Therapeutic thought (book excerpt: The Cure Within)

Harvard professor Anne Harrington, PhD, explores the mind-body connection in The Cure Within: A History of Mind-Body Medicine.

By Anne Harrington, PhD, AMNews contributor. June 23/30, 2008.

Book Excerpt
A peek inside what's new on the shelves on topics pertinent to physicians.

In this first excerpt, Harrington, chair of the history of science department at Harvard University, looks at the medicalization of positive thinking and the role played by Norman Cousins.

The general sense that positive thinking was a fine ideology for self-help gurus and preachers but of no interest to serious medicine did not begin to change until the second half of the 1970s. Why then? In 1976, the editor of the Saturday Review and well-known liberal political analyst Norman Cousins authored a highly unusual paper that was published in the prestigious New England Journal of Medicine. The paper was called "Anatomy of an Illness (as Perceived by the Patient)," and it was an autobiographical account of a radical experiment in self-healing that Cousins had undertaken in the 1960s. Diagnosed by his doctors with a degenerative disorder called ankylosing spondylitis (which causes the breakdown of collagen, the fibrous tissue that binds together the body's cells) and given a grim prognosis (a 1 in 500 chance of recovery), Cousins had decided there was nothing to be lost and potentially much to be gained by jettisoning the procedures of conventional medicine and taking control of his own treatment.

Significantly, however, Cousins claimed to have taken as his starting point for his alternative treatment, not the works of Mary Baker Eddy or Norman Vincent Peale, but the laboratory research of scientists such as endocrinologist Hans Selye and physiologist Walter B. Cannon on "the negative effects of the negative emotions on body chemistry." Reviewing the findings of these men, Cousins put it to the readers of NEJM that they might have told only half the story:

What about the positive emotions? If negative emotions produce negative chemical changes in the body, wouldn't the positive emotions produce positive chemical changes? Is it possible that love, hope, faith, laughter, confidence and the will to live have therapeutic value? Do chemical changes occur only on the downside?

Cousins decided it was in his interest to find out. With the support of an open-minded doctor, he arranged to be checked out of the hospital and into a hotel ("I had a fast-growing conviction that a hospital was no place for a person who was seriously ill"), where he began to manage his own recovery. The sense of control this produced in its own right was, he believed, health inducing. "Since I didn't accept the verdict [of no recovery], I wasn't trapped in the cycle of fear, depression and panic that frequently accompanies a supposedly incurable illness." He took himself off all pain medications and put himself instead on a diet of steady positive effect: Marx Brothers films, reruns from the television show Candid Camera, and humorous literature.

The first evidence that the "laughter" treatment was working, he reported, came when he discovered that "10 minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep." This was just the beginning. Over a period of mere weeks, a combination of "the laughter routine" with massive injections of vitamin C led to a rapid remission of virtually all of his debilitating symptoms. The account he offered of his remarkable recovery ended with a description of himself -- who had once been nearly paralyzed -- standing in the surf in Puerto Rico, then jogging on the beach, and then finally back at work full time at the Saturday Review. This was a story as good as any to be found in countless New Thought texts since the turn of the century, but what gave it particular authority was that it was published in the most prestigious mainstream medical journal of its day. And it certainly did not hurt that the man who was telling the story was a prominent public intellectual. "If Joe Blow of Altoona" had sent in an article of this sort to the NEJM, fumed one of Cousins' rare critics, "it wouldn't even get the courtesy of a rejection."

That might well have been true, but it is probably also true that even a Norman Cousins might have had trouble winning a hearing in the NEJM before the 1970s. This is because in the 1970s, mainstream medicine felt itself under greater pressure from the general public than at any time since the late nineteenth century. There was a general sense that the medical profession now cared more about serving its own voracious professional ambitions than it did about serving the legitimate health needs of patients; and there was much discussion of the idea that in many cases medicine actually did more harm than good. As discontent intensified, the appeal of alternatives outside the mainstream also grew. These years saw an exponential growth of interest in meditation, acupuncture (recently introduced from China as one legacy of then-President Nixon's diplomatic efforts), jogging, herbal treatments, biofeedback, and more. Such treatments were widely seen as gentle, effective therapies, but also as sources of patient empowerment that could ultimately have a transforming effect on the doctor-patient relationship and hence on medicine as a whole. "Biofeedback promises to return us to a more holistic kind of medicine," proclaimed one typical article from the period, "in which the patient will acquire more responsibility for, and power over, his own health. ... Biofeedback puts the emphasis back on training, rather than the 'miracle pill' or surgery."

Against this backdrop, Cousins' sudden arrival on the scene looked like a lifeline to many in the medical profession. Here was a patient interested in exploring holistic alternatives to the mainstream, but who told the mainstream medical profession that he wanted to ally with rather than fight them.

~~~

This excerpt details how the small town of Roseto, Pa., appeared immune from heart disease and recounts research of psychiatrist Stewart Wolf, MD.

Wolf was determined to get to the bottom of what he would later call "the Roseto paradox." Teaming up with a sociologist named John Bruhn, he reviewed the history of the town, conducted extensive interviews with the citizens, observed their lifestyle over years, and concluded that there was one key thing that set Roseto apart from its neighbors. Unlike Bangor and Nazareth, Roseto had been settled early in the previous century by immigrants from a poor town in southern Italy who had traveled together from the Old Country to build a new life for themselves. On arriving in Pennsylvania, the newcomers "were forced by snobbish neighbors" -- towns settled previously by immigrants from England and Wales -- "to look out entirely for themselves, to support one another for survival and to form their own enclave."

And therein, Wolf and Bruhn believed, lay the unwitting source of the residents' good health. Denied the opportunity to assimilate, the newly immigrated Rosetans created an oasis of Old World values and customs in the heart of a rapidly modernizing America. Multigenerational homes were the norm, life revolved around the Catholic Church and various civic organizations, and everyone (in the words of Wolf and Bruhn) "radiated a kind of joyous team spirit as they celebrated religious festivals and family landmarks." People up and down the street all ate the same sorts of meals on a reassuringly regular rhythm (pasta on Tuesdays, fish on Fridays, etc.), and standoffishness or one-upmanship among neighbors was explicitly frowned upon. "The local priest emphasized that when preoccupation with earning money exceeded the unmarked boundary, it became the basis for social rejection." For this reason, "despite the affluence of many, there was no atmosphere of 'keeping up with the Joneses' in Roseto." All these factors together, Wolf and Bruhn concluded, were the secret to the town's heart-healthiness. Roseto was living proof, as they put it, of "the power of clan."

Even as those investigations were in progress, however, there were signs that all was not well in Roseto's Old World paradise. Interviews with younger Rosetans indicated that many in the new generation actually harbored more "typically American" dreams of a bigger house and fancier lifestyle, and increasingly resented and resisted the old ways. As one of these young people put it:

There is very little excitement. No industry, which is the reason for young college graduates to abandon this town. There is no place to get ahead. Other than the mills, there is nothing a person can do for a living. ... The children in Roseto have a chance for a good education, but it is hard to live in Roseto if you acquire a specialized education. All Rosetans have a higher goal, but old people want to keep things the way they are used to.

In 1963, reading the writing on the wall, Wolf made a bold prediction: if the new generation of Rosetans did indeed abandon the ways of the "old people," Roseto would cease to be a haven from heart disease. It did not take many years before he had the opportunity to test his hypothesis. Young people started marrying non-Italians, leaving the Church, moving into new suburban houses, joining country clubs, and taking up golf; some women even joined Weight Watchers! In the words of one observer, "It seemed like a capsulized, accelerated fulfillment of the American dream."

Was it worth it? Some of the younger Rosetans themselves admitted that their new, more typically American lifestyle came at a price. "Everything is modern here, very nice," one housewife told Wolf a little wistfully. "I have everything I need, except people. When we lived in town, the neighbors were always in my kitchen and I was always in theirs. We talked. We knew what was going on there and there was always someone around to help you and keep you from feeling lonely. I miss that," she concluded, "but I guess I will never go back."

What were the health implications of giving up neighborly chats in the kitchens for the sake of a swimming pool in one's backyard and a second car? In 1971, Roseto found out: the first heart attack death of a person younger than forty-five years old occurred in the town. And things got worse. In spite of new efforts by townspeople to cut down on smoking and fat consumption, coronary heart disease more than doubled through the 1970s, hypertension tripled, and there was a substantial increase in strokes. By the end of the decade, the number of fatal heart attacks in the town had risen to the national average. Wolf's prediction, it seemed clear, had come tragically true.

Roseto was and remains, for many, nothing less than a morality play that really happened; an apparent vivid illustration both of the power of healing ties and of the medical dangers involved in fracturing those ties.

Reprinted from "The Cure Within: A History of Mind-Body Medicine" by Anne Harrington. Copyright 2008 by Anne Harrington. With permission of the publisher, W.W. Norton & Co. Inc. $25.95. Note that the work appearing herein is protected under copyright laws, and reproduction of the text in any form for distribution is strictly prohibited. The right to reproduce or transfer the work via any medium must be secured with the copyright owner.

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