Minding our health

If chemo fails, there's always positive thinking, or so we'd like to believe. Medical historian Anne Harrington looks at our persistent faith in curing ourselves.

By Katharine Mieszkowski

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Jan. 26, 2008 | If you have ever observed a workaholic boss barking orders at an underling and thought, "That dunderhead is headed for a heart attack," you've dabbled in mind-body medicine. If you've ever told a sick friend to "think positive," implying that she'll feel better if she just stays focused on the bright side, you've ventured there, too.

Mind-body medicine is the belief that thoughts and feelings have the power to both sicken the body and heal it. In "The Cure Within: A History of Mind-Body Medicine," Harvard professor Anne Harrington traces the migration of this idea from the alternative-health margins into the mainstream. The chairwoman of the history of science department at Harvard University, Harrington is less concerned with debunking dubious theories about magically thinking yourself well than she is with understanding where these beliefs come from, how they shape our experience of illness and why they persist.

Her captivating survey ranges from 19th century hypnosis to 1950s self-help books about the power of positive thinking to contemporary efforts to understand what happens to the brain during meditation by hooking Buddhist monks up to MRI (magnetic resonance imaging) machines. New theories about the mind's impact on the body emerge and old ones are reconceived -- even stress turns out to be a recent invention -- as each era grapples to make sense of illness, and sick patients, let down by the medical establishment, seek out alternatives.

Salon spoke with Harrington by phone from her office at Harvard in Cambridge, Mass. Listen to a podcast of the conversation by clicking here.

What is mind-body medicine?

It's a lot of different things, and that's what makes it both interesting and controversial and why people fight so much about it. Mind-body medicine is a patchwork of ideas about the way in which we think that our minds make us sick, and might make us well. The big ideas influence how we think about disease, how we seek out different care for ourselves, even how we experience our bodies in health and illness.

Let's take one of those ideas -- the power of suggestion. When was its heyday?

The power of suggestion emerged in its modern form in the late 19th century around efforts to make sense of hypnosis, in which certain kinds of people, in response to the instructions of a powerful authority figure, like a doctor, would experience changes in their bodies -- they might sweat, they might become paralyzed, they might do ridiculous things. The interpretation was that they were responding to the instructions of this authority figure, that this was an interpersonal drama.

But the interesting thing about the power of suggestion in hypnosis is that it's an emergent product of a much, much older interpersonal drama that actually goes back to medieval times, the drama of the exorcist who exorcises demons from the bodies of possessed people and exerts control over the demon. It was felt that demons had to do what the exorcist said, just as we believe we have to do what the hypnotist says.

So the hypnotist is a secular version of the exorcist?

Yes. Maybe that helps to explain why there is still this frisson of anxiety and mystery around this kind of interpersonal drama. There's a deep historical memory of the more mystical or supernatural authority that these kinds of people used to hold over patients.

How does the power of suggestion exhibit itself today?

In our fears around placebos and the effects of placebos.

The placebo effect was initially understood to be powered by the power of suggestion. They're inert pills or tonics or powders -- why do they work? Well, they don't really work, but patients think they work, and they think they work because their doctors tell them they're going to work, and it's really just suggestion.

Since the early 1980s, our thinking about the placebo effect has undergone a sea change. We now think if you take a placebo, and you believe it's going to work, your brain is going to change, and that might in turn lead to a cascade of effects that will cause your body to heal faster.

Our thinking about the placebo has shifted from the power of the authority figure to the power of our own positive thinking?

That's how I see the history. There was a self-help book about the placebo effect that said the placebo effect is the good news of our time. You can be cured by nothing but yourself. So now we attribute the effects of placebos to ourselves and how our own brains change. We see it as an empowering thing, as opposed to maybe 60 or 70 years ago, when we saw it as evidence of our susceptibility, our vulnerability to the influences of others.

Where did this notion of the power of positive thinking come from?

Well, the deep roots lie way back in biblical promises that if you have faith, you can be healed through faith.

People said: "Look, if the Bible tells us we can be healed through faith, then why not really take it at its word, and cultivate faith?" Chant mantras. Visualize. Do all the things that we now think of as New Age tricks. These go back to the middle-to-late 19th century.

How is the power of positive thinking still alive today?

It's still very much alive around our belief that we can use placebos to heal ourselves. Yet the power of positive thinking actually, just a couple of months ago, received a setback. In December there was an article published in the medical journal Cancer that claimed [the researchers] had attempted to see whether or not emotional well-being and a particularly positive attitude had any influence on the course of cancer. There was no effect.

I think people hold onto this belief in the power of positive thinking because there is a kind of moral -- not only a scientific, but a moral -- persuasiveness to this idea that if you believe, and refuse to admit defeat, you'll be rewarded for that. The power of positive thinking has really taken hold in areas where there are no quick fixes in modern medicine. So cancer has been a very important area.

You write about how it was once thought that being in a support group could extend the life of a terminal cancer patient. Even though that notion has since been debunked by numerous studies, it still exists. Why do you think it's such a persistent idea?

Love heals. This is yet another story about how friends are the best medicine. Community heals us not just of that which ails our souls, but maybe of that which ails our body. And, to be fair, there is a fair amount of epidemiological data that suggests [community isn't just about] wistfulness or nostalgia over some vision about what life used to be like before we all became disconnected and lonely.

Epidemiological data suggests that people who are more embedded, who are married, who go to church, who claim to have more friends tend, on average, to be more resistant to the slings and arrows. They live, on average, longer. What has experienced a blow is the idea that you could operationalize this idea by turning it into a therapy for people who are already very sick. In other words, you could take heart patients or take people in an advanced stage of cancer and put them in support groups and give them the community that they should have had all their lives.

That you could institutionalize community.

Yeah, you turn it into a kind of medicine, and a 90-minute dose a week might extend a person's life. Originally, there was a clinical trial by David Spiegel at Stanford that suggested it was possible to do this. An initial study seemed to indicate that women with metastasized advanced-stage cancer who participated in a support group for 90 minutes a week lived on average twice as long as those who didn't. But he hasn't been able to replicate, and others have not been able to replicate.

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