine-like substance that matches this receptor and triggers it. A few years after the opioid receptor was discovered, these natural substances were also discovered.
In 1975, the studies of Hughes and Kosterlitz from the University of Aberdeen in Scotland revealed the existence and structure of these substances. These are called "endorphins", which means "morphine produced by the body". The discovery of the opioid receptor and endorphins accelerated studies in the field of receptor chemistry, and the keys to the functioning of the mind-body relationship at the molecular level began to be obtained. Many new receptors and neurotransmitters have been discovered by clarifying the research methods that enabled these discoveries. It has been revealed that the body has an extraordinary communication network that operates through neuropeptides and their receptors. Thus, after the 1970s, a new era began in which emotions and behaviors began to be understood at the molecular level.
It was first discovered in 1981 by Psychologist Dr. The term “psychoneuroimmunology” used by Robert Ader has now solidified its place in medical terminology. When Ader used this phrase, it was believed that immunology, the body's immune system, worked independently of other systems. Ader experimentally demonstrated the interaction of the immune system with the senses, following a surprising experimental result that he came across by chance while working on a different subject. He gave mice a drug sweetened with saccharin that strongly suppresses the immune system. It was observed that the immune systems of mice that received this drug for a while were suppressed again when they were given saccharin alone. That is, the mind and body have established an association between the taste of saccharin and the suppression of the immune system, developed a kind of conditioned reflex and have not forgotten it.
Eric Kandel, who won the 2000 Nobel Prize in Medicine for his studies on memory, showed that memory occurs with the development of new synapses and that long-term memory requires the production of new proteins. Since the production of new proteins is related to genetic expression (genetic activation), Kandel's studies showed the effect of our life experience on genetic expression.
Although neurotransmitters are primarily produced in the brain, almost every tissue in our body produces or is triggered by these molecules. Thus, all systems in our body exchange information and communicate with each other thanks to neurotransmitters. These molecules govern our lives at the cellular level. The areas where neurotransmitters are produced most intensely are the parts of the brain related to emotions. Thus, every emotion we have, consciously or unconsciously, can affect our cells and physiology.
Through various neurotransmitters and receptors, information is exchanged between the brain, various organs and various cells; In this way, emotions, behaviors and body physiology can mutually affect each other. In 1984, Francis Schmitt, founder of the brain science research program at the Massachusetts Institute of Technology, called various neurotransmitters, neuropeptides, hormones, factors, and protein ligands “information molecules.” Candace Pert, who opened the door to receptor chemistry by discovering the opioid receptor, called these molecules "emotion molecules".
While all these studies reveal the mind-body relationship in a tangible way, they have also led to discussion of the idea that the mind is not limited to the brain. It has begun to be questioned whether the distinction between mind and body is correct. This can be seen as the beginning of a long-term questioning that can lead to significant changes in our view of life and our definition of ourselves.
The Mind Body Institute, founded at Harvard Medical School in 1988, has brought research results to the field of practice. Over time, similar studies have begun in other faculties and institutions. The institute's definition is: "Mind-body medicine combines modern scientific medicine, psychology, care, nutrition, exercise physiology, and faith with the aim of strengthening the natural healing capacities of the mind and body." This definition highlights the concept of "self-care", which can be translated as "taking personal responsibility for health, providing one's own care"; It includes meditation, visualization and similar practices.
In the White House TATP Commission report, meditation, hypnosis, purposeful imagery, dance therapy, music therapy, painting therapy, prayer and mental healing are included under the title of "Practices Based on Mind-Body Interaction".
By using various methods, the practices aim to ensure that the body learns to cope with stress, relaxes and activates its own healing power. Studies in the form of patient support groups are also among the practices in this field and are becoming increasingly common.
I believe that human relationships play a major role in activating the self-healing power, and that the patient-physician relationship has a healing effect on its own. I first learned about the existence of this effect from my patients. Later, I came across studies on this subject in various medical journals; all pointed to the importance of the patient-physician relationship in recovery.
Love, trust and faith are the primary factors that activate a person's healing power. If we can emphasize love instead of fear in our view of life and direct our lives, and if we can make our ordinary choices in daily life on the basis of love instead of fear, our health will benefit; I believe that we can help everyone we approach with love and care, whether we are doctors or not.
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