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The Mind and the Body—Connected

I find, by experience, that the mind and the body are more than married, for they are most intimately united; and when one suffers, the other sympathizes.

—LORD CHESTERFIELD

The mind is its own place, and in itself can make a Heaven of Hell, a Hell of Heaven.

—JOHN MILTON, Paradise Lost

One’s expectations are potent arbiters of well-being. But the curious case of Mr. Wright was proof, for the eminent psychologist Bruno Klopfer, that the mind can be so powerful it may even influence a cure. Writing half a century ago, Klopfer was one of the pioneers of the Rorschach test. Among his research interests was the exploration of “psychological variables,” including ego and degrees of hopefulness, and how they could help in cancer care. In a talk he gave in 1957, he relayed one patient’s experience, as told to him by the patient’s doctor, to show how the mind should be recognized as an important tool in treatment¹

There was little doubt among the doctors seeing Mr. Wright at a well-known clinic that he had little time left to live. He was suffering with a terrible type of lymphosarcoma that had spread throughout his body. The tumors in his neck, groin, and abdomen were the size of oranges, and radiation treatments would no longer shrink them. He was weak and had even resorted to taking breaths from an oxygen mask. His doctors, agreeing that treatment options had run out, were ready to provide palliative care until he succumbed to the disease.

But Mr. Wright seemed to have lucky timing. Just as doctors were conferring about his imminent end, a new drug came on the market, a chemical derived from a horse serum. Enthusiasm about the drug, known as Krebiozen, was rampant. Even the newspapers were reporting that it was a miraculous cancer cure. Mr. Wright read the accounts and found out that the clinic where he was being treated was one of the few test sites for the drug. He wanted to join the study. At first, his doctor resisted. He didn’t believe Mr. Wright, who seemed unlikely to live for more than two weeks, would qualify for the drug trial, which stipulated at least a three-month life expectancy. But Mr. Wright was absolutely certain that the miracle drug would make a difference and begged to receive it.

Mr. Wright’s case involves several deviations from ethics protocols that wouldn’t be allowed today, such as his doctor including him in a clinical trial simply on grounds of sympathy. But those deviations paved the way for some truly remarkable results. Mr. Wright received his first injections of Krebiozen on a Friday. His doctor returned on Monday to find his patient not only in excellent spirits and chatting energetically with the hospital staff, but with shrinking tumors. Astounded, the physician proceeded to give Mr. Wright the full course of treatment. Within ten days, he no longer appeared to be dying. He was breathing on his own and was so full of energy that the doctors decided to discharge him from the hospital.

However, over the course of the next two months, conflicting reports about the effectiveness of Krebiozen began to appear in newspapers. Many challenged the original research, and new information appeared that the drug was a sham. Mr. Wright, who’d kept up on the reports, was devastated by the news. He relapsed after two healthy months and returned to the hospital in a dismal state.

Recognizing that Mr. Wright’s hopefulness might have played a role in his two-month recovery, his physician decided to engage his positive outlook. Today’s ethics standards would never permit what happened next, but the doctor, having nothing more to offer his patient, told Mr. Wright that a new, double-strength preparation of the drug was arriving at the hospital, and that Mr. Wright was eligible to receive it. Even though he gave Mr. Wright nothing but fresh water injections, the doctor gave every indication that he was hopeful about the enhanced Krebiozen.

Mr. Wright’s enthusiasm returned, and the results were even more astounding than they’d been the first time. The tumors shrank again, his energy returned, and he was discharged from the hospital a second time. In fact, his health lasted two more months—until a definitive medical report appeared from the American Medical Association, stating that Krebiozen was a “worthless” drug. The news rattled Mr. Wright. Within a week of the public report, he was rehospitalized and died two short days later.

For Klopfer, who recounted the story in an address to a psychological professional society, the unusual case suggested that certain “types” of patients have a better opportunity to heal. Those individuals with fewer emotional impediments—less fear and more hope—are ultimately better equipped. Mr. Wright’s positive spirit “left all available vital energy free to produce a response to the cancer treatment that was nothing short of miraculous,” Klopfer wrote. The results didn’t last, he added, because the patient was easily swayed by disappointment, but the relationship with his doctor—and his doctor’s enthusiasm for the treatment—clearly affected his survival.

While this case provides an interesting narrative, it also raises some important questions: What if we learned to pay more attention to features like optimism? What if clinicians were trained to consider patients’ emotional capabilities as part of treatment? and What exactly is the connection between the mind and healing?

ENGAGING THE MIND FOR THE SAKE OF THE BODY

One of the long-standing characteristics of Western medicine, dating to the writings of Descartes in the eighteenth century, has been the dualistic separation of mind and body. The reductionist approach (referred to as the Cartesian split, and understood to be either body or mind, one or the other) has shaped how we as a society treat disease, how we approach research, and how we talk with people needing care. Health care systems have been structured along those lines, too. It is a zero-sum game. No one is surprised to learn that a friend with a heart problem will visit a cardiologist, and a different friend with cancer will see an oncologist. But people expect that their friends’ emotional, spiritual, and relational needs will be addressed elsewhere—with some other type of mental health clinician or counselor, if at all—but not in the specialized medical suite.

However, the exciting news is that our society is becoming increasingly comfortable entertaining the idea of the interconnectedness of mind and body. Wide-ranging randomized clinical studies from molecular biology to social sciences and a great deal of scientific evidence support the idea that both are integrally involved in sickness and recovery and that an individual’s emotional experience and expectations play a large role as well.² When people perceive information with their minds, it triggers the creation of a protein in the brain (a neuropeptide) that starts a cascade of physiological reactions that travel throughout the physical body. So, to be 100 percent accurate, no one would ever separate the mind from the body. Taken together, they are one interactive whole. Current research is helping us understand the fluid connection between the two—we cannot influence one without affecting the other. As naturalist John Muir has said, “When we try to pick out anything by itself, we find it hitched to everything else in the Universe.”³

The fact is, we know that personal interactions can make a difference in healing. Randomized clinical studies into the mind/body connection are important, because in addition to living in an era of technological advances, we’re also in an age that prizes what’s known as “evidence-based medicine.” This strives for treatments that include clinician insight and “the best available external clinical evidence from systematic research.”⁴ In short, if we are going to stand by any type of care, train people to administer it, and implement it in a rigorous way, we want scientific proof that it works. This is all for the good.

Evidence-based mind/body studies are showing that despite all the drugs and technologies at our disposal, our emotional experience during an illness matters as much today as it did centuries ago. For instance, seminal mind/body research at Stanford University as far back as the 1980s found that women with metastatic breast cancer had longer survival rates when they were active participants in support groups that enabled them to express their emotions.⁵ The latest research in this field by Barbara Andersen at The Ohio State University confirms that the active treatment involved in group support can lengthen lives.⁶ In this more recent investigation, 227 women with breast cancer were divided into groups that either did or did not participate in support groups of eight to twelve patients. During the sessions, two clinical psychologist leaders conducted interventions like relaxation training as well as discussions about positive ways to cope with cancer-related stress and fatigue, how to increase social support, healthy strategies to improve diet and exercise regimens, and adherence to cancer treatments. The women participated in twenty-six sessions spread over twelve months.

Then, all of the patients (those in the groups as well as the controls who did not participate) were followed for eleven years, during which time sixty-two had a recurrence of cancer. Of these sixty-two, some dropped out of the study or were too ill to participate. Ultimately, forty-one of the women with metastatic cancer were evaluated at intervals of four, eight, and twelve months. They were assessed for their psychological state, social networks, adherence to medical protocols, and immune system function (including the strength of their natural killer cells and the proliferation of T cells, a type of lymphocyte or white blood cell that plays a central role in immunity).

Dr. Andersen and her team found that the women who had participated in the support groups enjoyed biobehavioral advantages and as a consequence had a lower risk of death and a longer life span after their cancer recurred than those who had not participated in the groups. In addition, there was a longer interval between the initial diagnosis and the recurrence—affording these women more time to live cancer-free. These positive effects may have arisen from many different sources, including feeling part of a community of support, reduced anxiety and depression, and having the opportunity to express emotions about the disease.

This mind/body study is now considered the final word on the subject—and it points to the power of the human connection in healing and even in longevity. In fact, the Institute of Medicine of the National Academy of Sciences⁷ recommended the inclusion of these kinds of psychosocial peer support groups as part of the gold standard for the treatment of cancer. In their report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, the Institute stated: “Evidence emerging from the science of psychoneuroimmunology—the study of the interactions among behavior, the brain, and the body’s immune system—is beginning to show how psychosocial stressors interfere with the working of the body’s neuro-endocrine, immune, and other systems.” One of the recommended approaches to mitigating the pernicious effects of the negative emotions accompanying the illness and its treatments are peer support groups. Indeed, the Institute also made a case for a strengthened connection between patients and those caring for them: “All cancer care should ensure the provision of psychosocial health services by facilitating effective communication between patients and care providers.”⁸

ACTIVE VERSUS PASSIVE TREATMENTS

Why did the women in Barbara Andersen’s cancer support groups benefit from their participation? Some of the potential emotional consequences of cancer diagnosis and treatment include depression, anxiety, and posttraumatic stress disorder. People struggling with these emotional issues along with the disease may have difficulty adhering to the treatments their doctors recommend, which could shorten their life spans. In addition, they may suffer from pain, insomnia, and fatigue that could impact their ability to continue working (and earning a living) and carrying out their normal roles in life. All of these issues can compound their depression and worsen their health outcomes.

I believe that one of the reasons the support group extended lives is that regular psychosocial meetings such as those conducted at The Ohio State University or in other institutions such as the Cancer Support Community are active treatments. Rather than being passive victims of their disease and its difficult treatments and side effects, patients in support groups become engaged in their own fight for recovery.⁹ From my years of experience (and with increasingly convincing evidence from ongoing research in the field), I have found that healing requires just such an active process. It occurs when the people needing help form a strong connection to those who seek to help them.

Moreover, I have found that a connected interaction may be far more beneficial and far less harmful than quickly prescribing drugs—a much more passive approach. For one thing, as I mentioned earlier, drug interactions and polypharmacy cause far too many problems. For example, dementia or memory loss are common concerns, particularly as people age. Physicians generally prescribe medications with acetyl-cholinesterase inhibitors (like Aricept) to treat these conditions because they increase acetyl-choline, the neurotransmitter needed to make memories. However, other treatments with side effects that lower acetyl-choline are often prescribed simultaneously. These medications (many ending in “ine”) are used for allergies (Benadryl or diphenhydramine and Claritin or loratadine); muscle spasms (Detrol or tolterodine for bladder control); and depression, pain, and insomnia (Cymbalta or duloxetine and Elavil or amitriptyline) to name just a few. All of them have now been found to increase the risk of memory loss if used long term because they inhibit acetyl-choline, the very neurotransmitter that helps make memories.¹⁰ So one drug interferes with the action of the other—leading to poorer outcomes and frustration all around.

Besides, simply prescribing a pill does not require caregivers or patients to interact as they contemplate how life circumstances may have affected health, which I believe is a central element to healing. Let’s look at depression as a prime example of the potential dangers involved in a passive methodology. This disease has many origins (including life circumstances, genetics, and other illnesses such as cancer, hypothyroidism, and Parkinson’s) that can exacerbate symptoms. One of its underlying physiological causes is a lessened amount of serotonin, the feel-good hormone, in the brain. Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Prozac or Zoloft, work because they block receptors for this hormone, thus allowing more of it to circulate where it’s needed. Since the development of SSRIs, doctors have been treating depression passively with these drugs for many years now. In fact, taking pills, receiving acupuncture, or getting a massage are all passive therapies.

However, for every action there is a reaction. In the case of treatment with SSRIs, a less favorable result, called oppositional tolerance, can develop.¹¹ When the medication artificially blocks serotonin receptors with an SSRI, the body listens and adapts. Thinking it needs more receptors for serotonin, it creates them. Over time, a patient may develop tolerance to the antidepressant; since the body has boosted the number of serotonin receptors, the dose needs to increase too, in order to have the same “feel good” effect.

But let’s say a person doesn’t like the sexual side effects of the antidepressant. Or his mood is improving, and he feels he no longer needs the drug. So he stops cold turkey. Now the serotonin receptors are no longer blocked, which means that he has many more than he did before starting the medication. As a result, circulating serotonin binds to all these newly formed receptors, which triggers their levels to drop drastically—like water running down an open drain. This causes the person to feel terrible—even more depressed than before. He believes that he really needs to go back on the SSRI. The key, therefore, is to stop taking the drug gradually, so the body can readapt to a lower dose over time.

This same process occurs with many other medications and procedures. For instance, if doctors prescribe opioids like hydrocodone or morphine for pain, when all the opioid receptors are bound with the medication, the body adapts and creates more of them. Over time, treatment with opioids can increase pain sensitivity in some people, actually worsening the very problem we are trying to resolve. This is known in the literature as opioid-induced hyperalgesia.¹²

Similarly, when we shut off the acid pump in the stomach for extended periods of time with proton pump inhibitors such as Prilosec, the body thinks it needs to make more acid and is primed to do so—like a horse ready to bolt out of the gate at the Kentucky Derby. When the drug is stopped, the acid levels rise higher than usual (in a process called rebound hyperacidity), and patients develop severe acid reflux symptoms. Studies have found that physicians can actually cause heartburn in people who never had it before if they put them on acid-suppressing drugs for at least six weeks and then stop them abruptly.¹³ Not only that, recent research has shown that shutting off the acid pump long term with these drugs also causes nutrient malabsorption and increases the risk of dementia, heart disease, and kidney disease.¹⁴ There can be long-term harm from overuse of this quick fix. On the other hand, if a patient considers the metaphor “What’s eating me up inside?” maybe he won’t need to simply turn to a drug to block the acid pump.

Major bariatric surgery for obesity also leads to oppositional tolerance. The most successful form of this surgery is called a Roux-en-Y. The stomach is bypassed by replumbing the gastrointestinal track. A pouch that holds only a cup of food is fashioned from the small intestine. This is then attached to where the stomach used to be. The stomach is still present (it allows pancreatic enzymes to continue to digest food), but it’s off on its own now, creating the left side of the Y. Successful surgery can result in significant weight loss and even reversal of diabetes. But if a person regains her appetite and returns to consuming the same large meals, the body adapts. The one-cup pouch stretches to the size of the original stomach, and the pounds pile back on. In fact, after five years, 50 percent of people return to their original weight, with the addition of a number of side effects related to this aggressive surgery.¹⁵ This setback might have been prevented had the patient and clinician explored the emotional reasons behind the overeating.

The human body, and all of life for that matter, is remarkably adaptive. It has tremendous potential to heal if we take the time and attention to help it along. In Buddhist philosophy, there is a saying that encourages us not to “push the river.” When we try to change the normal course of nature, the river may overflow its banks, causing harm. Medications have been, and still remain, one of the most valuable therapeutic tools we have to treat disease, but if we overuse them and do not address concomitant emotional issues, we can “push the river” of the body.

There is another way. Indeed, healing from within requires a connection with another human being to develop insight into the real, underlying cause that may be triggering the body to react with symptoms. So if someone is depressed and bonds with a therapist who helps him understand what initiated his despair and how he can change his life, he then develops insight into the problem instead of simply manipulating serotonin receptors. This is why research shows that cognitive behavioral therapy (also known as CBT; reflecting on one’s situation, learning, and making changes) works as well as medication and with fewer relapses.¹⁶ This approach encourages exploration of situations that have led to patterns of behavior. Self-examination results in insights into how to proactively change the course of one’s life. Active therapies sustain healing. Passive therapies, like antidepressants, proton pump inhibitors, and bariatric surgery, can help reduce symptoms but they are not as sustaining, and often unsustainable.

Just taking the medicine without insight rarely results in healing. We are more effective when people can actively mobilize the body’s and mind’s own resources. But this requires caregivers and patients alike to turn toward challenges and suffering, which is much harder than simply taking a pill. Often both pills and behavioral therapy are needed and many people stay on medications long term. But for those with mild to moderate depression, I use these medicines only short term to improve energy and mood sufficiently to empower my patients to work on the active treatments. And then, if possible, I taper off the medication before oppositional tolerance develops.

Other active therapies have also been found to be quite powerful—for example, mindfulness, an ancient Buddhist practice, is the process of living in the present moment, on purpose, without judgment (see Chapter 7). Most of the time, the mind dwells in memories of the past or in the desires or expectations of the future. Most stressful thoughts come from past regrets—the “I should (and shouldn’t) haves” (I should have stopped at that red light. I should have asked her out on a date. I shouldn’t have sold that stock!) and fears for the future—the “what ifs” (What if I don’t pass this test? What if this relationship doesn’t work out? What if my child gets hurt at camp?). Regret traps the mind in the past and anxiety traps the mind in the future. Purposefully living in the present moment gets people out of the past and the future (about which they can do nothing) and into the “what is.” And research has shown that mindfulness-based cognitive therapy (MBCT),¹⁷ achieved through carefully structured meditations on the present moment, can reduce stress, anxiety, insomnia, pain, and depression.¹⁸ A positive experience can boost treatment and even provide better outcomes.

Jon Kabat-Zinn, a pioneer in bringing mindfulness practice from the East to the West, found that this meditation technique even improved the symptoms of a physical ailment such as psoriasis. The patients in his research were undergoing treatment of their red, scaly lesions using ultraviolet phototherapy, but those who also meditated using mindful techniques found their skin cleared up faster than those who did not.¹⁹

Whether caregivers are treating patients or helping a loved one recover, they can put the mind’s capabilities to work in healing. And one of the very best ways to boost good, positive, optimistic feelings is through a human connection that elicits hope and the expectation of a positive outcome.

THE SO-CALLED PLACEBO EFFECT

One of my patients, an ultramarathoner who runs one hundred-mile races, told me something that has stuck with me: “The mind always goes before the legs.” To run one hundred miles, both the body and the mind need to be fit, but the mind is in control. Beliefs about what is or isn’t possible send more or less energy to the muscles to do the job. The mind pulls the levers that make the body keep going, even under these extreme conditions. The relationship between mind and body continues to be a surprise to people, but it shouldn’t be. What we think and what we expect can change the course of the body’s responses. And this is particularly true of what we have come to call placebos.

In 1807, Thomas Jefferson wrote, “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together.”²⁰

Placebos! In Latin, the term means “I shall please.” The placebo effect refers to a patient’s positive belief that a treatment will work—and often it does. Many experiments have shown that placebos can play a role in improving asthma, heart problems, and even kidney disease. For instance, it has been found that blue placebo pills are more sedating than pink, and red ones are more effective than beige. Placebo pills that are “branded” are more helpful than generics. Bigger pills are “stronger” than smaller ones, and on and on.²¹ In fact, the more an intervention hurts, the stronger the placebo effect. Moreover, a recent research study has shown that the context of how the placebo therapy is administered (in this case, to people who suffered from osteoarthritis in the knee) influenced outcomes. As expected, the doctor giving a placebo shot or rubbing on a cream relieved pain more effectively than when patients simply were given a capsule to swallow.²²

Outcomes such as these are emblematic of the power of engaging a person’s own healing mechanisms. Call it the “placebo effect” if you will, but this is more than simply giving a dummy pill. In fact, I feel the term “placebo effect” can be misleading since it may suggest trickery. I believe a better term would be “the healing effect.”

The mind’s influence is especially powerful when it comes to the body’s self-healing capacity. Also known as “interpersonal healing,” it is initiated by the interaction between doctor and patient. It can be triggered by many behaviors, symbols, and rituals in the clinical encounter, all of which provide a patient with hope, trust, meaning, support, and empathy.²³ Indeed, placebos have dramatic potential to propel healing when caregivers are able to create the ideal belief, expectancy, and ceremony to trigger these mechanisms. They are beneficial in their own right if used strategically by a gifted clinician.

For instance, in 2006, Bruce Wampold and his team of researchers at the University of Wisconsin published their findings after analyzing the data from a 1985 landmark study by the National Institute of Mental Health (NIMH). The latter stressed the benefit of the antidepressant imipramine over a placebo. The Wisconsin team was concerned that this original investigation did not take into account the impact of the clinician prescribing the drug so they looked at 112 patients more closely to determine whether the psychiatrist–patient relationship had influenced the outcomes. They found that psychiatrists who were good at developing rapport and a trusting relationship had better results with a sugar pill than psychiatrists less skillful in these techniques when they prescribed the active drug. They also showed that this “talented” group had even better outcomes when they used the active drug. The connection the psychiatrists made with their patients was more powerful than the medication. And when they used the real medicine, the healing effect was enhanced.²⁴

Even more interestingly, a new study conducted in Portugal has shown that placebos are more effective for lower back pain than traditional treatments even when patients are told in advance that they are taking an inert compound. The rationale for this study: No single treatment has yet been found to significantly decrease pain when used alone. One of the most common medications given for back pain—nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Aleve or the more potent prescription versions—reduces pain but only by about 1 point on the 10-point pain scale.²⁵ And contrary to popular belief, opioids are also anemic pain relievers as they have not been found to significantly benefit pain, function, or quality of life over the long term.²⁶ So if the intrinsic value of the medication doesn’t do much, scientists have proposed that maybe physicians could create ceremony, ritual, and positive expectations to enhance outcomes. That’s exactly what researchers did in Portugal.

They randomly divided eighty-three people with low back pain into two groups. For three months, forty-one of the study participants took an open-label placebo—that is, the label on the pill bottle actually read “Placebo Pills.” The other forty-two patients continued treatment as usual without the placebo pills. But the researchers created positive expectations for the placebo pills. All participants were shown a short video summarizing past research supporting positive benefits of open-label placebos, and they were also told the following: “The placebo effect can be powerful. The body’s reaction to placebo is similar to the well-known conditioned responses of Pavlov’s dogs. A positive attitude can be helpful. Taking the pills faithfully for 21 days is critical.” After everyone received this education, they opened the randomized envelopes and those in the research group were given a bottle that was labeled “Placebo Pills. Take 2 twice a day.”

The researchers were looking for improvements in pain (on a scale of 1–10) and disability (on a scale of 0–24). They measured these at baseline, before the drugs were taken, and also after eleven and twenty-one days. They found that compared with the 1-point improvement with NSAIDs and a 0.2-point improvement with treatment as usual, the people taking the open-label placebos experienced a 1.5-point reduction of pain. The placebos were even more powerful for disability, which was reduced by 2.9 points on a 24-point scale compared with no improvement at all with the usual treatment regimen.²⁷

What are we to take away from this study? I believe that the benefits of any therapy a physician prescribes derives from much more than the intrinsic value of the substance itself. The ritual and expectations created around the medication can enhance its effects. Possessing a bottle labeled “Placebo Pills,” opening it, and taking it with the expectancy that even sugar pills can be beneficial, can improve outcomes. In fact, a talented clinician prescribing an open-label placebo can do more good with less harm than someone who doesn’t take the time to create positive expectations and prescribes drugs such as NSAIDs and opioids that have well-known and pernicious side effects.

HOW DO PLACEBOS WORK?

These powerful results have been correlated to visible changes in the brain. A person’s expectations of improvement stimulate production of dopamine (the reward hormone) and opioids (the pleasure and pain-relieving hormones) and a cascade of other neurotransmitters in the parts of the brain that receive information, process it, and influence emotions. Positron emission tomography (PET) scans light up the parts of the brain that are most active and show that a positive expectation influences the production of dopamine and opioids in the anterior cingulate, orbitofrontal, and insular cortices as well as the nucleus accumbens, amygdala (a small, almond-shaped structure in the brain that mediates emotions), and periaqueductal gray matter. That is strong medicine from a mere thought—an expectation.²⁸

One investigation, conducted by researchers from Wake Forest University and published in the prestigious journal Proceedings of the National Academy of Sciences, used functional MRI (fMRI) studies to measure pain and pain relief. The researchers found that when participants subjected to painful patches on their legs were told that their discomfort would be decreased (whether or not it was), they actually reported feeling less pain—28.4 percent less, to be exact. But there was physiological evidence, too: The fMRI scan showed a significant decrease in activity in all pain-centric regions of the brain. In fact, the authors wrote, “positive expectations (that is, expectations for reduced pain) produce a reduction in perceived pain that rivals a clearly analgesic dose of the opioid morphine.” ²⁹ The amount of morphine needed to reduce pain by 25 percent is normally 0.08 mg per kilogram of body weight. If a person weighs 170 pounds (77 kg), the positive expectation of reduced pain would have the same effect as if he took 6 mg of morphine. This echoes the findings in the study we discussed in Chapter 1 in which the nurse rather than the computer behind the screen administered the pain medication. In that study, human involvement reduced pain by about 8 mg of morphine.

Nevertheless, as a culture, we take so little stock in placebos because they have been thought of as a sham. They are utilized in clinical trials to gauge the worthiness of an up-and-coming drug. If the experimental chemical outperforms the placebo, which is usually a sugar pill, it’s deemed an effective medication and is readied for market. If the placebo is just as or more successful, the new medication is considered ineffectual and is shelved. I will be taking issue with this perception throughout this book. From my experience, interpersonal healing as mediated by the connection is not trickery but a valid and proven modality that modern science is just beginning to capitalize on.

Caregivers possess great potential as healers. They can be far more effective helping others if they take stock of their own powers. They may not be able to enact a cure in patients or loved ones, but they can certainly use their presence to mobilize the other person’s self-healing resources. They can provide support, a positive outlook, motivation, and hope, which can improve the potential to heal and the eventual outcome. These are the skills of emotional intelligence. When put to good use, caregivers will be able to apply their positive communications in order to set into motion the health of others. In fact, there is a biological root to human connectedness and compassion, one that we will explore in greater depth.