I have the conviction that when physiology will be far enough advanced, the poet, the philosopher and the physiologist will all understand each other.
—CLAUDE BERNARD
IN JANUARY OF 1983 John Florio, a seventy-eight-year-old landscape gardener, was contemplating retirement. He developed abdominal pain and underwent a GI series, which showed an ulcer. He was treated for one month and re-x-rayed to see if the ulcer had healed. This time, however, it was larger and looked malignant. A biopsy revealed cancer of the stomach.
I first met John in late February when he was referred to my office for surgery. I suggested to him that we get him into the hospital right away since I was going on vacation, and I thought that with a rapidly advancing cancer he ought to have surgery immediately. He looked at me and said, “You forgot something.” “What did I forget?” I asked. “It’s springtime. I’m a landscape gardener, and I want to make the world beautiful. That way if I survive, it’s a gift. If I don’t, I will have left a beautiful world.”
Two weeks after my vacation, he returned to the office, saying “The world is beautiful, I’m ready.” He looked incredibly well the night after his surgery, with no pain or discomfort. The pathology report revealed: “Adenocarcinoma, poorly differentiated, invasive through gastric wall and into perigastric adipose tissue. Proximal margin involved by tumor, seven of sixteen lymph nodes positive for tumor.” That simply meant he still had a lot of cancer left in him after the operation. I explained to him that he ought to consider chemotherapy and x-ray therapy to deal with the residual cancer. “You forgot something,” he said. “What did I forget this time?” “It’s still spring. I don’t have time for all that.” He was totally at peace, healed rapidly and was out of the hospital well ahead of schedule. (His granddaughter, an oncology nurse at Yale, was fully aware of the findings and his choice.)
Two weeks later he was back in my office, complaining that his stomach was upset, and I thought, “Aha, it’s the cancer again.” It turned out to be a virus, which I treated symptomatically, and he left my office.
In March of 1987 I arrived at my office and saw John’s name in the chart rack. “You must have the wrong chart,” I said to the nurse. “No, that’s the right chart,” she said. “Then there must be two people with the same name.” “No, no,” she insisted, “he’s sitting in there.” Then I showed her his pathology report to explain why I assumed she had made a mistake. If you think pathology reports predict the future for an individual, it wouldn’t seem possible that I could be seeing John four years after his operation. But that’s who I saw when I walked into my examining room.
I again feared that his visit would be related to cancer. Before I could ask him anything, the first words out of his mouth were “Don’t forget, this is only my second postoperative visit.” I think he wanted to make sure the insurance would cover it. “But why are you here?” I asked. “I have a question,” he said. “I’d like to know what you can eat after a stomach operation.” “Four years after, anything! But tell me, why are you here?” “I have a hernia from lifting boulders in my landscape business.” Since he refused to be admitted to the hospital, I repaired it under local anesthesia on an outpatient basis, and he was off and running again. If he rested at all I’d be surprised, even though he promised to have two young men do his normal work the first few weeks after surgery.
John is one of those exceptional patients who seem to most clinicians to defy understanding. But I have learned that all of these exceptional patients have stories to tell and lessons to teach. It’s not just a matter of being lucky or having “well-behaved” diseases (slow-growing tumors, “spontaneous” remissions and so forth). What you have to understand is that there is a biology of the individual as well as a biology of the disease, each affecting the other. On the day of diagnosis we don’t know either well enough to use a pathology report to predict the future.
It is now six years after his surgery, and John celebrated his eighty-third birthday recently. You have to wonder—what has happened to his cancer?
I don’t know if his immune system eliminated it or if it’s still in there, enjoying John’s life so much that it’s going along for the ride. What I do know is that when you look at John what you see are signs of his ability to live and love. Still passionate about his life’s work, he sends me letters with clippings about the therapeutic value of the outdoors and an article about himself in the local newspaper that quotes him as saying “If I find a little marigold just lying there, I feel so sorry for it I just put a hole in the ground with my finger and plant it.” The article ends by saying “Today . . . John is still on the job, planting and pruning. He loves it. And like the legendary cowboy who proudly professes he wants to die in the saddle with his boots on, he says when his turn comes ‘I always pray that I’ll die at work, gardening.’”
Working outdoors, John maintains what I call a celestial connection, and, like patients in the hospital who have been shown to heal faster when their room has a view of the sky, he is healthier because of it. John is too busy living to be sick. That’s his real secret. But how, in scientific terms, do we account for him? What can we learn from him? Is there really a physiology of optimism, peace, love and joy?
Spontaneous remissions like John’s I prefer to call self-induced healings. They make wonderful anecdotes and can also tell us a lot about communication between mind and body. But since most people don’t believe in the existence of these remissions—“error in diagnosis” or “well-behaved disease” is the standard explanation for them—there hasn’t been much of an attempt to understand them scientifically. The medical profession always gives the credit to the disease rather than the person. We need to start studying the person and success.
The Remission Project of the Institute of Noetic Sciences in Sausalito, California, is now trying to fill the vacuum by analyzing four thousand medical journal articles on the subject of spontaneous remission from all over the world. Since any given article can cover multiple cases, many more than four thousand cases are involved, in addition to which the project is also looking at extraordinary healings such as those that have occurred at Lourdes.
However, of all the thousands of cases cited, virtually none made any comment about the patients’ personal circumstances. Brendan O’Regan, the institute’s vice president for research, cites one exception, quoting from a paper concerning a woman with metastasized cancer of the cervix, who was considered close to death. Her condition changed dramatically when, in the words of the case report, “her much-hated husband suddenly died, whereupon she completely recovered.” (To protect husbands, however, I can tell you that eliminating your husband will not necessarily cure you. We used to have an empty room in the office where I kept twelve husbands so that when a woman would come in and say, “Here’s the guy who made me sick,” I could tell her to take a new one and leave hers. The women all thought that was a great idea, but everyone ended up bringing the new one back, because the old problems were less troublesome. They all learned that it’s yourself you have to change in order to heal.)
It’s incredible to think of all these thousands of people who recovered from “incurable” illnesses and were never asked how or why they thought they had gotten well. When you do ask, as I have done and as researchers more receptive to this kind of thinking have also, you find that over 90 percent of the people will tell you about a significant change in their life prior to the healing. An existential shift has occurred in them, and for the first time in their lives they are truly living. They don’t see their disease as a sentence but a new beginning.
In an effort to identify any psychological patterns that long-term survivors might have in common, O’Regan has gone to the San Francisco Bay Area Tumor Registry to track down people who are still alive ten years or more after a terminal diagnosis. If he succeeds in getting permission to interview the eighty-nine who have been located for him, they will shed even more light on the nature of the personality factors involved in healing.
Meanwhile, researchers like Dr. George Solomon, Sandra Levy, Joan Borysenko, Nicholas Hall, David McClelland and Candace Pert, at institutions like Harvard, the University of California at Los Angeles and the National Institutes of Health, are clarifying the physiological mysteries of mindbody healing. Gradually they’re becoming accepted as “scientific,” too, being invited to address major conferences on psychosocial factors in disease, and publishing articles in traditional medical journals as well as more recent ones devoted to the new disciplines of psycho-oncology and psychoneuroimmunology. There is still much to learn about the inner workings of mind-body communication, so we must continue to look at the anecdotal evidence available to us and proceed with the scientific studies that will substantiate it.
Anecdotal material is not statistical, but it is true, and it is evidence that can help us see where to direct our research. I hope that, while this research proceeds, all physicians will give their patients the option to become living anecdotes instead of dead statistics.
Anecdotes that can be used to change belief systems have been walking into my office for years, and I often meet up with people like John who I assumed were dead. Most doctors don’t encounter these people, because people who have been told “You’ll be dead in six months” don’t go back for a checkup. So the doctor never finds out they didn’t die.
I believe that studying the lives of these self-induced healers should be an important part of the attempt first to verify, then to identify the ties between mind and body, psyche and soma. Because of their experience, psychologists, neurologists, endocrinologists and immunologists are all much more aware of these connections than clinicians. Veterinarians too: I had a touching letter from one who said that he especially hates to have to put a pet to sleep when it belongs to an elderly person, because he knows that the loss can have a serious impact on that person’s health. Clinicians are rarely able to see the connections, however, because unlike the old family doctor, they don’t know their patients’ lives and don’t think it relevant to ask about them. We must get to know the people we’re taking care of, as doctors in previous generations did. We should know the person as well as the disease, and take a special interest in those people who have gotten well despite the odds. They are not just lucky. They have worked hard to achieve their healings, and we have much to learn from them. However, this is not to condemn or blame those who don’t recover. We are talking about possibilities versus probabilities, not success or failure.
Everyone who has ever experienced the placebo effect also has a role to play in the quest to understand the mindbody connection. These are the people who, for reasons we are now beginning to understand, will show rapid healing and pain-relief after taking a placebo, which is an inert substance or a sham procedure with no properties that would allow it to function as an agent of healing. Sometimes the reverse effect happens, and people suffer serious and unpleasant side effects. When the effects are negative, the substance or procedure that triggers them is not called “placebo,” which means “to please,” but “nocebo.” With both placebos and nocebos, it is the expectations aroused by the substance or procedure that are ultimately responsible for the result.
Sometimes the effect can be induced simply by the words or attitude of a doctor or other authority figure. I saw this happen with a patient of mine. One week after major surgery for cancer he was doing very well—no fever, no complications, and a hearty appetite. I was about to send him home when I decided to ask the oncologist and radiologist to see him in the hospital, because he was an elderly man and I wanted to save him trips to their offices. After those two visits his temperature went to 102 and he developed a raging wound infection. The only change in his circumstances had been their visits, which obviously depressed him, suppressed his immune system and led to the infection.
Two other authority figures, however—in this case the parents of a young boy undergoing treatment for a brain tumor—used words to create positive expectations strong enough to diminish the side effects of some very powerful anticancer drugs their son, Kelly, was taking:
The first time he took his CCNV pill we also gave him the recommended anti-emetic to lessen the nausea. He got very sick that night and was on the couch all the next day. The next time we gave it to him we told him that you only get sick the first time. This time we did not give him the anti-emetic and he threw up only once that night. He said he felt much better this time and was up and about all the next day. Hooray!
They also used placebo medications:
We have cut his prednisone dosage in half as he was really getting nasty mood swings. To restore his hair growth we rubbed a “magic mixture” on his head and told him it would make his hair grow. It did! When we stopped using it, it quit growing, and started growing again when we resumed putting it on.
When Kelly is on prednisone he eats like a horse and when he is off he has almost no appetite at all. To help out his suffering appetite I have been giving him folic acid out of the bottle for his prednisone, which he calls his hungry pills. Lo and behold his appetite has returned via the placebo prednisone.
Like the phenomenon of spontaneous remission, the placebo effect has been much maligned by the medical profession, but unlike remissions, placebos have been at least indirectly the subject of scrutiny for years. Researchers have had to study them, because clinical trials done on medications in the developmental stage usually have to show evidence that such drugs are more valuable than placebos. Generally speaking, about one-third or more of the people treated with placebos report positive results. So if only about one-third of the test subjects in a drug trial show improvement from the drug, it is generally considered to be no better than a placebo.
In alternative cancer care programs there is something comparable to the placebo effect, which I call the waiting room effect: About 10 percent of the people in these programs get well, and many more improve, for reasons no one in the medical community understands. However, I feel sure that it’s because of all the hope expressed in the waiting room. When there’s a strong belief in the value of the therapy, the power of suggestion can go to work, causing a fundamental change in the internal environment of the body. Therefore, an alternative therapy with a 10 to 20 percent success rate may have no intrinsic therapeutic value.
Feelings are chemical and can kill or cure. As a doctor I believe it’s my responsibility to help my patients use them to cure and heal themselves. While placebos can be useful, because as symbols of hope they activate expectations, my reputation, my training, my belief in my patients and my own hopefulness also have symbolic value, which I can use to guide my patients into health. When some of my patients get better despite the odds against them, you may say that these are people I have deceived into health. But I don’t see that as a crime. I will always use all the tools at my command, because all healing is scientific. If I’m accused of offering false hope, my answer is that there is no false hope—only false no hope–because we don’t know the future for an individual.
Ten years ago a woman with diffuse histiocytic lymphoma and widespread metastases came to see me. Her doctor in North Carolina had told her to go home and die—“Why go three hundred miles to the nearest medical center only to be made sick with chemotherapy?” was his comment. But a nurse friend of hers who was taking care of my father-in-law told her, without my knowledge, “Come to New Haven. Dr. Siegel makes people well all the time.” The oncologist I sent her to was not at all encouraging: “As you know,” he wrote me, “this is a rapidly progressive illness; survival for more than fifteen months is unusual, the average being six months.” He told me he really didn’t think he had much to offer her. After she met me at the hospital, however, she told her friend, “I knew I’d get well when he held my hand.”
The letters from her oncologist tell the story: July 1979 (just after starting treatment)—“Continues to be weak”; August 1979—“Marked response, weight gain, total regression of lymphadenopathy, and slight regression of lung nodule”; October 1979—“Continues to do well . . . an objective decrease in all disease”; December 1979—“In complete remission.” Letters covering the next three years report “Continues to do very well” or “extremely well” or “amazingly well” and, in July 1983, “She came in today looking the best she has in two years. Her physician at home thought the family had switched people (she looked so well).” One day in the corridor of the hospital the oncologist said to me, with a twinkle in his eye, “Isn’t chemotherapy wonderful?”
This was a woman who had to travel from North Carolina to New Haven every three months to get chemotherapy. I was concerned about the high hopes she obviously had for her treatment, because I knew her chances were not good. I would have been even more uncomfortable if I’d known what her friend the practical nurse was saying to her: Not only was she going to get well because of me, but when she had side effects from chemotherapy her friend told her, “You don’t have to have side effects, Dr. Siegel says so”—and they disappeared. She had been so primed by her friend to believe in me that I think we could have given her plain water and it would have worked. I began by feeling upset that her hopes were so high, and ended by having learned something—about the value of hope.
In the Journal of the American Medical Association (henceforth referred to as JAMA), a physician writing under a pseudonym as Jane A. McAdams told about how a message of hope affected her mother at a time when doctors were expecting her to live only a few weeks more. Her mother had grown up during the Depression and was as a consequence very frugal and opposed to waste of any kind.
I resolved to lift her spirits by buying her the handsomest and most expensive matching nightgown and robe I could find. If I could not hope to cure her disease, at least I could make her feel like the prettiest woman in the entire hospital.
For a long time after she unwrapped her present . . . my mother said nothing. Finally she spoke. “Would you mind,” she said, pointing to the wrapping and gown spread across the bed, “returning it to the store? I don’t really want it.” Then she picked up the newspaper and turned it to the last page. “This is what I really want, if you could get that,” she said. What she pointed to was a display advertisement of expensive designer summer purses.
My reaction was one of disbelief. Why would my mother, so careful about extravagances, want an expensive summer purse in January, one that she could not possibly use until June? She would not even live until spring, let alone summer. Almost immediately, I was ashamed and appalled at my clumsiness, ignorance, insensitivity, call it what you will. With a shock, I realized she was finally asking me how long she would live. She was, in fact, asking me if I thought she would live even six months. And she was telling me that if I showed I believed she would live until then, then she would do it. She would not let that expensive purse go unused. That day, I returned the gown and robe and bought the summer purse.
That was many years ago. The purse is worn out and long gone, as are at least half a dozen others. And next week my mother flies to California to celebrate her eighty-third birthday. My gift to her? The most expensive designer purse I could find. She’ll use it well.
Anything that offers hope has the potential to heal, including thoughts, suggestions, symbols and placebos. Many still think that placebos may be fine for “psychosomatic” problems but not for anyone with AIDS, cancer, multiple sclerosis or heart disease. It’s interesting that this point of view has been with us for so long, despite innumerable studies showing that placebos can alleviate problems ranging, as psychologist Robert Ornstein and Dr. David Sobel have tallied them, from “post-operative wound pain; seasickness; headaches; coughs; anxiety and other disorders of nervousness [to] high blood pressure; angina; depression; acne; asthma; hay fever; colds; insomnia; arthritis; ulcers; gastric acidity; migraine; constipation; obesity; blood counts; lipoprotein levels; and more.” As Ornstein and Sobel put it, “If such a treatment suddenly became available, we would believe that we had discovered a new wonder drug comparable to penicillin. Moreover, no system of the body appears immune to the effect.”
So how does the placebo effect work? Since by definition a placebo is a substance or procedure without any actual power to effect a change in a patient’s condition, it follows that any change that does result must somehow be mediated through the mind. In other words, the placebo effect can be understood only if we acknowledge the unity of mind and body. We must recognize, as a scientific text explains, that “placebo responses are neither mystical nor inconsequential, and that ultimately psychological and psychophysiological processes operate through common anatomic pathways.” The “common anatomic pathways” are the tangible expression of mindbody unity.
A quite dramatic instance of the mindbody connection is that of a Filipino woman who in 1977 was cured of a serious disease by a native healer, after Western medicine had failed her. Suffering from systemic lupus erythematosus, an autoimmune disorder in which the body’s immune system attacks its own healthy organs, she rejected her doctor’s suggestions for more aggressive treatment as well as his warnings that she might die if she stopped her cortisone, and returned to her native village in the Philippines. Within three weeks she was back in the United States, off cortisone and completely symptom-free, with liver and renal function back to normal, according to the doctor who treated her and who published the facts about her case in JAMA some four years later—by which time she had also had a normal pregnancy and delivered a healthy child.
To what did she attribute her miracle cure? A healer back home had removed a curse placed on her! It is interesting to me that one prestigious medical journal chooses to present a case about the healing power of a Filipino witch doctor while another, the New England Journal of Medicine, chooses to devote its editorial page to a denial of the healing power of laughter (as you’ll be reading shortly)—and both of them, I am told, have refused to publish an article by Dr. Randy Byrd on the efficacy of prayer (which you’ll read about in chapter 7). I myself think that we should look at all kinds of healing, for all are scientific.
I have heard of several other miraculous recoveries from lupus, including one reported by Dr. Charles A. Janeway, who described his patient as having “cured herself [by spending a year] unloading all her deep-seated and concealed hostility toward her father”—on him. In fact all the stories I’ve heard about recoveries from lupus involve confronting authority: Dr. Janeway’s patient used him as a way of confronting her father; the Filipino woman confronted her doctor; and another woman, a nurse, was feeling so sick that she confronted God with an ultimatum that He take her that night or make her well (she woke up well the next morning).
The more we learn from stories like these about mind and body as a unity, the more difficult it becomes to consider them separately. What’s in your mind is often quite literally, or “anatomically,” what is in your body: Peptide messenger molecules manufactured by the brain and the immune system are the link.
There are approximately sixty known peptide molecules in the body, including some with names that may be familiar to you, like endorphins, interleukins and interferon. They make feelings chemical and effect the link between psyche and soma. Endorphins, for example, are now thought to account for the placebo effect. It appears that the pain-relief reported in so many studies can be explained physiologically by the fact that the positive psychological expectations aroused by administration of the placebo lead to an increased production of endorphins, which are painkillers. So the pain relief really is “in the mind”—because that’s where the endorphins are.
What interests me most in all of this is the question of how we can eliminate the placebo and go straight to the source of the mind’s healing system, as Kelly’s parents helped him to do. How can we access it directly? It is possible, as the many exceptional people you’ll be meeting in this book will show you.
In an essay entitled “The Mysterious Placebo,” Norman Cousins gets to the heart of how it’s done, which he knows about from personal experience:
It is doubtful whether the placebo . . . would get very far without a patient’s robust will to live. For the will to live . . . enables the human body to make the most of itself. . . . The placebo, then, is an emissary between the will to live and the body. But the emissary is expendable. If we can liberate ourselves from tangibles, we can connect hope and the will to live directly to the ability of the body to meet great threats and challenges.
What the placebo suggests to us is that we may be able to change what takes place in our bodies by changing our state of mind. Therefore, when we experience mind-altering processes—for example, meditation, hypnosis, visualization, psychotherapy, love and peace of mind—we open ourselves to the possibility of change and healing.
A particularly dramatic transformation can occur when a person with multiple personality disorder (MPD, or split personality) switches from one personality to another. Once thought to be extremely rare, MPD is much more commonly reported now, as are the circumstances thought to give rise to it—child abuse. It appears that some victims of abuse learn to switch off their core personality when the suffering they must endure is too great; this enables them to switch into one of what may be as many as dozens of other personalities, which come into being to shield the child. Although no one can say for sure how the switch is accomplished, some sort of dissociation through self-hypnosis seems to be involved.
The first patient I encountered with multiple personalities would go through certain medical tests in one personality, because as that person she would experience no pain, fear or difficulties from the procedures. When the tests were over she would shift back to her dominant personality. Physiologically speaking, however, the differences among the personalities in a multiple can be much more startling than that.
There are certain physiological traits that we assume to be fixed, like diabetes, left- or right-handedness, allergies or color-blindness. It appears, however, that people with MPD may be allergic to cats or orange juice in one personality but not in another, may exhibit burns in one personality but not another, may show drug sensitivities in one personality but not another, may switch from being right-handed to being left-handed. I knew someone who had to keep half a dozen different pairs of glasses in her bedside stand, because she didn’t know who she would be when she woke up. I have also heard about a woman with MPD who got drunk at a party, and when her friends told her not to drive home, she said, “Don’t worry, the others won’t let me. One of them will.” Brendan O’Regan, whose Investigations newsletter has reported on the current state of research regarding multiples, says he has even heard of a woman whose eyes changed colors when she moved from one personality to another.
What makes the study of multiple personality of general interest is that it reveals the possibility of changing your body by changing your personality. Imagine, for example, having within your conscious power the brain’s incredible pharmacy of healers—the neuropeptides.
Biochemist Nick Hall of George Washington University is one of the researchers working on this possibility through research into the effects of meditation and positive visualizations on immunity. In a Discover magazine interview with Rob Wechsler, Hall described a lecture he once gave to a group he expected to be resistant to his mindbody marriage of psychology, immunology and neuroendocrinology: “I knew I had to do something to get their attention,” he said. “I walked up to the podium, pulled out a book from my back pocket and began to read them an erotic passage from Lady Chatterley’s Lover. When I was done and they were all convinced I was crazy, I looked up and said, ‘If you can arouse the reproductive axis with purely mental processes, why can’t you do the same with the immune system?’”
As Hall demonstrated, presumably to his audience’s satisfaction, images in the mind can have just as powerful an effect as those in the external world. Blushing is another example of the body’s response to what may be purely a mental event. Everybody agrees that these are physical responses mediated by the mind. But what about the immune system? Can you really activate it with the mind? If you change yourself enough, can your disease be rejected as alien to the new you? I believe that you can change that dramatically; I have seen it happen many times.
There is beginning to be an impressive amount of research to document the ways in which mind and body, brain and immune system are bound together. Although much more work needs to be done to trace this incredibly intricate network of communications, the most important thing is that we now know such communications do occur.
In 1964 Dr. George Solomon, who is affiliated with the medical schools of the University of California in both San Francisco and Los Angeles, published an article entitled “Emotions, Immunity and Disease: A Speculative Theoretical Integration.” When he sent it to me last year, however, next to the word “Speculative” he wrote: “Not any more.”
When Solomon wrote that article over two decades ago he started with a single hypothesis—that “stress can be immunosuppressive.” Solomon and others have long since proved this to be true. By 1985 he was able to propose and support a total of fourteen hypotheses concerning interactions between the immune system and the central nervous system, and at last count his list numbered thirty-five such hypotheses, for each of which there now exists a varied amount of “hard” evidence.
Dr. Solomon continues to do his pioneering work on the question of how emotions relate to disease, and has extended his work with cancer patients to people with AIDS. In an article on long-surviving people with AIDS, Solomon, Dr. Lydia Temoshok and colleagues list sixteen significant emotional factors and behavior patterns affecting longevity. This list will appear later in the book, as part of the practical advice for dealing with illness. For now, what’s important to know is simply that a fairly detailed psychological profile of the survivor personality can be drawn, and that psychological change and healing are possible for all of us. If change weren’t possible, there would be no practical point to being able to identify survival characteristics.
“Psychosocial Correlates of Survival in Advanced Malignant Disease,” a study by psychologist Barrie R. Cassileth and colleagues, appeared in the New England Journal of Medicine in 1985. In combination with an editorial by NEJM deputy editor Dr. Marcia Angell, entitled “Disease as a Reflection of the Psyche,” this caused quite an uproar. Though Cassileth’s study made relatively modest claims for what it could prove about the lack of any causal connection between psychological and social factors and survival time in cancer patients, Dr. Angell used the occasion to announce that “it is time to acknowledge that our belief in disease as a direct reflection of mental state is largely folklore.”
There was an outpouring of letters in response, more than any other article has received in recent years. The respondents did not come to any agreement about how mental state affects health, but there was a consensus among them that it did, and that this was a subject worth in-depth investigation, not dismissal.
Cassileth herself had qualified the scope of her conclusions by noting in the article that social and psychological factors “may contribute to the initiation” (my italics) of disease. And though she found that “the biology of the disease appears to . . . override the potential influence of life-style and psychosocial variables once the disease process is established” (my italics), it must be remembered that the 359 patients in her study did have, as the title indicates, “advanced malignant disease.” In other words, the disease process may by then have been so well established that the body’s ability to resist it was seriously damaged. In patients that ill, the hope factor may also have been gone. Because of the study’s focus, many of the fundamental questions about the mind’s impact on our state of health are not addressed.
But with dozens of other studies showing that the connection between body and mind is real and significant, and recent conferences on psycho-oncology at the National Institutes of Health and at New York’s Memorial Sloan-Kettering Hospital, it seems clear that the time for dismissing this belief as folklore is long past, and the time for study is here.
Still, Angell is not convinced. “Laughter is a worthy end in itself,” she writes, “not as a means or a medicine toward curing disease. That is not science.” Dr. Angell may not think so, but as neuropharmacologist Candace Pert of the National Institute of Mental Health has said, we have now come to the point where “the medical establishment is finally going to have to decide what to do about the mind.”
I predict that chemicals we produce in our own brains will become the basis of many therapies of the future. Candace Pert, for example, is already using Peptide T (the laboratory-produced clone of one of these natural chemicals) in AIDS patients, with striking results.
At the vanguard of this new science are the researchers who are studying a group of peptides known as growth factors, which are naturally occurring substances in our bodies now being cloned through the techniques of genetic engineering. In one recent test, described in Omni magazine, David Golde, chief of hematology and oncology at UCLA, used a growth factor known as GM-CSF on sixteen AIDS patients with low white blood cell counts, and pronounced the results “a revolution in medicine equal to antibiotics.” “Watching the white count come up was the most exciting thing I have ever done in science,” he said. “To my knowledge this was the first time it had ever been done in human beings.” “Spectacular,” commented David Nathan of Harvard Medical School. “A home run,” said Jerome Groopman of Deaconess Hospital in Boston.
Neurobiologist Rita Levi-Montalcini won both the Nobel Prize for medicine and the Lasker award for her discovery of nerve growth factor (NGF), which is another of these naturally occurring substances. Levi-Montalcini has shown that NGF affects cells in both the immune and central nervous systems, thus helping to account for the way the psychology of an individual could be related to immune function. “It has always been known that psychological conditions affect the welfare of people through the immune system,” she told Omni, “but it was never proved structurally that there was any relationship. Now we believe NGF is somewhat of a linking messenger.” The hope is that NGF can be synthesized by molecular engineering techniques for use in treating degenerative diseases of the brain, like Alzheimer’s, Huntington’s and Parkinson’s.
Soon physicians may be following in the footsteps of natural healers. Barbara Ann Brennan says in her book, Hands of Light, “What the healer really does is to induce the patient to heal himself through natural processes. . . . Your body and your energy system move naturally toward health.” This is what the scientists described above are now discovering, as they work with the substances that are the body’s own internal healers.
These internal healers have also been stimulated to work in Infants in the hospital. When premature newborns are assigned to a section of the nursery where nurses stroke them for fifteen minutes three times a day for ten days, they gain weight 50 percent faster than newborn infants in the same nursery who are not stroked. Why? Remember, our survival mechanisms are rooted in our primitive existence. When the mother lion leaves the den, for example, the lion cub lies quietly, its metabolic processes turned off to help it survive the absence of food and warmth. When momma returns with food, she licks and touches the baby, and the baby responds by producing growth hormones and other neuropeptides so that the food can be utilized appropriately.
Perhaps someday it will be possible to create exactly the right emotional prescription for each person’s needs. Until then we will be relying on the work of scientists who are cloning the chemicals that occur naturally within our bodies, as well as trying to get people to live in such a way that they will create more of these life-enhancing substances within themselves. If you will do that, then you can become your own genetic engineer. For it really is true that love, laughter and peace of mind are physiologic.
Two months before the New England Journal of Medicine article appeared, The Lancet, a comparable British journal, also came out with an article on mental attitudes and cancer. This study of fifty-seven women diagnosed with early breast cancer ten years before revealed that after the first five years, “recurrence-free survival was significantly commoner among patients who reacted to cancer by denial or ‘fighting spirit’ than among patients who responded with stoic acceptance or feelings of helplessness or hopelessness.”
After ten years, their survival statistics showed that 70 percent of the “fighting spirit” patients were still alive (with or without metastases) versus 50 percent of the deniers, 25 percent of the stoic accepters and 20 percent of the hopeless/helpless group. Though the authors of the article claim only that mental attitude is “associated with” survival time, rather than the cause, these are striking statistics.
However, the paper ends with a very “medical,” mechanistic reservation: “Whether mental attitudes can be changed and whether such changes improve survival are questions worthy of further study.” What distresses me is the first part of that question: It’s one thing to ask whether a change in attitude will improve survival rates, but quite another to ask whether attitudes can be changed. How many years has psychotherapy been around? Have Freud and Jung had nothing to contribute? To think that we can’t help people change is absurd. I know from the therapy I have been doing for the last ten years that we can teach people not to be helpless, we can teach them to be fighters, and in even the most desperate of circumstances we can still help them find the will to live.
Sandra Levy, associate professor of psychiatry and medicine at the University of Pittsburgh and director of behavioral medicine in oncology at the Pittsburgh Cancer Institute, has done research on issues similar to those addressed by the British study. In a 1984 article, she too speaks of “associations” between emotions and cancer, not causes, and she too finds that the associations are strong. This she concludes on the basis not only of her own ongoing studies of women with breast cancer, which indicate that survival time is associated with fighting spirit, but also of her review of dozens of other studies published during a thirty-year span. Their consensus is, as Levy summarizes it: “Lower survival rates from cancer are associated with depression or helplessness and higher rates are associated with a sense of coping.”
Like the British researchers, Levy asks about the possibility of changing mental attitude—“Can helplessness and the lack of coping among cancer patients be altered?”—but her answer is “undoubtedly yes.” Psychological techniques can be used to alter outlook, and other strategies like the relaxation response can work more directly on the damaging hormonal effects of stress while also providing patients with a sense of control over their thoughts and lives.
Levy’s latest research has revealed an interesting new finding: While the primary factor that predicted survival was the disease-free interval—the length of time between initial diagnosis and recurrence—to Levy’s surprise the second most significant factor was not fighting spirit but a sense of joy. Joy was an even more powerful predictor than the number and location of metastatic sites. Also associated with survival were the woman’s relationships with her intimate other and her physician.
While it’s helpful to know which feelings are most closely linked with good health, I believe that a healed life need not exclude the so-called negative emotions. Anger, for example, may be a more positive response to a grim diagnosis than passive resignation. Feelings are not to be judged. Anger has its place, so long as it is freely and safely expressed rather than held inside where it can have a destructive effect and lead to resentment and hatred.
A story is told about a snake that terrorized the children of a village whenever they went out to play. The elders of the village went to talk to the snake and ask it please to stop biting the children. The snake agreed, and for the next few weeks everything went well. The children enjoyed playing outdoors and returned home each day happy and safe. The elders then went to thank the snake, but they discovered it battered, bruised and tied in knots. When they asked it what had happened, the snake said, “Well you told me to stop biting the children.” “That’s right,” they said, “we did tell you to stop biting, but we didn’t say to stop hissing.”
It’s important to express all your feelings, including the unpleasant ones, because once they’re out they lose their power over you; they can’t tie you up in knots anymore. Letting them out is a call for help and a “live” message to your body. We try to live like this in our own family, and as a result one of our daughter’s friends who spent some time with us on Cape Cod said, “Your family doesn’t know how to be angry.” I said, “What do you mean?” She replied, “When your family is angry you talk to each other after half an hour, but in my family we don’t talk to each other for two weeks!” I took that as a great compliment.
Studies are under way to get down to a molecular understanding of how the emotions affect our bodies. Quantum physicists like David Bohm and Stewart Wolf are now saying that we may even be changing ourselves at the atomic level when we experience different emotions. Wolf has talked about fear affecting and perhaps being expressed by electrons, and love by photons.
David C. McClelland, a professor of psychology and social relations at Harvard, is particularly interested in the effects of love: “Right now we are trying to straighten out what the love variable is and what its impact is on the endocrine system,” he explains. “We don’t have any idea about the hormones that are connected with love and how love aids the lymphocytes and improves immune function. That’s what I’m working on now.”
While he’s working on it, others are putting it to work in their lives. I appeared on television with long-term AIDS survivor Niro Asistent, who had reversed the results of her blood test from HIV-positive to HIV-negative (HIV being the AIDS virus). When asked to summarize what she had done, she said, “When you live in your heart, magic happens.” How simple a summary of our total approach, and yet how hard to live in your heart!
The “love variables” that McClelland was discussing were self-love and what he jokingly called “divluv” (for divine love, a phrase he felt would not look good in a psychology journal). “Divluv” refers to the kind of noninvolved striving he sees in many religiously inspired people. It means “that you are not worried about your ego at all. You’re not the least bit concerned whether you’re succeeding or failing. You might say you’re acting from the heart. [Who did we just hear that from?] The state of being egoless comes from recognizing that you’re okay within yourself.” If you get an F on an exam it is still only an exam; you are not worthless or a failure.
Accepting that she was “okay within herself” became the foremost challenge of an extraordinary young woman named Evy McDonald, who was diagnosed with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) in 1980. She was told by her neurologist, “Evy, you have six to twelve months to live. If you want to do something nice, leave your body to science.” That afternoon she was fired from her job as a nurse, because she’d been out sick so much, and that evening she discovered that her apartment had been broken into and all her valuables stolen. At that point she decided that her doctor’s advice sounded pretty good.
In a letter to me she wrote, “Death seemed inevitable, and a part of me was truly looking forward to ending this life. Yet I had unfinished business: a strong compulsion to discover what unconditional love was about before I died” (my italics). Note that Evy did not deny her mortality. But people like her don’t go home to die just because some doctor has sentenced them. They use their diagnosis as the spur to start living, and then feel too good to die.
Evy knew that her journey would have to begin with an acceptance of her own body, which she had always hated, and in an article she wrote she describes how she accomplished that first step toward self-love:
There I sat in front of a mirror in my wheelchair. In the six months since I’d been diagnosed as having ALS, my once firm, strong muscles had wasted away into flaccid, useless ones. I was dying from a particularly rapid form of this incurable disease and had, at best, six more months to live. I looked with disgust at my deteriorating body. I hated it. The mirrored reflection of one spindly, ill-shaped leg (the legacy of a childhood bout with polio) paired with a mammoth, once-muscular one was hideous to me. . . .
As the hours of my day were now relegated to sitting alone in my wheelchair, I. began to observe rather than react to my thoughts. I noticed there was one consistent thread throughout the fabric of my life—a relentless obsession with weight. I was sure that if I became “skinny” enough, an admirable body would magically greet me in the mirror. And now I sat in a wheelchair with acutely atrophying muscles. My arms and legs were shrinking.
Was it just coincidence that I’d always wanted a smaller body and that ALS was granting me that very desire? . . .
As I sat in my wheelchair, six months from death, a single, passionate desire pressed to the front of my mind. In my last months of life I wanted to experience unconditional love. I wanted to know that sweetness.
But how could I even hope to realize that goal if I couldn’t accept my own body? . . .
The first step was to notice and write down how many negative thoughts I had about my body in the course of each day, and how many positive ones. When I saw the huge preponderance of negative thoughts on the paper, I was forced to confront the degree of hatred I had for my body.
To counter this habitual and ingrained negativity, every day I singled out one aspect of my physical body that was acceptable to me, no matter how small. Next, I’d use that item to begin the rewriting. Every negative thought would be followed by a positive statement like “and my hair is truly pretty,” or “I have lovely hands,” or “My bright eyes and warm smile light up my face.” Each day a different positive item would be added as each day the rewriting continued.
I felt like a jig-saw puzzle being put back together; and when the last bit was in place, my mind shifted and saw the whole perfect picture. I couldn’t pinpoint just when the shift occurred, but one day I noticed that I had no negative thoughts about my body. I could look in the mirror at my naked reflection and be honestly awed by its beauty. I was totally at peace, with a complete, unalterable acceptance of the way my body was—a bowl of jello in a wheelchair.
For the first time in my life I knew my body to be esthetically pleasing. A new movie had been written [Evy had earlier referred to the body as “the screen where the movie is shown”], and I experienced a soft, sensuous human being sitting in that wheelchair.
Once the old scripts and demeaning images were finally and totally gone, they were never to emerge again. I accepted my body. It didn’t need to be any different; it could be whatever it was and become whatever it was to be. . . .
This was one step in a journey that over time brought about unexpected and unsolicited physical improvements. But if the outcome had been different and the deterioration of my body continued, it would not have altered or diminished the inherent beauty I now accepted.
My illness was a challenge and a gift. I was stimulated to examine my deepest thoughts, desires and beliefs. The journey of self-discovery restructured my life and led me into a powerful experience of the mind-body connection.
Her “physical body stopped deteriorating (in other words I didn’t die),” she says in her letter, “and began reversing the havoc wreaked by ALS. This reversal was a by-product of all the other changes. Physical healing did not occur because I set out to ‘cure’ myself, but because my job on earth was not complete. . . . Since then, I joyously awake each day, filled with enthusiasm, and continue to play my role in the transformation of medical practice.” Notice that her goal was to discover the experience of unconditional love, not to avoid dying. So she was not setting herself up for failure, but for an experience that was within her power to give herself. Love and healing are always possible, even when a cure is not.
Evy has been an incredible teacher. When she heard that I was telling people to live a month at a time, she wrote to me and said I was too lenient—that in order to really think about their lives, people should live ten minutes at a time, as she had had to do. You will be hearing more from Evy, for she has many practical things to say about her steps toward healing.
Today many scientists think we should not talk about a central nervous system and an endocrine system and an immune system, but rather one healing system that constitutes a sort of superintelligence within us. Just as that healing system can be set in motion by self-affirming beliefs, self-negating or repressive emotional patterns can do the reverse. As Woody Allen said in one of his movies, “I can’t express anger. I internalize it and grow a tumor instead.”
Internalizing is exactly what you don’t want to do. When someone asks you how you are and you say “Fine” even though you feel terrible, that’s internalizing. This kind of behavior disturbs me so much that when I do workshops I ask for volunteers to take an opaque, soundproof bag, pull it down over their heads, tie it at the ankles and go for a walk in the street. Everybody objects: “We could get killed doing that.” Right. That’s my point, that just as your eyes and your ears and the rest of your five senses are there to protect you from the world, so you have a sixth sense, your healing system, which is meant to repair injuries and protect you from invasion by bacteria, viruses and diseases. But if you deny your needs and don’t ask for help, you’re pulling a bag over that healing system. The message you give it when you put on a performance is that you don’t want to recover, and the result is that your body cooperates by helping you to die.
So don’t “try” to be positive—that’s just performing, and it’s hard work. Our goal is peace of mind, which will give your healing system a true “live” message.
Many techniques for achieving peace of mind are available. These include hypnotic suggestion, biofeedback, relaxation training, visualization, yoga and other consciousness-altering techniques. (Sandra Levy would remind us of joy, David McClelland of love and egolessness too.) The effectiveness of these techniques can be measured experientially—people feel better if they use them. With the sophisticated new tools of molecular biology, some of the effects can now be measured at the cellular level as well.
Though the precise mechanism of the healing response remains to be elucidated, all these techniques work to create bodymind communication and unity. Thus, what we ordinarily think of as automatic body functions come under the control of our minds. You can use relaxation training, for example, to lower blood pressure, slow your breath and heart rates and reduce muscle tension.
Studies have shown that relaxation training and related techniques can be helpful in combating the negative effects of prolonged stress on the immune system components. A dysregulated immune system can affect everything from your susceptibility to colds to your ability to kill cancer cells or AIDS viruses, and may also be a factor in asthma, allergies, diabetes, multiple sclerosis, rheumatoid arthritis, lupus and other autoimmune diseases in which the body attacks itself.
Joan Borysenko, a cell biologist and psychologist who ran the Mind/Body Clinic at New England Deaconess Hospital, has written about the uses of relaxation in her book Minding the Body, Mending the Mind. These include its ability to help diabetics lower their need for insulin. I myself know of one patient who used relaxation to completely eliminate her need for insulin. Relaxation is so commonly acknowledged to be effective that some hospitals now broadcast relaxation programs on closed circuit television in the patients’ rooms. The list of diseases altered in a positive way by relaxation would fill this page.
Psychotherapy and other techniques that bring repressed emotional material into consciousness can also heal, both psychologically and physically, by helping us to achieve peace of mind. One interesting series of studies by psychologist James Pennebaker at Southern Methodist University showed that people who confided traumatic experiences to a diary showed better immune function than those who didn’t. He and Janice Kiecolt-Glaser asked twenty-five adults to write down details of disturbing life experiences and describe their feelings about them. A control group of equal size wrote only about superficial topics. Blood tests showed strikingly improved immune function among the emoters, who also made fewer visits to the doctor, but no improvements among the control group. Six months after the experiment was over the emoters still showed positive health effects.
By focusing on events that most people try to forget as quickly as possible, the emoters allowed themselves to express their feelings and hence gave their bodies “live” messages. I also believe that the act of writing these events down allowed the emoters to rethink them. In other words, they engaged in a simple form of cognitive retraining: The events themselves remained the same but lost their destructive power.
What we get back to again and again is that, although there’s no question that environment and genes play a significant role in our vulnerability to cancer and other diseases, the emotional environment we create within our bodies can activate mechanisms of destruction or repair. That’s why two people who grow up in the same environment, even when they have the same genes, as identical twins do, don’t necessarily have the same disease at the same time. A man showed up in my office at age fifty-nine with cancer. Some thirty years before, his identical twin had died of cancer. He told me that until recently he had always been happy and busy, but he had just been through a year of total despair and depression and had wanted to die. His brother, however, had always been unhappy. Sometimes it’s not so much a matter of disease grasping us as of our being susceptible to the disease.
The mind-altering techniques mentioned in this section, many of which will be discussed in more detail later in the book, can make us less susceptible to disease, or better able to turn it around if we are already sick. By helping us achieve peace of mind, they give us access to our body’s healing system. It takes more distress and poison to kill someone who has peace of mind and loves life.
Body and mind are different expressions of the same information—the information carried by the chemical transmitters known as peptides. In humans, animals, plants, eggs, seeds and on down to one-celled organisms, the peptides are the messenger molecules that carry the information from state to state. In man they make possible the move from perception or thought or feeling in the mind, to messages transmitted by the brain, to hormonal secretions and on down to cellular action in the body—then back again to the mind and brain, in a never-ending feedback loop.
The key juncture in the loop, the place where body and mind meet and cross over through the action of the peptides, is in the limbic/hypothalamic area of the brain. It is here that scientists have found dense numbers of receptors clustered together in what they call “hotspots.” Peptides fit into these receptors, key and lock fashion, to activate the inner workings of the cells on which the receptors are located.
However, it’s not just the brain that contains peptide receptor hotspots. Examples of other peptide-rich areas are the linings of the gut and the stomach. This may be why people often say they feel their emotions in those areas. You’ve heard of “gut reactions”—well, it now appears that there is literal, physiological truth to the expression. In fact, the emotions seem to be everywhere in the body, not just in the brain. “They are expressed in the body and are part of the body,” Candace Pert says. “I can no longer make a strong distinction between the brain and the body. . . . Indeed, the more we know about neuropeptides, the harder it is to think in the traditional terms of a mind and a body. It makes more and more sense to speak of a single, integrated entity, a ‘bodymind.’”
The research Pert and her immunologist husband, Michael Ruff, have done on peptides may even have given a physiological basis to Freud’s and Jung’s concept of the unconscious:
For Freud and Jung, the unconscious was still a hypothetical construct. For us, the unconscious more definitely means psychobiological levels of functioning below consciousness. Deep, deep unconscious processes are expressed at all physiological levels, down to individual organs such as the heart, lungs, or pancreas. Our work is demonstrating that all the cells of the nervous system and endocrine system are functionally integrated by networks of peptides and their receptors.
Though it used to be thought that communication between the brain and other bodily systems was mainly one way, brain to body, recent findings, both anatomical and biochemical, make it clear that the conversation is reciprocal. Immunologist J. Edwin Blalock suggests that in the presence of invaders, like viruses and bacteria, for example, peptide transmitters produced by the immune system function as a sort of sixth sense, supplementing the information the brain receives from the other five senses and possibly accounting for the way some people sense that something is wrong before they actually get sick. I see this happening all the time with my patients, especially when we start looking at their dreams and their drawings. Often they can’t explain why they think there’s something wrong, and they may not show any symptoms, but something in them knows. This is why, when a woman comes into my office and tells me that the lump she’s had in her breast for a year needs to come out, even if the exam and the mammogram show no change, you can bet I take it out. I know that just as we were given five senses to protect us and make us aware of what’s going on in the external environment, so our Creator also gave us this sixth sense to monitor our internal environment. We are dealing with one unified, comprehensive, self-regulating system, with beautiful intelligence inherent within it. As Albert Szent-Györgyi has said, the brain is not just for thinking; it is a survival organ.
For most of us, bodymind unity is of interest mainly because of what it suggests about possible routes to better health. As Candace Pert explains: “We know that the same neuropeptides secreted by the brain can also facilitate the movement of white blood cells of the immune system to a locus of injury. So why could you not direct it consciously? . . . It’s a wild idea in that there is no experimental proof for it—yet there is nothing that excludes the possibility either.”
Not only is there nothing to exclude the possibility, but there is plenty of evidence that many bodily processes we think of as automatic can be brought under conscious control. For example, yogis trained in Eastern meditative techniques can change their heart rate from thirty to three hundred beats per minute, as Swami Rama demonstrated to the satisfaction of a number of Western scientists at the Menninger Foundation.
Such feats are not confined to Indian mystics, or even to our species. Dolphins who do not want to have blood drawn for experimental purposes can redirect their blood flow so that it is inaccessible to the probing needles of researchers. Studies performed on rats and mice have shown that even the immune response can be “taught,” or conditioned, to be either more or less active: When an immune suppressant or enhancer with a specific taste is administered to the animals, that same taste can later cause their immune systems to respond accordingly, even when the drug itself is absent. In fact, the whole principle of vaccination is based on the capacity of the immune system to learn. Think of what this may mean for the future. We have the ability to train our bodies to heal and eliminate illness.
But to me there is something even more interesting than the idea of gaining control of specific body processes. I think we can use the meditative and life-style-altering techniques I’ve mentioned in this chapter to gain access to the superintelligence I’m convinced resides within each of us. This superintelligence is the message carried by psyche and soma via the peptides—the printout of our DNA, the code to life itself. It makes us who we are and, if we listen to it, will keep us on our path.
The more I see of the workings of our universe, the more mystical I become. I’m not mystical in spite of being a surgeon; I’m mystical because I’m a surgeon. As a surgeon, I watch miracles daily. When I cut the body open I rely on it to heal. I don’t yell into the wound or leave it instructions telling it how to heal. The body knows much more than I do. In fact, every time I perform surgery I rely on its wisdom, because I don’t know why a wound heals or how anesthesia works (nor does anyone else—as I had to tell the medical student who made excuses for his failure to explain these phenomena by saying he must have missed that lecture!). Neither do I understand how a fertilized egg grows up to be a human being. But I do know that each cell, organ, system of organs, and person is directed by what I call the loving intelligence of energy.
So the peptides and neuropeptides within each one of us, coursing through our bodies to create an integrated healing network, informed by the superintelligence that is the key to life itself, will help us to achieve our greatest potential—if we heed our body’s messages. That doesn’t mean some of us won’t die at two and others at a hundred and two, but it does mean that our system will function to its greatest capability and provide us with the healthiest, longest life of which we are inherently capable.
Many of us have grown deaf to these inner promptings, though we don’t start out that way. As a surgeon who does a great deal of pediatric surgery, I have the chance to observe many children. After I operate on a child, he or she will lie quietly in the crib, healing, and then suddenly one day start pulling out all the intravenous lines and tubes. I know at that moment that the child’s body is recovered and healthy and that all these things can be discarded—because the child knows and is telling me so. That self-knowledge is what we must seek to recover.
Quantum physicist David Bohm has suggested replacing the word “psychosomatic”—which he thinks perpetuates the split between soma and psyche, body and mind—with a new word, “‘somasignificance,’ to emphasize the unity of soma with significance and ultimately with meaning in all its implications and possibilities.” Our bodies mean what they say, and they speak to us in the language of health and disease. Once we learn to take responsibility for our health by listening to our bodies, and talking back to them as well, then we will begin to be able to use our diseases to redirect our lives.
Many people fear that encouraging patients to take responsibility for their own health and emotions will make them feel like failures if they don’t cure themselves. That is missing the point. We are asking people to play an active role in their health care, not demanding of them that they get well. Exceptional patients don’t try not to die. They try to live until they die. Then they are successes, no matter what the outcome of their disease, because they have healed their lives, even if they have not cured their diseases. The next chapter will describe ways of listening to the message that psyche and soma wish to give you about how to find your unique path.