The Healing Brain
By: Robert Ornstein and David Sobel
From: Psychology Today, March 1987
Questions: J. Geffen
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1.
Every day hundreds upon hundreds of people receive the phone call they
dreaded ever receiving: A disembodied voice informs them that a loved one has died.
The circumstances might be violent and shocking or the death may have been
expected for some time, but in any case the survivors suffer greatly while grieving
their losses during the months that follow.
2.
Since the mid 1970s R.W. Bartrop and his colleagues in New South Wales,
Australia, have been systematically studying the effects of bereavement, not only the
emotional consequences but the effects on physical health as well – specifically, the
body’s ability to fight off disease. They followed the lives of surviving spouses,
charting the transient changes in immune function during mourning, and in one 1977
study they reported that the immune systems of grieving spouses were indeed
weakened. Specifically, they had lower activity levels of what are called “T cells” –
one of the blood cells that attack foreign invaders.
3.
That study was the first to show, in human beings, a measurable weakening of
the body’s defense system following severe psychological stress in a real-life setting.
It precipitated a number of investigations into the larger question of how mind, brain,
body and society are intertwined. At first glance it may seem that changes in one’s
social world, and in related emotional and mental states, have little to do with disease.
But there is mounting evidence that “real,” organic diseases are linked to changing
beliefs about oneself, to the nature of one’s relationships with others and to one’s
position in the social world. Such links only seem impossible – or at least irrelevant –
from the early and simplistic medical view of the body as automaton. Our lungs,
hearts and stomachs are hardly independent, autonomous organs. While they certainly
have autonomous functions, they are all in communication with and regulated by the
brain.
4.
While there is much we still don’t know about the relationship of brain, mind,
body and society, evidence from many areas of research is beginning to make some of
the connections clear. The heart cannot decide that a loved one’s death in a train
wreck is too much to bear; the liver does not feel the shame of embarrassment; the
immune system does not know whether its client is employed or not, divorced or
happily married. It is the brain that knows and feels. Indeed a primary function of the
brain, perhaps as important as rational thought or language, is health maintenance.
The brain has evolved complex “bodyguards,” designed to ward off disease, and it
may even be that our human tendency toward social connectedness may help keep us
well.
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5.
There have been many studies since the original Australian investigation. A
study at the Mount Sinai School of Medicine confirmed and went beyond those
findings. Men who were married to women with terminal breast cancer showed a
similar drop in responsiveness of the lymphocytes (another of the blood cells
specialized for defense) immediately after their wives’ deaths, a drop that continued
for two months. But between 4 and 14 months after the death, the husbands’ immune
functioning had recovered, a change that occurred as their bereavement diminished.
6.
But how can grief and bereavement “get into” the immune system? Is it
something the bereaved do differently than others? Changes in nutrition, exercise and
general activity do affect the workings of the immune system, but the people in this
study had maintained their normal habits. What appears more likely is that the
numerous connections between the nervous system and the immune system allow the
mind to influence resistance or susceptibility to disease. For example, extensive
networks of nerve endings have been found in the thymus gland, an organ that plays
an essential role in the maturation of certain cells in the immune system. Similarly,
the spleen, bone marrow and lymph nodes are richly supplied with nerves supporting
a brain-immune system link.
7.
In addition, the cells of the immune system appear equipped to respond to
chemical signals from the central nervous system. Receptors for a variety of chemical
messengers – catecholamines, prostaglandins, growth hormone, thyroid hormone, sex
hormones, serotonin and endorphins – have been found on the surfaces of
lymphocytes. These neuroendocrines, neurotransmitters and neuropeptides may
somehow stimulate the differentiation, migration and activity of the lymphocytes.
8.
Given the links between the nervous system and the immune system, the idea
that instability in the social world can affect immunity becomes less far-fetched.
Research shows that physical and psychological upsets release several powerful
neurohormones, including catecholamines, corticosteroids and endorphins. These, in
turn, alter immune function. For example, corticosteroids exert such powerful
immunosuppressive effects that steroids are widely used as drugs to suppress
immunity in allergic conditions like asthma and hay fever and autoimmune disorders
like rheumatoid arthritis and to suppress rejection of transplanted organs.
9.
During certain types of stress the brain also releases endorphins, the brain’s own
morphine-like chemicals, which block pain sensation. Psychologist John Liebeskind
and colleagues were able to stimulate the release of endorphins by delivering brief,
mild electrical shocks to rats, and psychologist Yehuda Shavit later reported a
corresponding decrease in tumor-fighting ability in natural killer cells, yet another
fighter in the body’s immune response.
10. To test whether this immune suppression was mediated by the release of
endorphins, the researchers injected the rats with endorphin antagonist – a drug that
blocks the effects of endorphins. They found that the activity of the natural killer cells
had been restored, supporting the idea that the immune suppression was caused by
The Healing Brain / 3
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endorphins. This explanation was reinforced by the additional finding that natural
killer cell potency was also suppressed when the animals were actually given a dose
of morphine.
11. Other animal research links stress and the development of disease. The late
Vernon Riley and his colleagues performed scores of experiments on a strain of mice
that are genetically predisposed to develop breast cancer. In one series of experiments,
the mice were subjected to what was called “rotational stress” – that is, they were
spun on a record turntable at various speeds (ranging from 16 RPM to 78 RPM). They
found that the faster the rotation, the larger the growth in tumors.
12. Other studies suggest that tumors grow more rapidly in animals exposed to
uncontrollable stress than in those exposed to stress they could control. Rats were
implanted with tumor cells and the next day experienced either no electrical shock,
escapable shock or inescapable shock. Fifty-four percent of the first group rejected the
tumor; 63 percent of the rats receiving escapable shock and only 27 percent of the rats
receiving inescapable shock rejected the tumors.
13. These findings are supported by changes in immune function. Steven Maier,
Mark Laudenslager and co-workers at the University of Colorado studied how
exposing animals to controllable or uncontrollable electric shocks affected immunity.
One group of rats was taught that they could terminate a mild electric shock by
turning a wheel in their cages. Another group of rats received a shock every time the
first group did, but nothing they could do would control the shock. Immune function
was assessed by the ability of the T-cells to multiply in response to stimulation. The
results showed decreased immune function only in the rats receiving the
uncontrollable shocks.
14. Generalizing from rats to humans is always difficult, but scores of studies on
humans show that various types of social instability and the lack of resources to
regain stability are associated with subsequent illness. For example, psychologist
Stanislav Kasl and his colleagues at Yale University followed the development of
infectious mononucleosis among West Point cadets in a study published in 1979. All
the entering cadets were given blood tests over a four-year period to screen for the
presence of antibodies to Epstein-Barr virus, the agent that causes mononucleosis. In
addition the investigators reviewed interview data, which included information about
the cadets’ expectations and family backgrounds.
15. Each year about one in five of the susceptible cadets were infected, but only
about one-quarter of those infected actually developed symptoms of mono. Cadets
who had fathers who were described as “overachievers” and who themselves strongly
wanted success in a career but were doing poorly academically were most likely to get
sick. The combination of high expectation and poor performance was reflected in
increased susceptibility to infectious disease.
16. More recent studies link the onset and course of virus infections with stressaltered immune function. For example, approximately one person in four suffers from
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recurrent infections of oral herpes simplex. In a recent study, 18 people between 20
and 43 years old with a history of three to four recurrent episodes of oral herpes per
year completed a stress questionnaire twice; once within three days of the first
appearance of a lesion marking the recurrence of herpes and another time when they
had no active lesions.
17. In the week prior to a recurrence of infection, the group reported increased
stressful life events, daily “hassles” and anxiety, indicating that such stressful
circumstances are associated with an increased likelihood of recurrent herpes lesions.
Later studies suggest that it probably is not the actual stress that brings on the herpes
but the person’s emotional reaction to the disease. If someone is continually depressed
about having herpes, this reaction itself keeps bringing it back.
18. Psychologist Janice Kiecolt-Glaser, virologist Ronald Glaser and colleagues at
Ohio State University College of Medicine have shown that even mild upsets –
milder, that is, than the loss of a spouse – can affect the immune system. In this study,
medical students reported on the number of “life change events” in the previous
months as well as their loneliness. Both loneliness and the mild life stress were
associated with decreased immune cell activity.
19. During a situation where there are conflicting signals or a sudden unexplained
threat or a threat that is beyond the organism’s ability to handle easily, the
sympathetic nervous system is activated. This increases the level of circulating
hormones that suppress immune function.
20. Most of the research on the relationship of psychological states and immunity
has focused on stress-induced immune suppression. But the question of whether
positive states of mind enhance immunity is the subject of a growing amount of
research. There have been many extravagant claims made for the effects of “positive
attitude” and “imagery” on subsequent diseases, but there is little hard evidence that
attitude alone can cure serious disease. There is, however, some real evidence that
people can voluntarily improve their own immune function and thus prevent disease.
21. In one study, psychologist Howard Hall of Pennsylvania State University and
colleagues gave 20 healthy people aged 22 to 85 blood tests before hypnosis, one hour
after and one week later, in order to measure the response of the lymphocytes to
hypnotic suggestion. When they were hypnotized they were told to visualize their
white blood cells as powerful “sharks” swimming through the bloodstream attacking
weak, confused germs (this is not too far from the truth about lymphocytes). They
were told to practice the visualization. The people did self-hypnosis two times a day
for a week, each time telling themselves the shark story.
22. Not everyone showed changes in immune function; the older people were less
likely to. But enough did show improvement to suggest a link between the separate
worlds of the “soft” mental images and the “harder” phenomena of lymphocytes. The
younger people showed a small but real increase in the responsiveness of their
immune systems following the hypnosis and visualization. In addition, those people
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who were easily hypnotized showed increased numbers of lymphocytes after their
hypnotic sessions.
23. These changes in immune functioning were small, but so was the experimental
“treatment” – just two hypnotic sessions and self-hypnosis for a week. But if such a
minor series of events can lead to real changes in immune functioning, what might the
possibilities be for increasing our ability to control our own immunity?
24. Kiecolt-Glaser and colleagues have found that relaxation training can also
enhance cellular immune function. Forty-five geriatric residents of an independentliving facility were taught progressive relaxation and guided imagery techniques three
times a week for one month. Relaxation was presented to these residents as a way to
gain some control over their world. By the end of the training period the group
showed a significant increase in natural killer cell activity compared to a control
group and a group that merely had “social contact” visits from a college student. The
relaxation group also showed significant decreases in antibodies to herpes simplex
virus, possibly because the herpes virus was being controlled better by the immune
system. These relaxation-induced improvements in immune function were
accompanied by self-reports of less psychological distress.
25. A series of interesting and still controversial studies by Boston University
psychologist David McClelland and colleagues suggests that the need to exercise
power over others is related to differences in immune function and susceptibility to
disease. In McClelland’s view, some people have a greater need for power – the
desire for prestige or influence over others – than they do for affiliation – the desire to
form close affectionate relationships. When people who need power are for some
reason unable to exercise it, there seem to be changes in their immune function.
26. McClelland and colleagues have found that college students who were high in
power-related life stresses – a major personal achievement, for example, or the threat
of physical attack – reported more frequent and more severe illnesses than other
individuals. They also showed elevated levels of epinephrine and depressed levels of
salivary immunoglobulin A (S-IgA) – considered a factor in resistance to respiratory
infections. As expected, lower levels of S-IgA correlated with reports of more
frequent illness. McClelland interpreted the findings as indicating that if a strong need
for power is inhibited, there is chronic overactivity of the sympathetic nervous
system, which suppresses the immune system.
27. Similar results were obtained in a 1982 study of first-year dental students.
Psychologist John Jemmott and colleagues found that students with an inhibited high
need for power reported greater incidence of upper respiratory infections following
periods of high academic stress than after periods of low stress. However, variations
in stress did not appear to correlate significantly with reported illness in students who
were below average in their need for power.
28. Other studies show how feelings, expressed or not, are associated with immune
function and disease. In a 1979 study that compared long-term survivors of breast
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cancer with those who did not survive, psychologist Leonard Derogatis and
colleagues at Johns Hopkins University School of Medicine found that long-term
survivors expressed much higher levels of anxiety, hostility, alienation and other
negative moods and were perceived as having negative attitudes toward their illness.
29. We take a somewhat controversial approach to interpreting many psychological
effects on the immune system, looking not only at the individual’s attitudes, moods
and thoughts but at his or her relationship to the larger social environment. The well
known increase in mortality rates among bereaved spouses cannot be fully understood
as individual reactions alone. There seem to be some mechanisms in animals and in
human beings that respond to social needs. When the Sika deer suffer from
overcrowding, many of the herd die more quickly, even though they have adequate
food. Maybe the same phenomenon occurs in humans; the immune system may cut
down resistance to disease when a person is grieving or is no longer part of a viable
social unit, as in widowhood. It may be an accident of the close neural connection of
the systems, or it may well have resulted from some evolutionary selection pressures.
But in any case there are relationships between health and the social world that might
well be considered from this simple perspective.
30. And conversely, a solid and stable connection to a larger social group, or to
humanity in general, may have the opposite result: improved resistance because the
person is probably more valuable as a member of a group. From our speculative
viewpoint this may be one reason why almost all societies have developed
conventions emphasizing the same virtues and why there is such an emphasis in most
religions upon caring for others, being generous to others and serving them. Perhaps
one of the many reasons is that doing so is not only helpful to the entire community
but also the health of the donor.
31. Consider a final study. When college students were shown a file of Mother
Teresa, winner of the Nobel Peace Prize, tending to the sick and dying of Calcutta,
their immune functioning (as measured by S-IgA concentrations) immediately
increased. So even watching a person engaged in a selfless act of service to others
may have important functions for the health of the community. McClelland noted in
an interview that this immune effect occurred even in people who said they disliked
Mother Teresa: “The results,” he suggests, “mean that she was contacting those
consciously disapproving people in a part of their brains that they were unaware of
and that was still responding to the strength of her tender loving care.”
32. We wouldn’t necessarily describe it that way and in fact think that McClelland
has gone beyond what the data support; but even so, looking outside of the dominant
self-system seems to be important. Even attending to a pet or a plant seems to have
health benefits. We don’t mean to be absurdly reductionist and imply that all social
norms exist for health purposes, but one aim of social and religious communities over
the millennia has been to keep their adherents alive and well, to encourage health
through specific diets and prohibitions, through cleansing rituals and other means.
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33. Could attention to the larger group, away from our biologically primary but
primitive focus upon ourselves, and away from the hostile reactions to others, be
something we are also organized to resound to? All this is very speculative, but we
may well have to think differently about how closely we are related to others in order
to understand ourselves, our organs, even our white blood cells.
The Healing Brain / 8
Answer in your own words.
Answer the question below in English.
1.
How is bereavement – paragraph 2 – likely to affect us?
Answer: _________________________________________________________
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Answer the question below in English.
2.
Wherein – paragraphs 2-3 – lies the novelty of the studies conducted by R.W.
Bartrop and his colleagues?
Answer: _________________________________________________________
________________________________________________________________
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________________________________________________________________
Answer the question below in English.
3.
What bodily organ – paragraph 4 – is ultimately responsible for the various
diseases we are prone to?
Answer: _________________________________________________________
________________________________________________________________
Answer the question below in English.
4.
What thesis does the study carried out at Mount Sinai School of Medicine –
paragraph 5 – illustrate?
Answer: _________________________________________________________
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Answer the question below in Hebrew.
5.
How does the information provided in paragraph 3 relate to that given in
paragraph 2?
Answer: _________________________________________________________
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________________________________________________________________
Answer the question below in English.
6.
How did the husbands married to terminally sick women – paragraph 5 – react
to their deaths?
Answer: _________________________________________________________
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Answer the question below in English.
7.
How could the bereaved persons mentioned in paragraph 6 have conceivably
become less susceptible to disease?
Answer: _________________________________________________________
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Answer the question below in Hebrew.
8.
In what sense – paragraphs 9-10 – is the release of endorphins not necessarily
beneficial?
Answer: _________________________________________________________
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Answer the question below in English.
9.
What do the studies conducted on rats – paragraphs 10-13 – suggest?
Answer: _________________________________________________________
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Answer the question below in Hebrew.
10. Whose susceptibility to disease – paragraph 13 – was least affected by the
administration of electric shocks?
Answer: _________________________________________________________
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Answer the question below in English.
11. Mention the various characters and situations exposing us to a decrease in our
immunity (paragraphs 14-22). Do not provide names.
Answer: _________________________________________________________
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Choose the best answer.
12. The long term survivors – paragraph 28 – are those who
a. are unaware of their condition.
b. accept their condition quite stoically.
c. are by definition passive observers rather than actors.
d. deeply resent their condition.
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Answer the question below in Hebrew.
13. In what sense is the altruism hinted at in paragraph 30 not entirely
unambiguous?
Answer: _________________________________________________________
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Answer the question below in Hebrew.
14. What traditional assumption concerning human nature – paragraphs 31-33 –
would be undermined should the author’s speculations prove accurate?
Answer: _________________________________________________________
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