If I had read only the first half of this book, I would have unreservedly recommended it. It is subtitled, ‘A Journey into the Science of Mind Over Body’, but it is more than that. It is also a book about the people involved in the journey – the scientists, the clinicians, but, above all, the patients. Their stories are told with great empathy and compassion.
The journey starts with the placebo and nocebo effects. We learn how powerful the placebo effect can be, but also its limitations. An understanding of it can enable people to be brought off excessive medication, but that understanding is still rare among health professionals, and resources are squandered in health systems. Nocebo effects are even less well known. We still don’t know the harm we may be doing by accompanying medication with long lists of side effects, and by publishing scary health stories in newspapers and on the Internet.
Giving a placebo presents a health professional with an ethical dilemma. Jo Marchand assures us this need not be. An ethical placebo, where the patient knows (s)he is being given an inert medicine, may still have beneficial effects. In a trial involving seventy children with attention deficit hyperactivity disorder a placebo was administered along with the effective medication. The active medication was then reduced, while the placebo was continued. Placebo- controlled dose reduction is still in the experimental stage, but promising results have been observed in patients with psoriasis and asthma as well as ADHD.
How we insist that diseases are either biological or psychological, and are unwilling to allow that they can be both, is illustrated by the reaction of a patients’ group, representing people with chronic fatigue syndrome, to a new experimental treatment. The treatment combines graded exercise therapy with cognitive behavioural therapy. It is based on the hypothesis that, if you suffer from CFS, a central governor in your brain has its settings wrong, and is overestimating how fatigued you are. Although the treatment has been shown to be moderately helpful, and better than any existing treatment, it is opposed by a patients’ group, which insists that the disease is biological.
I have no difficulty in accepting hypnosis as an effective treatment for pain relief, even as an anaesthetic, because I once saw a very powerful demonstration. With opioid addictions, and fatal overdoses described as ‘one of the great unfolding tragedies of our time’, I agree that hypnosis as a method of pain control needs to be given very serious consideration.
‘There is tremendous prejudice against hypnosis,’ says Peter Whorwell. He has been using gut-focused hypnotherapy to help patients suffering from the very painful and distressing condition, irritable bowel syndrome. Since 1984, he has been publishing results which show the benefit of hypnotherapy to patients for whom other treatments have failed. A recent audit of a thousand patients showed that 76% had a clinically significant reduction in symptoms. 83% of responders were still well after one-to-five years. 59% were taking no medication. 41% were taking less. 79% were consulting their doctor less often, or not at all. Although NICE now recommends hypnotherapy for IBS where conventional treatments have failed, Whorwell says that he and others involved in the work are still fighting those who fund treatment.
Our brains have a limited capacity for conscious attention, and distraction has long been recognised as a way of dealing with pain. Snow World is a very sophisticated form of distraction being used in Burns Units in the USA. When patients put on their virtual reality goggles and their headphones, they block out all sights and sounds from the outside world, and enter the Ice Canyon where they can fire snowballs with a computer mouse. Snow World consistently cuts pain scores by 35%. When used with pain medication, brain scans of patients show that activity in pain related areas is almost completely extinguished. When hypnotic suggestions are made, while the burns victim is immersed in Snow World, it is possible to extend relief from pain, and to aid recovery in the longer term.
In the first half of the book, which dealt with the application of mind-body research in a health care setting, it was not difficult to see where Jo Marchand’s sympathies lay. However, it was while reading the final chapters, which suggested ways in which research might be used to guide decisions about keeping healthy, that I began to feel slightly uneasy. Although Jo Marchand has a PhD in genetics and medical microbiology, and says she believes passionately in the scientific method, she seemed to be selecting research that agreed with her beliefs, and underplaying that which disagreed. These are very reasonable and widely held beliefs – that stress is damaging to health, that continuity of care and friendship have positive effects, that prayer and belief are beneficial to health. The problem for me was that some of the studies she quoted were preliminary and small. I can’t help being sceptical about studies on the epigenetic effects of social interactions, for example, and I feel she underplayed the harm caused to some people by mindfulness meditation. However this is a book well worth reading, a story of lost opportunities to help those in greatest need, but also with promise for the future.
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Customer reviews
An interesting book, good research and clearly stated
Reviewed in the United Kingdom on 6 November 2018
The quality of this second-hand book left a lot to be desired, with folded-over pages and a considerable amount of ballpoint underlining (see picture)
Reviewed in the United Kingdom on 6 November 2018
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