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Psychoneuroimmunology By Jay Quinlan Jay Quinlan owns and operates Global Learning Solutions Inc., a company which provides both individual and group therapeutic sessions within the Neuro Linguistic & Hypnotherapeutic processes. In addition, Jay provides training and seminars in related topics and communication skills and is a regular presenter at international conferences. Jay is a certified instructor with the National Guild of Hypnotists, the Florida Society of Professional Hypnotherapists, and the National Federation of Neuro Linguistic Psychology and an apporved school for the International Medical and Dental Hypnotherapy Association. If you wish to contact Jay you can do so at (416) 523.9720 / (519) 928.9624 or currently Email jay.quinlan@sympatico.ca A Brief History of the Mind-Body Medicine Hypnotherapy or Therapeutic Hypnosis Non-Allopathic Process are all Placebo This article looks at the controversial issue of mind-body therapy. In particular it will examine the relatively new science of Psychoneuroimmunology, its formation and its relevance to the medical community in finding potential cures for disease through the immune system. This article will also look at some of the alternative therapies, which have proven to be successful, and for which Psychoneuroimmunology provides a potential scientific reason for their success. "For this is the great error of our day that the physicians separate the soul from the body" Hippocrates A traditional view, still held by many scientists, is that the immune system is autonomous. That is to say that it is self-regulatory and functions separate and independent from the rest of the body. With the increasing focus on the relatively new science of Psychoneuroimmunology (PNI) these old views are becoming less legitimate. The name Psychoneuroimmunology was provided in 1975, by Dr. Robert Ader, director of the division of behavioural and psychosocial medicine at New York's University of Rochester. Dr. Ader believes that there is a link between what we think (our state of mind) and our health and our ability to heal ourselves. In particular, this was borne out in a study conducted by Dr. Ader and his colleagues which showed that it is possible to classically condition the immune system. The experiment that caused this development consisted of feeding mice with saccharin while simultaneously injecting a drug that caused upset stomach. By association, the mice learned to avoid the saccharin. An additional side affect of the drug used was that it suppressed the immune system. When the experiment was repeated without the drug to reverse the aversion Dr. Ader found a high proportion of the mice formally injected died when receiving saccharin alone. Dr. Ader hypothesised that the conditioning had been so successful that saccharin alone suppressed the immune system enough to kill the mice. It is possible then, that when there is stress on the organism, mental or physical, that there is a corresponding link between the two. That is to say, if a person has a mental state of depression, this state can be interpreted by the body to produce lethargy and other corresponding ailments. Conversely, if the body is diagnosed as ailing from a serious disease, i.e. cancer, a negative mental state may ensue. By conditioning the immune system through mental processes a connection in communication has been made. Providing the patient with some feeling of control over their circumstances may create a positive outlook and attitude. Some believe that this may, "Inoculate against disease and act as a valuable supplement to conventional medical care." Psychoneuroimmunology then is the scientific field of study investigating the link between bi-directional communications among the nervous system, the endocrine (hormone) system, and the immune system and the implications of these linkages for physical health. This article will look at the history behind Psychoneuroimmunology, and the different sciences that make up Psychoneuroimmunology. It will also look at the research behind these sciences and the different therapies, including hypnosis that compliment these studies. In addition, the notion that all non-allopathic medicine is placebo response will be discussed. A Brief History of Mind-Body Medicine: There is, and has always been, much controversy over the mind and body connection. It is interesting how the history affected medical philosophies causing the dichotomy between eastern and western medical cultures. Looking at the ancients, one can see a strong connection in their beliefs that the mind and the body should be treated as the whole. Hippocrates, often referred to as the father of medicine, would caution against not including all of the possibilities in healing. In Chinese medicine the belief is held that certain organs of the body represent various mental or emotional conditions. In addition, a lot of connections are made to nature, through energy meridian lines and hands on manipulation (accupressure). The practitioner will take the time to look into the person's life and see what is happening that may cause a change in the 'balance of the organism within their environment'. Knowing what psychological situations are going on in someone's life becomes important when deciding upon what course of treatment to follow. In the present day western system, the doctor spends only as much time as needed to generally inquire about the symptoms of the ailment, and then to prescribe a particular medicine. This system is derived from the philosophies of Rene Descartes in the seventeenth century. Descartes believed 'there are two distinct and separate substances in the world: matter, which behaved according to physical laws, and spirit, which was dimensionless and immaterial'. A belief that these were the differences of spirit and body and that the two were totally unrelated became the philosophy of the day. And so it became that the western culture accepted that pathogens were the cause of all disease. This theory was substantiated in the late nineteenth century by a study of Robert Koch, a German doctor who injected the disease anthrax into healthy sheep and noticed they too contracted the disease and died. From this, 'Koch theorised that every disease had a simple, specific cause: germs'. In the 1920's, Dr. Walter Cannon, a professor of physiology at Harvard University, looked at the need for mental and physical balance throughout the organism and coined the term, "Homeostasis", from the Greek word homoios, meaning similar, and stasis, meaning position. It was his studies into the relationship between the effects of emotions and perceptions on the autonomic nervous system, namely the sympathetic and parasympathetic responses that initiated the recognition of the 'fight or flight response'. Following on Cannon's work was that of Hans Selye. Selye experimented with animals putting them under different physical and mental adverse conditions and noted that under these conditions the body consistently adapted to heal and recover. He referred to this as the general adaptation syndrome. Selye also noticed during this adaptation the thymus and other major organs of the immune system shrank. In these studies it was found if the stress of the environment was continued then the immune system reduced and the animal would be overwhelmed and die. These studies validated the path for the connection between emotional states affecting physiological behaviour and states. Current Research in the Field: Research continued in the area of molecular communication between the mind and the body, this however was often seen as unwelcome by the existing science community. Research over the past twenty years has seen the development of Psychoneuroimmunology, which is based primarily upon the neuro sciences of the central nervous systems, the neuroendocrine system and the immune system and their inter-relationships. The central nervous system is a huge array of connections throughout the body incorporating sympathetic and parasympathetic systems. It allows the brain to send information throughout the body via chemicals generally referred to as information substances (IS). It was once thought that the brain sent out these information substances to respond to the various problems in the body and that the communication was that of a one way direction. What has become clear is that the central nervous system virtually controls the body's defence mechanisms. This being said, "Every thought, emotion, idea or belief has a neurochemical consequence". These natural chemical messengers, called Neuropeptides, were at one time thought to be found in the brain alone. Pioneering research by neuropharmacologist, Candice Pert, revealed that these neuropeptides are present on both the cell walls of the brain and in the immune system. These information substances affect our emotions as well as our physiology. These cells of the body have their own receptors on the surface that act like satellite dishes. These receptors receive the chemical information substances being released by the brain and sometimes return messages at the appropriate times. Pert believes that peptides probably provide solutions to every medical problem. As these complex messengers travel throughout the body they provide vital information and sometimes almost instant physical feedback. If you have ever encountered something unpleasant, possibly by surprise, you may have found yourself instantly shivering, then literally shaking off the feeling produced. This is a simple example of how fast the information can be transmitted from thought to physiology. The emotions we create are just that, created. This requires input from the brain. The centre for the brain that deals with emotional issues is the limbic system and in particular the hypothalamus. The discovery by Candice Pert, that neuropeptides and neurotransmitters are also on cell walls of the immune system shows a close association with emotions and suggests that emotions and health are deeply interdependent. Showing that the immune and endocrine systems are modulated not only by the brain but by the central nervous system itself has had an impact on how we see disease and how its created. For its part, the endocrine system is a series of hormone secreting glands that themselves moderate the function and balance of the body. Primarily the pituitary, thyroid and adrenal glands send these hormonal chemicals to regulate the function of other organs. Using this network of transmitters and receivers the body is in constant adjustment to ensure balance. The balance is kept as long as the immune system is functioning optimally. The immune system is literally on patrol throughout the body and is a complex surveillance system. The immune cells, called Lymphocytes (white blood cells) are the keys to the immune system. Produced initially in the bone marrow of long bones, some of these cells known as stem cells will migrate to the thymus where they multiply and are known as T cells. Those cells that remain in the bone marrow mature to become B cells. Each attacks the enemy in different ways. Circulating the body, when these antigens are discovered an army of appropriate cells (antibodies) is produced to attack the invader. To prevent this army of cells taking over, they in turn are suppressed and attacked. On this continuous patrol, natural killer (NK) cells attack and destroy cells that are produced by the organism which are mutated or abnormal. It is this action which prevents most people contracting cancers or other immune deficient problems such as A.I.D.S. Research has indicated that an inextricable chemical link exists between our emotions, which includes all stress in our lives, both good and bad, and the regulatory systems of the endocrine and immune systems through the central nervous system. This research emphasises the importance of expressing our emotions both verbally and physically in an appropriate way. When strong emotions generate fear, anger or rage and these are not expressed in a healthy way then the body's natural response is that of the sympathetic nervous system as demonstrated in Cannon's research on homeostasis and the fight or flight syndrome. At this point, inappropriate storing of these stressful emotions produces an excess of epinephrine. This excess of epinephrine causes a chemical breakdown, resulting in internal weakening of the immune system and an increased potential for disease. For all of the research that has been conducted and continues to be conducted, this new research is not without its detractors. In 1985, Marcia Angell published an article in the New England Journal of Medicine on the new science of Psychoneuroimmunology in which she labelled the science "folklore". She stated that, "No one had unequivocally shown a state of mind can cause or cure a disease". Imagination is more important than knowledge, for while knowledge points to all there is, imagination points to all there will be. Albert Einstein The application of this field is truly cross-disciplinary and is readily available to the public. There are many techniques and they may be used by a variety of professionals. These professionals include: medical doctors nurses, naturopaths, osteopaths, Chinese medicine and Chiropractors for the body model and psychiatrists, psychologists, psychotherapists, social workers, hypnotherapists and counsellors for the mind model. It now becomes a choice for the individual as to whether they attend these mind-body therapies used by a traditional medical person or a practitioner from one of the complimentary systems. While the systems purporting to deliver mind-body therapies are many, this paper will restrict itself to an overview of some of the most popular and those with recorded successes. Guided Imagery or visualisation, is a process that involves the use of symbols to imagine the changes the individual desires takes place. Patients who enter this therapy are encouraged to relax and imagine a journey described by the practitioner. This may include having the patient imagine that their problem is like many other things that they know to be true but curable. An example of this would be relating the body's abilities to send the appropriate healing to a cut on the hand. No thought is required for this to happen, it happens naturally and therefore those learning's from that natural state can be transferred to the presenting problem. In fact, while visualisation has been used for many centuries, it gained a lot of attention in the early 1970s when cancer patients were encouraged to use it to fight cancer cells in their bodies. A direct approach could be to have the patient imagine the cells of their immune system attacking the active problem or cancer cells and watching the cancer cells being subdued. Scientific research has looked into guided imagery. Dr. Richard Smith, a psychiatrist at the University of Arkansas, conducted one such study, for Medical Sciences. In this study a woman who had had the virus chickenpox and had a natural defence mechanism to it, was injected under the arm with the virus. The resulting swelling at the site of injection and its later disappearance was the expected result of someone whose immune system was working well against the virus. This was confirmed by blood work showing an increase in her white blood cells responding to the virus. Over each of the next three weeks she was injected again and each time she was instructed to use imagery to reduce the size of the swelling. The result was a smaller swelling with each subsequent injection and a corresponding reduction in the white blood cell count required to deal with the virus. In the final analysis, the woman was instructed to return her immune system to normal. Further injections resulted in the original response. This experiment showed that guided imagery could have an affect on the immune system. Researchers believe that visualisation may reduce stress, thereby boosting the immune system and helping the body fight disease. It may give people a more positive outlook, an important benefit on its own. The word "biofeedback" was coined in the late 1960s to describe laboratory procedures then being used to train experimental research subjects to alter brain activity, blood pressure, heart rate, and other bodily functions that are not normally controlled voluntarily. The most common forms of biofeedback today are the electromyographic (EMG) and the electrodermal (EDR). These sensors allow the person to monitor their own muscle relaxation, heart rate, breathing patterns and perspiration and concentrate on changing it through either the visual or auditory information provided by the equipment. In initial studies, some scientists believed that a day might come when biofeedback would provide a major degree of control over our bodies. With people exerting their "will" they thought it might be possible to change the patterns of our brainwaves to create healing without drugs which produce often unpleasant side affects for patients with high blood pressure. It is recognised by most scientists that eliminating the need for drugs by this method is unrealistic. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. Most patients who benefit from biofeedback are trained to relax and modify their behaviour. Most scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those disorders induced or aggravated by stress. Disorders that have been successfully controlled with biofeedback, include anxiety, migraines and Raynauds disease and syndrome. Hypnotherapy or Therapeutic Hypnosis The use of hypnosis to assist individuals in their own healing is not a new concept. Franz Anton Mesmer, in the 1700's believed in animal magnetism and through his practises the term, Mesmerism and its therapy came into being. Mesmer had a successful practise. A Royal Commission later discredited him in France, this commission included Benjamin Franklin and Joseph Guillotine. They found no scientific evidence to support his claims and believed the successes were a result of expectation and suggestion. It is interesting that they thought he was a charlatan, and yet, their conclusions found the basis of hypnosis. It was much later in 1843 that the British surgeon, James Braid, utilised Mesmerism to operate without anaesthetic. Due to the similar appearance of sleep, Braid named this state Hypnosis from the Greek hypno, to sleep. Today the medical community sometimes uses hypnosis but more often specialised hypnotherapists, who fall within the increasing field of complimentary health, utilise these processes. Hypnosis is probably one of the most researched modalities and yet because much of its success cannot always be repeated in the laboratory, the scientific community has seen its use as merely a placebo irritant. Recent breakthroughs in Psychoneuroimmunology studies now give increasing evidence of the connection between mind-body communication and the rationale as to how hypnosis plays a factor in this. There are as many different definitions of hypnosis as there are beliefs about how it works. The previous examples of 'Guided Imagery' and Biofeedback' are inclusive in the hypnotic process. It is interesting to note that many people have a misconstrued idea about hypnosis and it is this that promotes fear and mistrust about being controlled. A simple description offered by Dr. Karen Olness M.D., of Case Western Reserve University, is, "A form of self-induced, focused attention that can make it easier for you to relax or control your body's functions." It is generally known that our bodies require two states during a twenty four hour period, that of wakefulness and that of sleep. This is called our Circadian rhythms. Recently, research has indicated our bodies naturally go through rhythms during the day, which create a 'break response stimulus'. These rhythms are referred to as "Ultradian rhythms" and generally are about ninety minutes to two hours in length. During this period the mind-body pauses and turns inward to focus on its healing. Modern Hypnotherapists utilise these natural Ultradian rhythms to assist the patient to create a mental link between their required goal and natural physical abilities to heal. To achieve this the patient is guided by the therapist to a relaxed state, which allows for a communication to the unconscious mind. It is at the unconscious level that many conditions and thoughts exist, which are out of reach to the conscious mind or that the conscious mind is ill equipped to deal with. What Psychoneuroimmunology provides us is a blue print of cellular and molecular communication between mind, body and gene which takes hypnotherapy out of the realm of magic and into a psychobiological reason for success. Non-Allopathic Process are all Placebo: Placebo, from the Latin, meaning, "to please" is now commonly recognised as a false medicine. The medical community have for years prescribed placebo to people they feel are considered hypochondriacs. It is interesting that three elements need to be in place for a placebo to be effective: 1. A positive expectation by the patient. 2. A positive expectation by the health care provider. 3. A trusting relationship between care provider and patient. Based upon what has already been discussed, it appears that this basic criterion is the foundation of proven Psychoneuroimmunology. "Some doctors now believe that the placebo effect is due to a response within the mind and body that strengthens the immune system and speeds healing." Rather than writing off non-allopathic processes, the scientific community is indicating to the medical community that the thoughts and emotions of the patient can be in and of themselves, enough to generate good health. With this in mind, all methods of complimentary health can be looked at with a different and more open viewpoint. While some modalities certainly appear to have no scientific or logical reason for their success, it is too easy to condemn them as fringe or charlatan practises without research. The purpose of this article has shown that the new science of Psychoneuroimmunology presents solid information about the communication link that exists between the mind-brain and body. Certainly evidence has been established that supports the idea of some illnesses being contractible or aggravated by psychosocial pressure which induces stress in the organism. It is too simplistic to believe that all diseases have their basis in emotions but a growing number of experts believe that some diseases are emotional, as opposed to organic in origin. A sense of loss of control over ones situation can lead to a loss of normal homeostasis. When this happens, our immune system is weakened making it easier to contract disease. While it is certain that the biological, allopathic approach has made amazing advances, its limitations lay in not capitalising on the patients emotional well being from a humanistic approach. A complimentary approach would appear to be best for the patients well being. This would require a huge paradigm shift for the present way in which the medical community completes its business. There are some associated dangers in the Psychoneuroimmunological approach. Regardless of which modality is selected by a patient one thing becomes clear. A strong trust and expectation develops between the patient and the therapist. This leads to suggestions from the therapist being excepted readily, and without in some cases, examination by the patient. This is especially true if the modality used is hypnosis, which is working with the unconscious (non-analytical) mind. Regardless of the modality it seems for some people the view of a person in authority is accepted without question and therefore their word becomes very powerful. While this is what makes positive changes and healing possible for some, a misplaced or ill-conceived statement could have an equally negative response for others. In this respect, while caution should be placed upon overly optimistic comments, negative truths can result in a helplessness, which can cause vagal death in some seriously traumatised patients. As discussed, there is not a therapy as such called Psychoneuroimmunology but rather the science itself. The applications are within other therapies that fit the concepts and beliefs associated with Psychoneuroimmunology. For those who wish to explore a career in the sciences that make up Psychoneuroimmunology, it is now a part of many universities curriculum. One of the leaders in this field is the Centre for Psychoneuroimmunology at the Department of Psychiatry at the University of Rochester, New York. These courses are under the directorship of Dr. Robert Ader, founder of the science of Psychoneuroimmunology. Others who wish to practise in the field with patients need to assess which modality they first wish to train in. Most of the modalities can be trained from within and from outside of the medical community. People who wish to train as therapists have to be vigilant to ensure their training is both appropriate and accredited by recognised organisations. It has been said, "The human body can be conceived as a five million year old healer, with a pharmacopoeia of neuropeptides, neuroendocrine secretions and immunological restoratives that maintain and enhance health." If that is so, then Psychoneuroimmunology is a science that truly has laid the groundwork for many complimentary health care approaches, especially hypnosis and Neuro Linguistic Programming, to have a validated scientific support. The benefits are many as it supports the premise of a health care without always turning to drugs. All of the modalities which utilise the science of Psychoneuroimmunology are non-invasive and return an element of control to the patient for their own health and welfare, in a world where the individual often feels a loss of that very control over their own lives. Psychoneuroimmunology is a new field and requires more research. In 1985, there were no Psychoneuroimmunology listings cited in Medline, the worlds largest medical database. Between 1995 and 1997 over one hundred publications were posted. Despite this increase, further research needs to be conducted in the laboratory and in the field. Unfortunately, there are too few researchers who have interdisciplinary training and experience to make the connections between psychology, immunology, and endocrinology. The challenge that lies ahead is to further substantiate that the immune system can indeed be enhanced through thoughts, belief, emotions and behaviour.
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