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The Psychosomatic SecretThe unscientific allure of mind-body medicine.

By Amanda Schaffer
Posted Monday, Jan. 14, 2008, at 7:35 AM ET

(Continued from page 1)

Of course, many of these ideas have not stood up to scientific scrutiny. Theories about how disease is caused by the mind have often served, in fact, as "an index of how much is not understood about the physical terrain of a disease," as Sontag put it. Better science has undermined the notion that stress causes ulcers, that unresolved dependency triggers asthma, and that Type A personalities lead to heart attacks. It has also undercut the myth that emotionally frigid "refrigerator mothers" are responsible for their children's autism.

Science hasn't succeeded in ratifying many well-hyped mind-based treatments for cancer and heart disease, either. Studies have repeatedly failed to find life-extending benefits in positive thinking, though they've hinted that managing negative thinking may sometimes be useful. For instance, in the late 1990s, research showed that breast cancer patients with a "fighting spirit" did not have better five-year survival rates, though feelings of helplessness and hopelessness were associated with worse outcomes. In 2001, a randomized trial found that supportive group therapy did not extend life for women with metastatic breast cancer. And this October, researchers also failed to demonstrate any link between emotional well-being and survival for patients with head and neck cancer. Meanwhile, for heart patients, treatment to reduce feelings of isolation and depression did not lower the odds of a second heart attack, a 2001 study found. Given these failures, it's easy to view mind-based treatments, especially for cancer patients, as all side effect and no cure.

But Harrington inspires a more generous view. At least some studies have shown that group therapy for cancer patients can improve mood and reduce pain. And the drumroll for therapy and social support has probably encouraged cancer programs and clinicians to pay more attention to emotional issues and quality of life. That's a good thing whether or not it increases life span. And when all is said and done, the side effects of positive thinking still pale in comparison with those of some medical interventions for cancer that also turned out not to work. Next to, say, high-dose chemotherapy for breast cancer, which brought patients to the brink of death, forced optimism as a failed experiment doesn't really seem so bad.

Ultimately, mind-based remedies will have specific, limited successes—just as other medical interventions do. The placebo effect may not cure many diseases, but it does seem to reduce some kinds of pain. Massage therapy appears to reduce acute pain after major surgery. And certainly, for psychiatric conditions like depression and anxiety, cognitive behavioral therapy is often successful. Research that treats the mind simply as a phenomenon of the brain—and looks for neural and biochemical explanations for apparent effects, as well as mechanistic links between the brain and the rest of the body—will yield the most credible and medically useful results. Even if no one sings about it on Broadway.

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Amanda Schaffer is a science and medical columnist for Slate.
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Remarks from the Fray:

Kudos to Amanda Schaffer for exposing the unscientific basis for much that passes for mind-body medicine.

Neglected though are the vested interests among psychiatrists who believe that the key to obtaining grants is to make unsubstantiated claims about the benefits of their studies for extending human life.

My colleagues and I recently published a careful review of the available literature in which we concluded that there never had been any evidence that psychotherapy or support groups prolonged the survival of cancer patients, including flawed classic studies making claims to the contrary.

The reaction from some grant holders was swift. The president of my university was contacted twice to complain that I was demoralizing the young people in the field. Colleagues in my own and other departments at my university reported being contacted to pressure me.

Exaggerated claims about mind-body connections are associated with big $$$$.

--James Coyne

(To reply, click here.)

I have only this to say: through a number of surgeries and other procedures, I have always figured that if I was a happy camper, if I had a sense of humor and made my doctors and nurses laugh, they would want to come back and see me. That is, through my humor and my optimism, I might receive better treatment than the curmudgeon in the next room.

A personal and untested theory, I admit, but I'm sticking with it.

Hope and humor!

--SoccerFreak

(To reply, click here.)

On a loosely related note, when I was doing my residency a lot of us picked up the superstition that bad things seem to happen to good people; on the other hand, nasty people seemed to last forever.

Every resident seemed to have a story about a really nice patient with a really nice family who would end up getting diagnosed with some sort of horrible advanced cancer. For each of those stories, there was a some mean, belligerant patient who would get admitted for some problem related to drinking or drugs, get coded, spend a night in the ICU, and then go on to demand narcotics and yell at the nurses another day.

Anecdotal and unscientific, yes. But maybe someone needs to look into whether being nasty helps you live longer!

--Grungie

(To reply, click here.)

I think that people who emphasize attitude are blaming the patient for the disease. Some of them do this because they are afraid of getting sick themselves. They want a reliable cure, and they want to stay in control of events. They imagine that a smile and a good attitude will act as a talisman to keep them safe from disease.

--JedRothwell

(To reply, click here)

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