|
The Connection (2014)
NARRATOR:
We're in the midst of a chronic illness epidemic. Sicknesses like cancer, heart disease and diabetes are sweeping the world. There's a one-in-two chance you'll end up with a chronic illness. It's likely you know someone or you are someone who is sick. Diseases our grandparents have never heard of are becoming common. Mental illness. Autoimmune disease. Metabolic syndrome. These are modern sicknesses. They're not infectious, but they are spreading fast. I think we've been seeing a stress epidemic in our society for decades now, and it seems to be only accelerating as the pace of modern life is increasing. It was always obvious to the ancient wisdom traditions that mind and body were interconnected. But somewhere along the line we sort of created a dichotomy as if they were separate. We came to believe that everything could be cured by drugs and surgeries, whereas, to this day, they can't. When we talk about much of mind-body phenomena, we're talking about the non-physical mind affecting the physical body. That's not allowed for in the Western scientific paradigm. And we now understand these concepts that were rejected by academic medicine. So, this is something that actually has enormous implications. Modern science has shown us that the mind has the power to heal. We should use that capacity. I was 24 when I got my first break in journalism. My life became focused on deadlines and chasing stories that took me away from my family and friends. Then everything changed. I was diagnosed with an autoimmune disease. One doctor warned I could end up in a wheelchair or with organ failure. Over the next six years I spent $30,000 on numerous specialist doctors, constant tests, drugs and alternative therapies. I was flat with fatigue and riddled with arthritis. No-one could tell me why my immune system was attacking my own body. But there was one thing I did know. The more I was stressed, the worse I felt. I knew there had to be a connection. On my journey to getting better I travelled the world to find answers, meeting some of the leading experts at the frontier of science, and tracking down people with remarkable stories of recovery. This is the film I wanted to see when I got sick. In the older days there was no separation of mind and body. In fact, throughout the world, many cultures have never separated them - in the East, for example. But our scientific approaches were so awesome that they overwhelmed any mind-body approaches or any mind-body potentials. In Western science, unless you see it, it isn't real. Unless you can measure it, it isn't real. And that's what allowed the huge advances in modern medicine and science - the ability to do these amazing things that we can do with cures today. And we now understand these concepts that were rejected by academic medicine because we didn't understand them. We understand them now in the language of science. And now where we're at is we can take these principles and apply them to clinical care, to the next phase, the next new frontier, which is integrative medicine. The body is always responding to whatever the mind tells it to do. So when the mind's tense, the body's tense. When the mind's happy, the body's happy. So the body is always responding, not just in ways in terms of our physical tensions, like the tensions of the muscles, but even right down to the very core of our souls, even what's happening in the level of our DNA. And what's really been interesting in the last five, 10 years is really understanding that it really is a lot of two-way connections. And there's a lot of molecules that we always have thought of as just in the body, and we're recognising that they actually also play roles in the brain, and that the brain can also influence the body at even a very cellular level. All these terms, I think, are approaching the same idea, that the mind is not separate from the body. In fact, my belief is that the only way you can really separate mind and body is verbally - that they're two aspects of the same underlying reality, or two poles of the same thing. Here's what we know about the mind-body connection. You may be familiar with the idea that your brain is like a central message centre, sending and receiving electrical and chemical signals all over your body. And now scientists are starting to understand that the communication between your brain and body is far more significant than they once realised. For example, over 60 neurotransmitter and hormonal receptors have been found on the surface of immune cells designed for fighting disease. Your brain has a direct connection to your body's first line of defence, and those cells can talk back. In another major breakthrough, scientists have discovered around 80 million neurons in your gut. They're calling it the second brain because while it talks to the brain it can also act completely independently and influence behaviour. So rather than there being a mind in your head, it's more like your mind is all through your body. But the easiest way to understand how your mind affects your health is by looking at stress. So if we think that we're... Imagine ourselves walking through a jungle, and out comes a tiger, and it's a very hungry tiger. We activate the fight-or-flight response. We've got to fight with the tiger or we've got to fly, get out of danger really fast. So if we think about this stress or fight-or-flight response as an activation response, like a turbo charge of energy, the body going into a different gear, then it makes sense. So the heart rate, the blood pressure, the blood vessels to the muscles open up to get all of this extra fuel, sugars and fats are pumping into the bloodstream, the respiratory drive kicks in in the brain. We start to sweat to keep ourselves cool while we're exerting ourselves. Our blood gets thick and sticky and will clot faster than normal, and the body pumps out inflammatory chemicals to activate our immune cells and to start mobilising for tissue repair. The attention centre in the brain lights up like a Christmas tree. This is a major physiological, neurological, immunological, metabolic change in our system. And it's designed to help us to adapt to a clearly perceived present-moment threat in the environment. And it's the kind of thing that's there to save our life, not to make us sick. Unfortunately, 99% of the tigers we're running from are the ones that are actually in our minds, not the ones that are really there. And when we do that over the long term, it produces an effect that's called allostatic load. It's a physiological wear and tear that we place on our system. It's like getting the car and just absolutely flogging it like crazy. And if you asked your mechanic, are your repair bills going to go up? He'd say, "If you drive your car like that, "your repair bills will go up "and your parts will wear out faster." It's pretty much like that with our bodies. My name's Craig Duncan. I'm from Sydney, Australia. I'm a nonsmoker, nondrinker. I'm active and exercise most days of the week, and have for a long period of time. I'm a vegetarian as well. I was working for a professional soccer team, in charge of the sports science. I was under enormous stress, and I had been for a long, long time. A lot of it's self-imposed - just rushing around at a million miles an hour. I was frustrated and unhappy in what I was doing, and that was difficult. I was struggling to sleep, or sleep well. And I just... Even though I might be healthy on the outside, exercising and that, it all became too much. I was at the gym and I was lifting weights, and at the time I didn't know anything had really gone amiss. It wasn't till that afternoon that I went for a run and got chest pain. And again, didn't think too much of it. But in the next couple of days I continued to try and run, and the chest pain got more and more, and pain down my arm and in the jaw - the classical heart attack symptoms. And that's when I realised that I had a real problem. When I went into emergency, even though the emergency ward was packed, they took me straight in. And when they did some tests, it was obvious that I'd had a heart attack. I had a spontaneous coronary artery dissection, and when I looked up the literature, there had only been 150 cases reported, and most people die. And that's...that's frightening. I had no risk factors. My cholesterol was normal and my blood pressure was normal. I'd recently had an ECG. That was OK. Never had chest pain. Didn't have any family history of heart disease. But yeah, I was under a lot of stress, and I think that contributed. There's no doubt about that. If I let my stress and my emotions get out of control and am not in control of my life, there's no doubt it could happen again. And I really am not ready to not be here. CRAIG HASSED: If you help a person to manage stress better then you significantly reduce the risk of a person having further cardiac events in the progression of heart disease. These are all reversible effects if we learn how to recognise the inappropriate activation of that response and learn to switch it off when it's not actually required. Then these effects will start to reverse themselves right through the body, and interestingly in the brain as well. HERBERT BENSON: And I think the major breakthrough was recognising that the body has a capacity opposite to the stress response. That's what we've called the relaxation response. We did an experiment in which we took people who meditated, and we found there were dramatic physiologic changes. And the essence of those changes are a decreased metabolism in the body, a quieting of the body. There's decreased heart rate, decreased rate of breathing, slower brain waves. So here was a reaction exactly opposite to the stress response. This now was science. Here was something measurable, predictable and reproducible. CRAIG DUNCAN: If you do not have your mind in some sort of balance it doesn't matter how healthy your body is. I really had to use breathing techniques and different forms of meditation that have helped me to just stay calm. That's it. But I suppose the overriding thing that's helped me to stay healthy and to decrease the stress, I have to pray regularly. If I'm praying, for me, it brings a calmness. It centres me. HERBERT BENSON: The two basic features of evoking the relaxation response are repetition and the disregard of other thoughts when they come to mind. And what those two things do is break the train of everyday thinking. And often that everyday thinking is what's stressful. It's not a real sabre-tooth tiger in front of you. It's your fear of losing your job, it's your fear of illness or what have you. Then we return to the literatures of the world to see whether these two steps that are breaking the train of everyday thinking had been described before. And every single culture of humankind that had a history had these two steps. There's a commonality. So if a person argues, "My technique, my religion, "is better for bringing this forth than another," it's foolish, because it's a bodily response. Just as there are scores of techniques that are stressful - same fight-or-flight response - so there are scores of approaches that evoke the relaxation response. One way scientists teach people to evoke the relaxation response is to train people to meditate by focusing their attention on just one thing. With practice they become inwardly aware and focused on the present moment. And now, with the development of modern brain imaging technology, researchers are starting to understand the biological mechanisms underpinning the practice. While to an outsider it looks like a person meditating isn't doing much, it turns out there's a lot happening in their brain. The really wonderful thing about MRI is that it lets us look at the human brain in a way that we couldn't before. Most of the work that we've done centres on how meditation can change the actual structure of the brain. So the research shows that a part of the brain called the amygdala gets turned down. And the amygdala is important for the fight-or-flight response. So when you see something scary, for instance, if you're walking in the woods and you suddenly see a snake out of the corner of your eye, your amygdala's going to alert you and say, "Oh!" and make you jump. And that part of the brain seems to get quieter as you meditate. And so this is consistent with a sense of decreased arousal and greater feelings of peace. Brain imaging technology is relatively new in the context of scientific discovery, and it's early days for mind-body research. But Dr Sara Lazar's Harvard study on meditating people has interesting parallels with studies recently done on mice at the National Centre for Biological Sciences. Researchers took normal mice and stressed them out for two hours a day. When they measured their brains they found the amygdala got bigger. After 10 days, they left the mice alone, but two weeks later they observed they were still acting anxiously. They measured their brains again, and although their stressors had been removed, they found the mice's amygdala were still large. This is the opposite of what we're seeing with people who meditate. Their life is exactly the same as it's always been. So they still have a stressful job, all the difficult people in life are still being difficult, but their amygdala has gotten smaller and they're reporting less stress. So it shows in both cases that it's not so much the environment but your reaction to the environment, and how you're relating to the events and the people in your life. And so it's not about changing your life, it's about changing your relationship to your life. My name is Jason Wachob. I live here in Brooklyn, New York. My back pain probably started in 1996, when I was playing basketball at Columbia. After I paid off the mountain of college debt that I accrued, I got into start-ups. I love being an entrepreneur and I love start-ups, but there's also the pressure that you're constantly trying to grow, and you're never growing fast enough. And you're trying to raise capital and you're trying to make money and you have investors and you're trying to pick up business. And it's a frenetic pace, and that can be stressful. I think I internalise stress. At least, that's what my wife says. So I'm not a yeller or a screamer. People think I'm very even-keeled, which I think I am, but I think I internalise it. I think most...a lot of people internalise stress, and stress manifests itself. And I think one of the ways it manifested itself for me, at this time of my life, was through my back. I would wake up without pain, and as soon as I got out of the bed, within five or ten minutes, I would have shooting pain. I could not walk more than a block without keeling over in pain. It started to wear me down, I think. And then you're stressed about the pain, so it's kind of a vicious cycle that you catch yourself in. I went to see two different doctors, specialists, and both of them told me I needed back surgery. However, the second doctor said, "You may want to practise yoga. That may help." He said... It was like an afterthought. So as a last-ditch effort, I started to practise yoga. The work that I do revolves around the clinic that I started 34 years ago now called the Mindfulness-Based Stress Reduction Clinic, or MBSR. I was having lunch with a bunch of dermatologists, and they were talking about some of their patients giving up on their treatments in the dermatology clinic, particularly patients with the skin disease psoriasis. And the treatment for it was a course of ultraviolet light therapy. We did a small randomised trial that compared people just getting the light treatment with people meditating while they were getting the light treatment and it turned out the meditators' skin cleared at about four times the rate of the non-meditators. And I didn't believe it. It was such a powerful finding. So we replicated it and tried to make a little bit more rigorous study design, and lo and behold, again the meditators were healing four times as fast as the non-meditators. And it is a beautiful example of the mind-body connection, because you're doing something with your mind and something is happening in the skin. So it just doesn't get any better than that. I think yoga is the perfect blend of mental and physical if you're doing it right. You're moving, and you're really paying attention to your breath. And for me that's just magical because yoga turns into meditation in motion, essentially. I basically twice a day, every day, for about 15 or 20 minutes in the morning and the evening I would do these four or five poses religiously every day. Like, I would just find a spot, and maybe do a third time or a fourth time, do what I needed to do. And it just started to work. After a week I started to feel better, and after three or four weeks I could literally start to feel my spine sort of move and work itself out. And then I started to take classes, and, you know, there's a great instructor here, Tara Stiles, who I started to go to her class, and she helped me, like, take it to another level. And the back pain's gone and it hasn't come back. Through practising with them, everything went away, and to me it's just... it's just magical. Like, I am sold on yoga and its healing power. JON KABAT-ZINN: I mean, that's one of the beauties of yoga. You get down on the floor and start working with your body in a kind of a way, systematically, over a period of time, and it's, like, you feel so good. It's like you didn't even realise. And it's not like callisthenics and it's not like, you know, intense aerobic activity, although it could be. But there's just this sense of, again, integration, that you are at one with your body, and isn't it amazing what it actually does? So a question I frequently get is, "Well, you know, meditation or yoga, it's about attention. "But what about other activities "that require a lot of attention?" So, for instance, like rock climbing or playing a musical instrument. When we look at brain activity during meditation, we find that many parts of the brain actually get turned off during meditation. Some areas are more active, but mostly there's a lot of turning off. The focus is really inward. So when you're running, people are wearing headphones, you know, or they zone out. Whereas with the yoga and the meditation you're really paying attention very closely to what's going on inside, and you really get really in tune with your body and with your mind. You really notice things that you didn't even notice were there before. The deep structure of these meditative - and I would include yogic - practices, they've been around for thousands and thousands of years. It's not the next fad. If they have value, they've had value for a very long time. That's why they've survived. And they really have to do with how we live our lives. So it's not like, "Oh, something else should come along "that will make this irrelevant." This is about as relevant as you can get, as long as the breath is moving in and out of your body. I think it's vital that people understand the power of the mind-body reaction. And it's best understood by most by recognising you have within yourself a capacity that's opposite to the stress response. And to the extent that stress is causing any disorder, be it the brain, the body, the liver, what have you, to that extent, by reversing stress's activity through the relaxation response, you can treat that. Does that mean you give up drugs or surgeries? Of course not. But you've got to bring this in to that same level of respectability, because now we're scientifically proven. When you think about your emotions, you may notice you don't feel them in your brain. You feel them in your body. Your face may flush. Your heart may race. Your stomach may flutter. These feelings are a result of chemicals and hormones released when your brain is in a certain emotional state. And now some researchers are starting to link these states to health outcomes. We know happy people live up to 10 years longer than unhappy people. If you're optimistic, You have about half the risk of getting heart disease than if you're more pessimistic. In one landmark study of 2,000 middle-aged men who worked at the Western Electric Company in the 1950s, those who had been emotionally depressed at the start of the study were twice as likely to have died from cancer 20 years later. While you might be thinking this is explained by happier people being more inclined to make healthier life choices, this research made allowances for smoking habits, alcohol intake, weight and cholesterol. Even age, job status and family history of cancer were factored into the results. Findings like this are demonstrated in thousands of studies published in peer-reviewed academic journals. My name's Ann Salerno. I'm a paediatric nephrologist, which is a physician who takes care of children with kidney disease, and I live in Hopkinton, Massachusetts. I was married at 33 years old, and about a year later we actively started trying to have children. And after a year of trying, really felt like there was some barrier and that we should look into going to a fertility specialist. All my testing was normal. All the signals were happening at the right time, and still nothing happened. About a year into my journey, one of our chickens was killed by a coyote in the backyard, and the other four chickens stopped laying eggs. It was really just a wake-up call that... Look at this simple animal model of a chicken, and how them feeling that there was danger and feeling stressed had affected their fertility and their ability to ovulate. The doctors that I had been to had not really attended to how this infertility treatment and journey had been affecting me emotionally. I didn't realise it was happening, but I started feeling more and more depressed. WOMAN: Women with infertility become very depressed and very anxious. And we actually published a paper that showed that women with infertility were twice as depressed as women who were fertile. So depression is really common in the infertile population. You know, you throw away the birth control, you try for a few months, you don't get pregnant, you start to get anxious and depressed about it. So even if the physical problem that caused the infertility at the beginning goes away or gets treated, the angst about not getting pregnant can then kick in and independently contribute to the infertility. CRAIG HASSED: Emotions have a profound effect on the body, for better or for worse. We shouldn't be one-dimensional about emotion, thinking there's only one positive emotion, and that's smiling and laughing, and if we're doing anything else, like feeling sad, then that's a negative emotion. We do have, like a piano, if you like... We've got a whole lot of octaves. We've got a whole range of emotions. And so there might be times when it's quite appropriate to feel sad, and if we express that sadness in a way that we feel comfortable with then that's not a negative emotion, that's a natural human emotion. It's really when the emotions, what's on the inside, gets out of step with what's on the outside, and then we start to wrestle with emotions, we start to wallow in emotions. We get caught up in negativity, caught up in self-criticism, caught up in anger, so that it lasts and lasts way after its use-by date. And that has a long-term and cumulative effect on the body that's not particularly healthy. MAN: It's a sobering thought, but it's true. Depressed people don't live as long. That's true with heart disease as well. If you're depressed and you have heart disease, you're not going to live as long as if you're not depressed and have heart disease. So it's a major risk factor with the major medical illnesses that kill us. People who are depressed feel hopeless, helpless and worthless, they may not exercise as well, they don't sleep as well. CRAIG HASSED: So the mind has its direct effects on the body by what we think - that mind-body relationship - but we also should consider how the mind affects our health via indirect means. So that is, the mind decides what we eat, whether we exercise, how we live. And so the state of the mind has profound effects on the body, both in the short term and the long term. DAVID SPIEGEL: And depression is something we can do something about. So it's a predictor of cancer outcome that we can have an effect on, and potentially affect disease outcome as well. We published an article in the 'Journal of Clinical Oncology' showing that the course of depression over a period of a year for women with breast cancer predicts survival time. So the women whose depression was getting better lived substantially longer than the ones whose depression was getting worse. And it wasn't just two months after we studied their depression, it was seven years later. And this prediction was independent of all the standard risk factors - oestrogen receptor status, progesterone receptor status, time from initial diagnosis to relapse, all of which are powerful predictors of outcome. This depression prediction was independent of that. Study after study has shown that people who are lonely and depressed and isolated and three to ten times more likely to get sick and die prematurely than those who have a sense of love and connection and support. And I don't know any single factor in medicine - not smoking, not cholesterol, not blood pressure - that affects our lives and our survival to that degree. ALICE DOMAR: If you look at the data that I've clocked in in my career on the impact of the mind-body program on fertility rates in infertility patients, and the fact the program costs a few hundred dollars and pretty much doubles pregnancy rates, yes, if you had a pill that did that, every infertility patient in the country would take it. ANN SALERNO: I learned about Ali Domar's mind-body program for infertility, and it sounded like exactly what I needed. Just going to the first meeting and seeing all these women in the room that looked like they were normal, and just looking around the room and saying, like, "I'm not alone. I'm not a freak. "I'm just, you know, "another woman that has a struggle like the rest of them." And that was just extremely powerful in terms of just turning my mood around and helping me to feel more optimistic about my life regardless of whether I got pregnant or not. After a period of using the mind-body techniques that I had learned, I felt that I would proceed to the IVF treatment. We ended up getting just one embryo, and that embryo took on the first try. And I did conceive, I got pregnant, and ultimately delivered my first child, my baby boy, Luke, who's now almost two years old. ALICE DOMAR: Most of my research is actually looking at the impact of the mind-body program on infertility patients. And we found the women who did the mind-body program, in addition to having much fewer physical or psychological symptoms, had a 55% take-home baby rate compared to a 20% take-home baby rate in the control group. So 55%, 20%. The research shows that if a woman feels stressed she continues to meet the demands of her family, her home and her job, and she lets go of her friends, which is the thing you need the most when you're stressed. And I think there's an expression that a crisis shared is half the burden. And so I think that's why social support is so important. In the 1960s a US town called Roseto was an anomaly in America. No-one under 55 had died of a heart attack or showed any signs of heart disease. The local death rate for men over 65 was half the national average. A team of researchers led by Dr Stewart Wolf considered whether this was because of their diet, location, family history or exercise habits, but on the surface nothing was different from the rest of America. In fact, the town was made up of Italian immigrants who worked in quarries and factories, smoked unfiltered cigars and had dinner tables laden with rich Italian food. Rosetans of the 1960s still held onto their old-world ways. It was normal to find three generations under the same roof. 80% of men in the town were members of at least one community group. They would gather in each other's kitchens, play cards and simply talk. The conclusion? Rosetans were nourished by each other. Over the next decade the multi-generational homes broke up. And by 1971, when opulent houses, expensive cars and swimming pools appeared, the first person under the age of 55 died of a heart attack. By the 1980s the rate of fatal heart attacks in Roseto was the same as the rest of the country. DEAN ORNISH: Many people don't have an extended family that they see regularly. They don't have two or three generations of people who live in the neighbourhood together. They don't have a church or synagogue they go to regularly, a job they've been at for many years. We all know that these things affect the quality of our lives, but they actually affect our survival and to a much larger degree than we had once realised. And so what we've learned is that it's not enough to focus on the behaviour, it's not enough just to give people information, we have to work at this deeper level. The number one most commonly prescribed prescription drugs in the US and probably most of the world have been antidepressants for the last 10 years, because there are a lot of depressed people out there. Now, a sceptic might say, "Oh, come on, give me a break. "You mean sitting around talking about my feelings will "somehow help me live longer if I've got cancer? Please." It's so easy to make fun of these ideas, how we're just so touchy-feely, you know. But we are touchy-feely creatures, we are creatures of community. That's how we've survived as a species, is by learning how to care and love and nurture each other. And we ignore those ideas at our own peril. ANN: I just felt a contentment that I had never felt before in my life. It was a feeling like if I never accomplished anything or never did anything special for the rest of my life, that it was OK. And...um, about five months ago I found out that I was naturally pregnant, which was very much a surprise, and that, uh, you know, it happened the way it was, you know... ..I always thought it was supposed to happen. But I think a lot of that has to do with, you know... ..sort of that you no longer have that inner stress, that inner angst. It's definitely another miracle in our lives. I think that as a physician I never was taught to appreciate sort of, um, how a patient is coping with an illness or coping with an ailment and how that interplays with their therapy or their success in their therapy. It just wasn't even mentioned. There are now more than 10,000 peer-reviewed academic papers looking at the science of mind-body medicine, with more research being published daily, and with it comes the molecular underpinnings of emotions and disease proving a mind-body connection. And yet in most conventional medical centres the mind is not a component in a treatment plan. Millions of people are being turned away from doctors' rooms with potentially curable chronic illnesses. Hi. My name's Scott. I was diagnosed with melanoma in 2000. I think, looking back, I was a bit of a worrying sort of person - not so much worried about myself or where I'm gonna be in 10 years... ..but I think I just worried about stuff. You know, a bit of a perfectionist by nature and... I don't know, I just probably obsessed a bit about my life, and how this worked and how that worked and whether that was a good way to do things and things like that. My doctor never gave me a prognosis. But I did ask him. You know, I said, "How unwell am I?" And... I think I said, "How serious is this?" And my doctor said, "It doesn't get any more serious." My doctor was happy to call me a terminal patient. You know, I was unwell. I had stage IV melanoma, and people with stage IV melanoma didn't get better. And my doctor said, "Well, look, you can have chemotherapy if you like, "but it's only got a 5-10% success rate." He said, "But that's all I've got for you." They offered me chemotherapy as a palliative treatment and that's all they had for me. I never looked to myself. You know, I just...looked to the medical system and whacked a drip in my arm and sat there and said, "She'll be right, mate." Like, that's the mentality that I had. But I wasn't right, because it kept coming back. I think there's an art in how you approach a patient. The words that a doctor uses have great power. I've written also about what I call 'medical hexing', which is the negative side of this, that many patients have been told by doctors in one way or another that they're not gonna get better. Often, doctors haven't, you know, meant to do that, and they may even be unconscious of the things that they've said, but I think this is an area that needs correction, that doctors need to be aware of how powerful their words are and to use them, you know, to promote healing rather than hinder it. DAVID SPIEGEL: Medicine used to be a trade. It used to be that you would apprentice yourself to a doctor and roam around with - mostly then - him, not her and learn the craft. At the beginning of the last century there was a report called the Flexner Report in the United States that said, you know, medicine should be a science, and so people started going to formal medical schools after university. But, I think, in an odd way, we solved one problem and created another because the old general practitioners, they understood the importance of emotional support as well as whatever medication or surgery you gave. So the oldest adage of medicine is that our job is to cure rarely, relieve suffering, and comfort always, and in the Flexner era we rewrote that job description to be that our job was to cure always, relieve suffering if you had the time, and let someone else do the comforting. MAN: We've started to look at the doctor-patient interaction and then, even more broadly, this ritual or theatre, even, of healing. What is it that we do when we prescribe a medicine, or see a patient about a surgery or even conduct surgery? What is in that environment and how does it affect a patient's brain? There's a couple of trials which have been done by a colleague of mine in Italy, Professor Benedetti, in the early 2000s, and they were able to look at post-operative pain with the drug morphine, and were able to show that morphine was almost half as effective when you didn't know you'd received it. In other words, the effect of a drug is a combination of the pharmacology of the drug and the effect of your brain knowing that you're having the drug and the therapeutic ritual of the drug administration. That component is the placebo effect, and that's what we're studying. ESTHER STERNBERG: What we're really talking about here is what has been almost misnamed 'the placebo effect' - the brain's own healing mechanism. And the reason it's misnamed is it's usually the placebo effect... The word 'placebo' is usually preceded by a four-letter word - 'just'. "Oh, it's 'just' the placebo effect'." Well, it's not 'just' the placebo effect. It's a very powerful effect that contributes about 30% to 50% of the effect of any biological cure. Belief is critical because belief has the ability to trigger part of the overall healing response, if you like. In simple terms, belief is part of why we get better. It's not the complete answer, but it's one part of any medical treatment, which is important. And that's both at a patient level - having belief - and at a doctor level - realising that belief is important. And the communication about some of these things with the patient is important as well. My name's Ian Gawler. I started off my working life as a veterinarian, but after just a couple of years of being in practice I got a swelling in my right thigh which turned out to be a very aggressive form of bone cancer. And so in the beginning of 1975 I had my leg amputated through the hip, and it got worse because less than a year later, the cancer reoccurred. Nobody on record had lived more than six months with that particular type of secondary cancer, and most people seemed to die within about three months. Being a veterinarian, I'd seen animals healing through their own natural agency, if you like, and so that set me off on this sort of quest for healing. And I was very fortunate because I was around in the early days of mind-body medicine when meditation was just starting to be used therapeutically, where nutrition was starting to be taken, by some people, seriously for its therapeutic value, and that whole role of the mind and emotions and health was being considered. As I was putting all this effort into getting well, I reached a point where I... ..it was very apparent that my mind was the limiting factor, because up to that point I'd been doing all these things that had the possibility of helping me to recover, but it became apparent at that time that I had some level of doubt about it. I was told about this Indian holy man named Sai Baba, who was revered in India at the time as a...as a divine incarnation. I must say, of all the people I met through my healing journey in terms of presence and in terms of fulfilling the expectation of what one would have of a really extraordinary holy man, he really fitted the bill. And he said to me very clearly, very directly, "You're already healed. Don't worry." And he'd sort of picked up on the fact that there was this doubt sort of there. And with doubt, you hang back a bit. And although from the outside I would have looked like I was very committed, very engaged with this whole healing process, I know - it was a fact - that there was this level of doubt there that was sort of holding things back. And through the agency of meeting him and the catalytic effect that he had and the sort of power of his presence, which is, like, what made him for me a true healer, I was able to actually switch that and I came away from there with conviction. And it didn't actually change what I was doing, but it changed how I was doing it in this quite deep and profound way. And so everything from then on I thought... You know, I came away, you know, thinking I'd really get well. In recent years the scientific line of inquiry has moved from being not if, but how, belief effects your health. And while the study of placebo responses still has a long way to go to influence the practices of conventional medicine, scientists are starting to uncover a physiological basis for placebo. Neuroscientists can see placebo treatments prompt chemical responses in the area of the brain that modulates things like mood, sleep and pain reception in a similar way to drugs. Research on the brains of people with Parkinson's disease has shown that placebos increase dopamine, a chemical that affects emotions and sensations of pleasure and reward. In a study of patients with irritable bowel syndrome, people got better even when they knew pills given to them were fake. These people were told their doctors felt the pills would help, and they did. This is a really important reminder that the therapeutic interaction between the therapist - any healthcare professional - and the patient, is important, and I think people have known that for years. And now we can, through placebo research, demonstrate that it's important because there's a clear biological manipulation or altering of...of symptoms. I think 'healing response' is a better term than 'placebo response', because in most doctors' minds, placebo responses... People only think of giving sugar pills and saline injections, so this is fooling patients, duping them in some way. And doctors don't like to see themselves as duping patients, and patients certainly don't want to see themselves as dupes. So I think to avoid all that I would tend to talk about these as mind-mediated healing responses. Now, it doesn't mean, you know, "I think I'm gonna get rid of my cancer "or my, you know, other major illness "and it's just gonna go away," but it does mean that the body's response to the insult of an infection or a tumour or something else may be modulated by central nervous system effects, including expectation and placebo. There's no way you can ever draw a line and say, "On this side are the intrinsic effects of treatment "and on this side are the mind-mediated effects." And not only is it impossible to do that, it's foolish to do that, because to me the placebo response is the meat of medicine - that's what you're trying to make happen. IAN GAWLER: It wasn't like I found some magic medical thing that fixed me or some alternative treatment that fixed me. I think if there's a magic bullet involved in my case, it was actually that sort of inner capacity for healing and activating that. After I recovered, a lot of people heard about my story and wondered what I'd done and whether it could be of help to them. And really, my story's got less and less significant in that sense because the real body of the work is the testament of all the people who've done these things over many years. A friend had mentioned the Gawler Foundation to me. Straightaway in this program, things started to make sense to me. You know, like, full light bulb moments. You know, I was motivated and I was keen to stay alive. I'd just got married. I was...I was 27. Like, I didn't want to die. And I made a lot of changes. IAN GAWLER: And I have no trouble in saying, "I don't care what the odds are. You're an individual. "You've got a body, you've got emotions, "you've got a mind, you've got a spirit. "It's possible that you're gonna recover." A lot of the people that I've helped that have managed to recover sort of in spectacular ways against difficult odds have found that point of conviction at some point in their own healing journey. SCOTT: They teach you about the effects of emotions on your body, your immune system, the importance of meditation, nutrition, having some sort of spiritual connection to whatever it is you believe in, all these things. And they're all things that you can do for yourself. So some people say that my... ..my healing is this miraculous recovery. But to me, it was... ..it was just hard work and perseverance. And belief. I believed these things, you know, were good for me. The easiest way to sum it up for someone is would I have got well without all these approaches like meditation and, essentially, looking after yourself? No. Would I have got well with just that and no chemical intervention? Maybe. But if you wanted to break it down, the drugs weren't gonna cure me, not by themselves. I was a terminal patient. I had stage IV melanoma. And here I am, cancer-free, 6.5 years later. Despite the overwhelming evidence that your mind plays a major role in both determining your sickness and wellness, there remains a major line of inquiry to explore - the role of genetics. Genes are stretches of DNA that sit in almost every cell in your body. They contain instructions for producing proteins that run every bodily function. We inherit half our DNA from each of our parents. And if your parents, grandparents or other relatives have an illness, you have a greater risk of getting sick too. I'm George Jelenik. I'm a medical doctor who is in academic medicine, and emergency medicine is the specialty I've been trained in. Mum was diagnosed with MS. So MS is multiple sclerosis, which is... ..which means that you've got multiple lesions, or little areas of damage, through your nervous system. Generally it's thought to be an autoimmune disease, so the immune system essentially attacks your own nervous system. And she deteriorated quite quickly. Within perhaps five years of diagnosis, she could no longer walk. And I remember her then coming to my medical school graduation in a wheelchair and having to be sort of lifted up the ramp to get inside to...to see me graduate from medicine. I'd done three years of residency as a doctor and I thought I would just take off and see the world and go for a few years. And in fact it was at my going-away party that I was rung to say that my mother had been found dead. She was intent on finishing her life perfectly rationally and...and reasonably because of what her life had become. And so she took an overdose and was found in the morning. There's a very strong genetic predisposition to MS, so if you have a first-degree relative who had MS, like my mother, then your chance is about 20 to 40 times the average chance of the rest of the population. And it was 1999, 18 years later, when I was 45, that I first developed symptoms of MS. We used to think that the genes you were born with are what you're stuck with and that's it, that it's set in stone. And it turns out that's not the case. You're born with the genes. The genes aren't gonna change. But the way they are expressed is very profoundly affected by the experiences that you go through. So often I hear people say, "Oh, I've just got bad genes. "It's all in my genes. What can I do?" Well, actually you can do a lot. For the last 36 years, I've directed a series of research studies showing what a powerful difference changes in diet and lifestyle can make not only in preventing disease, but actually in treating and often reversing it. We were able to show for the first time that we could slow, stop, or even reverse the progression of early-stage prostate cancer. We looked into some of the mechanisms to help explain that, and we found that over 500 genes were favourably changed in just three months. And, in fact, turning on the good genes that prevent these conditions and turning off particularly the oncogenes that promote prostate cancer in men, breast cancer in women, colon cancer and so on. And I think these findings are giving many people new hope and new choices that they didn't have before. So the bedrock principle of biology, that genes are fixed and unchangeable, has now been shaken to the core. Through the study of gene expression, scientists now know that your genes can be switched on and switched off. And while for the most part every cell in your body contains exactly the same genes, and that won't change, being exposed to external forces can flip the switch one way or another. By studying epigenetics, researchers also know that gene expression can be passed to the next generation. The way your great-grandmother lived could be affecting your health. And here, at the front line of science, there are major implications for mind-body medicine. Recently, research on the relaxation response was taken to a whole new level. Scientists at the Benson Henry Institute for Mind Body Medicine looked at the genetic expression of people who meditated. And the results revealed that meditation can flip the switch on genes affecting disease. But it's even, from my point of view, more remarkable than that, because the first time you evoke the relaxation response, these genomic gene expression changes occur. Now, what happens, the more times you do it daily, the more intense is the response, the more anchored it is, but it happens the very first time when you go through these instructions. That's incredible. That's absolutely remarkable. So what you're saying is that within minutes of doing a technique that evokes the relaxation response, we can change the way our genes are expressed? Yes. Yes. And that's... Now, there is a very important point here, namely, the more you do it, the more intense the response. That means the daily practice of these techniques is vital. Sure, you can get a benefit, but you can get so much more benefit if you do it on a daily basis. GEORGE JELENIK: To be diagnosed with MS was just an enormous... an enormous blow. I mean, it's impossible to really adequately convey how life-changing that is. At a stage when you've got a really young family and you've just been appointed to a really important new job, and things seem, apparently, to be going really well in your life, it's like an enormous hand just reaches in and takes your life away from you. In an instant it's just gone. I started thinking, "Why have I gotten sick? "Why did I get sick right now? "What is this illness doing for me? "What does it mean in the context of my life?" And so I...I had a path suddenly to explore. I'm no stranger to medical research in the job I do, so it was relatively easy for me to look through the medical literature and see what had been written about this illness before. And really the literature had so many clues about what causes MS and what makes it worse that it wasn't that difficult to put that together. I think I got sick, in hindsight, because everything in my life was really out of whack. It was really out of balance. And it was the exploration of that path, really, that led me to be well and keeps me well. For a long time, I wouldn't use the word 'recovery' because I thought... That doesn't even get discussed in medical circles, that it's possible to recover from MS. And I thought it was really sticking my neck out to say I'd recovered. But in fact, from what I've seen in my own personal experience now, I think it's perfectly reasonable to start a conversation about recovery from MS. Why not? It's just another chronic illness like many of the others we see in the West. Why couldn't you recover from that? If you looked at my life now, it is unrecognisable from my previous life. I live a pretty healthy lifestyle. So I exercise every day of the week, plus walking to work and back. I eat a plant-based wholefood diet, I eat a lot of fish, take omega-3 supplements, vitamin D. I'm perfectly happy to meditate with my colleagues at work. And, interestingly enough, the whole organisation at St Vincent's Hospital is starting to embrace meditation. When things go wrong, I seek counselling, I keep my diary, I've got some really good friends I can sit and talk to and really close family who really understand me. So, all in all, it's a whole lot easier for me to stay emotionally healthy now than it was in other parts of my life. If you looked at the kind of cards I was dealt, then I think the average person would have said that that's a recipe for... for a disastrous life. And yet I don't remotely feel like I'm living the kind of prescription that was delivered. It's real hope that you can end up perfectly well after 10 or 15 years with this illness. I mean, I have. Through the story of George Jelenik, a professor of emergency medicine, we have living proof that your wellness is determined by far more than your genes, that you can apply the latest science to change the way your chronic illness affects your life. But here at the frontier of mind-body medicine, it doesn't stop at gene expression. Thanks to the work of a Nobel Prize-winning team of researchers from the University of California, we know that high levels of stress affect the rate your DNA ages. They found, for example, that women with the highest levels of stress in their lives had about 10 years of accelerated ageing compared to low-stress women. They measured this by looking at telomeres. These are little caps that sit on the ends of your DNA strands, like the ends of shoelaces, and guard your genetic information. As you age, your telomeres get shorter, and the shorter your telomeres, the greater the risk of illnesses associated with ageing. Shortened telomeres have been linked to increased risk of cancers, heart disease and dementia. But it's not too late. A pilot study by Dr Dean Ornish has shown that even this is reversible. DEAN ORNISH: When people went through our lifestyle program, which included stress management, exercise, a healthier diet and more love and intimacy, their telomeres actually got longer, so their lives get longer. It's still the only intervention, including drugs, that's been shown to actually make your telomeres longer. And I think these findings are giving many people new hope and new choices that they didn't have before. CRAIG HASSED: I just think it's fascinating to be thinking you're sitting in a chair practising a mind-body technique like meditation and you're doing genetic engineering at the same time. I find that extraordinary. So how we feel and how we relate to ourselves in the world has an effect on our ageing through a whole lot of different mechanisms from genetics to physiology, for better or for worse, and things accelerate ageing and there are things that slow it down, and it's not surprising. Having good emotional health, coping well with demands of day-to-day life, leading a healthy lifestyle, slow it down, and the things that we associate with poor mental health and an unhealthy lifestyle speed it up. It just depends on how fast we want to burn the wick. But if there was a patentable product that had those kinds of effects we'd be all over it. We'd be spending billions of dollars on research and rolling it out in no time at all. It's been nearly 10 years since I was diagnosed with an autoimmune disease, a 3-year journey to make this film. I am not in a wheelchair. I am not on medication. I now see that when it comes to my health, balancing my mind and body is as essential as the air I breathe. And in a strange way I'm grateful for the illness because, like so many other people I've met along the way, it wasn't until I got sick that I realised I needed to get better. DEAN ORNISH: I can't tell you how many patients have said things to me like, "Having a heart attack "was the best thing that ever happened to me," or, "Being diagnosed with prostate cancer..." You want to go, "What? Are you nuts?" And they say, "No, that's what it took to get my attention "to begin making these changes in my life "that have made it so much more meaningful and beautiful "that I might not have ever done it otherwise." They're spending more time with their loved ones, they're eating and exercising more, so they feel better. And so for me that's what... I mean, we're all gonna die, so... More important than how long we live is how well we live. HERBERT BENSON: For health and wellbeing and to treat illnesses, of course we need drugs, of course we need surgeries, but we also need the power of the mind. Now we have the evidence-based proof that the mind can heal, and it should be added appropriately to drugs and surgeries. DEAN ORNISH: I've spent my whole life professionally documenting what a powerful difference these simple changes can make. You know, we think it has to be a new laser or something really high-tech and expensive - a new drug, a new surgical technique. We are trying to show that these very simple choices that we make in our lives each day have a powerful impact on our lives, much more and much more quickly than we had once realised, for better and for worse. JON KABAT-ZINN: Absolutely. We have much more to say over how healthy we'll be than our doctors, and how we do that whether it's though yoga, whether it's through meditation, whether it's through exercise, whether it's through changing our diets, whether it's through giving more... ..airtime to our relationships and appreciating that our relationships aren't, like, off to the side someplace. They're absolutely critical to how well we will feel. DAVID SPIEGEL: I believe in the power of group support. I have no doubt at all that it helps people live better. And we are not just splendid individuals. We define ourselves in part by the people around us and how they interact with us. And so I have no doubt at all that it helps people live better, and I think the evidence is accumulating that it helps them live longer as well. ALICE DOMAR: I know our mind and body are connected. I've had thousands of patients get pregnant. I know there's a mind-body connection. I've seen it, I've done research on it. It's a given. ANDREW WEIL: I think mind-body medicine is central to good medicine. In fact, you know, one thing I often say is that one day we'll be able to drop the word 'integrative' - this will just be good medicine. There is no doubt that the mind and the body are connected. There is no doubt that the brain and the immune system and the rest of the body are connected, and that when those connections are intact and in balance you have health and when they're broken you have disease. You can't always overcome your genes. You can't always overcome your environment. But with help, with an experienced practitioner who can help guide you, you can find the best formula to help your body and your brain to help you heal. |
|