MIND OVER MATTER Professor Glenn Wilson, Gresham College, London PSYCHOKINESIS Literally the capacity to influence the physical world by mind power alone (e.g., moving objects, influencing dice, bending spoons). No evidence for this that could not be explained by publication bias. Anyone with such powers would make a fortune in Las Vegas. Magician James Randi has offered $1million to anyone who can demonstrate it under properly controlled conditions – so far no takers. FIRE-WALKING Walking across hot embers is performed by Japanese priests as a purification and endurance ritual. Often regarded as a mystical mindover-matter phenomenon but explanation is physical – anyone can do it given the right conditions, without superpowers or incantations (often done on office “motivational” weekends). Dangerous though: Embers must be in late stages of burning and not contain metal debris. Need to walk at a steady pace, not run (which causes the foot to plunge too deep). HOMEOPATHY An “alternative” treatment based on theory that “like cures like” and the more dilute the better. Remedies often double diluted to point that no molecules of “active” substance are left - they are just water. Despite that, many feel better for various reasons (e.g., withdrawal of unpleasant medical treatments). THE PLACEBO EFFECT Placebo = “I shall please” Belief one is being treated and expectation of improvement will alleviate distress, regardless of any medical mechanisms (c.f., Mummy “kissing it better”). Prescribed by many doctors but seldom blatantly. Usually as vitamin tablets or mild, over-the-counter analgesics that might give some general benefit (thus averting ethical dilemma). PLACEBO COMPONENTS Many factors contribute to effect in clinical practice, including “bedside manner”, spontaneous recovery, regression to the mean (patients seeking treatment when at lowest point) and “hello-goodbye” effects. Drug trials try to minimise all but “true” placebo effect but usually unsuccessfully. (Schematic pie-chart from Ernst, 2007) PERCEIVED POTENCY Trappings of medical authority help (e.g., white coat, stethoscope, diploma). Enhanced by expense (e.g. Bayer Aspirin beats generic form). Large pills better than small; two better than one. Colour: “hot” best for stimulants, green for anxiety, blue for insomnia. Capsules more effective than tablets; injections beat both. SHAM SURGERY Despite ethical issues, bogus surgery (anaesthesia, incisions, declaring the op a success) sometimes as effective as real surgery. Studies include ops for angina, arthritis of the knee, spinal infusion for osteoporosis and neuronal implantation for Parkinson’s. Results show staggering placebo effects (c.f., psychic surgeons of Indonesia). PLACEBO RESPONDERS Trait optimism predicts placebo response (Geers et al, 2010). Ego-resiliency, altruism, straightforwardness and low anger/hostility predicted placebo analgesic effect (together accounting for 25% of variance) along with higher endorphin release and reduced cortisol secretion (Pecina at al, 2012). (Placebo response thus not down to stupidity, gullibility or “weakness” of personality). Effects, when observed in the brain, generally mimic equivalent active medication, e.g., placebo analgesia similar to effects of opiates (hence they are “real”). PET scans from Petrovic et al, (Science, 2002). ACUPUNCTURE Inserting & manipulating needles in various body areas reduce pain and stress in some sufferers. Difficult to find control procedures for true double-blind evaluation (hard not to notice you’ve been stuck with a needle). Differences between true and sham procedures are small – evidence that either exceeds placebo is unconvincing. Release of endorphins a better explanation than traditional Chinese theory of “meridians” and “energy balance”. NOCEBO EFFECTS Negative (noxious) effects on health also occur. Voodoo curses, pointing the bone, being bitten by a non-venomous snake, etc. can cause death by shock or selfwill (e.g., starvation). Chinese & Japanese regard No.4 as unlucky. Cardiac mortality peaks on the 4th day of each month; no such effect in White Americans (Phillips, 2001). Doctors have a moral dilemma about informing a patient their condition is terminal – some give up hope and die more quickly. HEADED FOR AN EARLY GRAVE? Feelings of well-being lower mortality in both healthy and diseased groups (Chida & Steptoe, 2008). People more likely to die just after a major birthday or holiday than before. People with +ve initials (A.C.E., V.I.P. etc) live longer that those with –ve initials (P.I.G., D.I.E. etc). Due to self-esteem? (Christenfeld et al, 1999). Catastrophes such as earthquakes and military conflict have cardiac consequences. When England lost a penalty shoot-out to Argentina in the 1998 World Cup hospital admissions for coronaries increased 25% (Carroll et al, 2002). PERSONALITY & ILLNESS Little evidence that personality is prognostic with respect to cancer proneness or survival, at least not extraversion, neuroticism, or suppression of emotion (De Vries et al, 2012). Hostility (one component of so-called Type A personality) predicts coronary proneness but effect size small and cause and effect unclear. Irascibility could be early sign of disease process. Better evidence for Type D Distressed) personality. Negative affect (anxiety, depression, anger) is associated with poor cardiovascular outcomes. IMMUNE FUNCTION Stressful childhood + current stress reduce ability of immune system to fight certain diseases. Fagundes et al (2012) found that child neglect combined with recent life stress led to increased vulnerability to basal cell carcinoma. BCC is common nonmalignant skin cancer, but same may apply to lethal cancers normally kept at bay by the immune system (e.g., melanoma and ovarian cancer). Cohen et al (2012): stressed individuals more likely to catch a cold when exposed to the virus (due to immune suppression). GUIDED IMAGERY Guided imagery is a kind of meditation in which patient’s thoughts are turned toward places that are safe, happy and relaxing. One approach is to picture the immune system gobbling up cancer cells and the tumour shrinking. Supportive in reducing stress, anxiety & pain but little impact on physical symptoms and no evidence that it cures cancer (Roffe et al, 2005). FORGET THE PAIN Mindfulness is an approach to therapy derived from Buddhist meditation. Argues that people are happier when their thoughts are focused on the present. (“A wandering mind is an unhappy mind”). However, depends on circumstances. In prison, or dentist’s chair, preferable to fantasize? Evidence that distraction, e.g., performing a difficult mental task, can be harnessed as analgesic in the treatment of chronic pain (Sprenger 2012). Marquis of Anglesey to Wellington at Waterloo: “By God Sir, I’ve lost my leg.” ELECTRIC ZEN Knowledge of results is a major principle in learning. Biofeedback works on theory that if person can observe their own physiological processes they are better able to exert control over them. Devices include EEG, ECG, skin conductance and skin temperature. Clear evidence that biofeedback is a useful adjunct to treatment of many conditions such as stress, hypertension, headaches, urinary incontinence (Yucca & Montgomery, 2008). “CONVERSION” DISORDER Psychogenic (hysterical) symptoms such as blindness, paralysis & amnesia are well documented. Famous case studies of Breuer & Freud but still occur today. May be difficult to distinguish from deliberate malingering and somatic causes. Signs include: (1) precipitated by extreme stress, (2) “belle indifference”, (3) secondary gain (4) retention of normal reflexes. A HELPING HAND Since hysteria (“wandering womb”) is more common in women, many psychiatrists considered sexual frustration to be the primary cause. Since masturbation was considered dangerous to health, mid-body massage became a favoured treatment approach - popular with patients and doctors alike. May have given some relief at a time when female orgasm was little recognised but today the doctor would be “struck off”. MESMERISM Origins of hypnosis are in animal magnetism. Mesmer initially thought effect was physical (c.f., electrical brain stimulation). Since it worked especially on “hysterical” conditions, soon recognised that the mechanism was suggestion. Patients were responding to his personal magnetism and persuasion. Freud favoured psychoanalysis because not all patients could be hypnotised. Amazed at how often female patients recalled sexual episodes with their fathers, he attributed hysteria to child sex abuse Anton Mesmer (1734-1815) found that (later revised this as fantasy/desire waving magnets across hysterical patients on part of patient). could alleviate their symptoms. MODERN HYPNOSIS Suggestions of sleep/relaxation, attention focus and compliance are used to induce a trance state. Suggestibility is a stable trait, not a mental weakness. “Good” subjects engage with the hypnotist and use imagination but seldom behave in ways grossly out of character. Used as therapeutic tool in dealing with common problems such as pain, anxiety, phobias and habit control (e.g., smoking). Effects go beyond simple role-play (more like total absorption in a movie) but little evidence for super feats of strength or memory. False recollections may be elicited (e.g. of past lives, alien abductions, child sex abuse). FAITH-HEALING Works best on conversion symptoms. Some “miraculous” cures have apparently occurred, dating from Biblical days. Still popular within Catholicism and “charismatic” (e.g., Pentecostal) churches. Pilgrimages to Lourdes are popular, where praying or drinking the waters are believed to heal the sick. Miracle cures are rare (Vatican has validated 67 out of 7000 claims) but many more might benefit from stress reduction and placebo. STIGMATA Crucifixion-style wounds have appeared in devout Catholics, since Francis of Assisi, 1224. Generally poorly documented. Some are fraud, some selfinflicted in trances during fasting. A few may be psychogenic purpura – purple blotches resulting from powerful selfsuggestion (c.f., markings of alien medical exams appearing under hypnosis). Appearance on palms rather than wrists owes more to mediaeval paintings than Roman execution procedures. Padre Pio, a celebrated stigmatic, canonised in 2002, was accused of using carbolic acid to create his wounds (Lazzatto, 2007) HYSTERICAL CONTAGION Mysterious illnesses strike throughout the world. After environmental toxins are excluded, are put down to hysterical anxiety. Symptoms include fainting, swooning, tics & paralysis. Victims typically socially cohesive teenage girls. Theatrical, attention-seeking (histrionic) individuals most susceptible. Social stress often implicated (c.f., Medieval dancing plagues & possessed nuns). Outbreak of fainting in a Kenyan school “THE TOWN THAT CAUGHT TOURETTES” A recent episode in the town of Le Roy, NY (2011) was subject of a Ch.4 documentary. Several teenage girls from the same school showed violent tics & convulsions. No plausible organic basis found but those affected seemed to have difficult life circumstances and feelings of neglect. Treatment with antibiotics helped some to recover but probably a placebo effect. LeRoy students present symptoms on TV chat show. THE INCREDIBLE SHRINKING MANHOOD Not only women affected. Outbreaks of koro (belief that one’s genitals are shrinking) occur sporadically in S.E. Asia, usually in times of social stress. Men may apply pegs or clamps to prevent total retraction (thought fatal). In W. Africa, outbreaks of penis shrinking and theft are attributed to evil magic. Those accused are likely to beaten to death (at least 14 penis-thieves were put to death in Nigeria in 2001). MIND MATTERS Mind and body closely intertwined. Few disorders purely physical or mental. Peptic ulcers were once attributed to stress alone. Then discovered that 80% involved helicobacter pylori. However, most people colonised by h.pylori are asymptomatic, so not just an infectious disease. Warts are due to viruses but often disappear mysteriously, so the “wartcharmers” remain in business. Seems that stress impairs immune resources that normally keep these disorders at bay. Psychosomatic effects are real, not imaginary – their action can be observed in the brain. Need to study interactions between mind and body in order to optimise treatments and benefit health.