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Chapter 1
A SEARCH FOR SOMETHING THAT LASTS
When I was a student at Harvard Medical School, I was taught that the greater part of what I was learning about the human body would be obsolete within five years. In other words, a few years after I finished medical school, before I even completed my hospital residency and became a full-fledged member of the medical profession, medical science would have progressed so far as to create a whole new set of rules for taking care of patients.
Thus began my search for something in medicine that lasts. I wanted to identify some timeless source of healing, the merits of which could never be denied. Not only would this "treatment of choice" outlast the five-year mark but it would have proven value for generations present, for generations past, and for generations to come.
I will confess that, in part, youthful laziness launched my search. No medical student relishes the idea of having to learn a subject over and over again. But my contemplation of the enduring aspects of human life began in earnest when I was twenty-one, a premed student in college, and had to face the death of my father from rheumatic heart disease. In my mind, science never adequately explained his passing. With their diagrams, definitions, and anatomic drawings, my textbooks couldn't begin to capture the spirit and presence he embodied.
This was a man who had grown up in the jungles of South America, who came to the United States with only a fourth-grade education, who spoke five languages, and who went on to become a successful businessman in the wholesale and retail produce industry in Yonkers, New York. My father tried to impress upon me and my siblings the importance of "doing things fight." He told us about the time a shopkeeper had had to let him go from his job sweeping up. To finish the job well, my dad was especially thorough cleaning up that night, so the next day the shopkeeper called to tell my father that if he was willing to return, the shopkeeper would find the financial means to keep him on.
This was what defined my father's life, the same way that family and work, hardships and victories, principles and life lessons define the lives of all human beings. But these matters were rarely addressed in the education I received as a physician -- in the scientific literature, in grand rounds, or even in the training I received at the bedside. And as much as I began to believe that science was all-powerful, snowballing in its ability track and explain life's mysteries, I had a nagging feeling that medicine was missing a critical point.
Accumulating the Evidence
This book traces my steps over thirty years of accumulating evidence of an eternal truth about human physiology and the human experience. Luck, hunches, and happenstance often guided my journey, as with most people's careers. I went from patient to patient, from research study to research study in the same way that all physician-researchers do, unable to predict how each line of inquiry and its corresponding results would contribute to long-term improvements in medicine. But deep down, I always hoped that some immutable wisdom would emerge.
Partly because my father had died from heart disease, I started my career as a cardiologist. But soon I began to feel inhibited by my specialty, which limited its explorations to keeping chambered organs pumping in patients' chests. Increasingly, I was drawn to mind/body research, and would go on to become one of a handful of medical investigators who established the scientific field recognized today as mind/body medicine.
Except for a brief training stint in Seattle, and the time I spent in the U.S. Public Health Service in San Juan, Puerto Rico, I've spent my entire career working within Harvard Medical School's teaching hospitals. In 1988, I founded Harvard's Mind/Body Medical Institute at Boston's Deaconess Hospital. Perhaps my most significant contribution to the field was in defining a bodily calm that all of us can evoke and that has the opposite effect of the well-known fight-or-flight response. I call this bodily calm "the relaxation response," a state in which blood pressure is lowered, and heart rate, breathing rate, and metabolic rate are decreased. The relaxation response yields many long-term benefits in both health and well-being and can be brought on with very simple mental focusing or meditation techniques.
Teaching these methods to patients, health care professionals, and others, I began to realize the power of self-care, the healthy things that individuals can do for themselves. More and more, I became convinced that our bodies are wired to benefit from exercising not only our muscles but our rich inner, human core -- our beliefs, values, thoughts, and feelings. I was reluctant to explore these factors because philosophers and scientists have, through the ages, considered them intangible and unmeasurable, making any study of them "unscientific." But I wanted to try, because, again and again, my patients' progress and recoveries often seemed to hinge upon their spirit and will to live. And I could not shake the sense I had that the human mind -- and the beliefs we so often associate with the human soul -- had physical manifestations.
First Hints of Mind/Body Influence
I had witnessed this firsthand while serving as a merchant seaman the summer after my junior year of college. From the time I read Joseph Conrad as a youth, I was determined to "go to sea." And together with my best friend Howard Rotner, I fulfilled this dream by acquiring this incredible "summer job," which took me across oceans and to ports as diverse as Casablanca, Morocco; Naples, Italy; Piraeus, Greece; Southampton, England; Istanbul and Izmir, Turkey. In these ports, my fellow seamen were fond of barroom bingeing and often returned to the ship with awful hangovers. Knowing that I planned to be a doctor, my suffering shipmates would come to me for relief. But all I had to offer them were vitamins, which I promptly dispensed.
Though the vitamins should have had little or no effect, my shipmates' symptoms -- and foul moods -- improved rapidly and dramatically after taking the pills. And as word spread of the wondrous results, more and more of my fellow sailors sought me out for my magic pills. But once my indoctrination into medicine began, I found my medical mentors and peers far less interested in this phenomenon. For the first time, I realized there was a great disparity between the things laypeople felt were good for them and those that medical scientists decided were good for them.
This disparity made me uncomfortable, as did the fact that a diagnosis -- a few words from a doctor -- could dramatically change a patient's view of him- or herself. On the basis of an office visit and a simple test, a doctor could, for example, in diagnosing hypertension, ask a patient to take medication for the rest of his or her life, to endure aggravating side effects, and make major adjustments in diet and lifestyle. Overnight, patients diagnosed with chronic medical problems or illnesses began to think of themselves as "sick," and the effect that label had on their psyches and their physical health was substantial.
This is what happened to a patient of mine, Antonia Baquero. Before I met her, Ms. Baquero had had calcium deposits removed from her breast, an operation that left a large indentation. The calcium deposits were benign, but her surgeon recommended the operation because of the relatively small chance that a malignant tumor might later develop. The mere suggestion that she might develop cancer frightened Ms. Baquero. "I panicked," she explains. "I decided immediately, in one moment, to have the calcium deposits removed." Later, she regretted the decision. "My body felt cut up. It was a very difficult time in my life. I was trying to juggle business and family. I would wake up at three A.M. and be unable to sleep. There was too much tension."
Seeking relief from the anxiety and panic that escalated after her surgery, Ms. Baquero happened to pick up my book Your Maximum Mind at the library. Soon after, she came to Boston from her home in New York to see me. I talked with her about the relaxation response and the ways in which this relaxed physical condition could be brought about, or "elicited" as I prefer to say. To elicit the response, I explained that she needed to focus silently on a word or phrase for a period of ten to twenty minutes twice every day, gently brushing aside any everyday thoughts that distracted her to return to her focus. I told her that this was the mental exercise I had shown would dramatically ease the body's usual alert mode of operation, not undermining it, simply letting it calm down and rest for a while while one was awake.
As so many of my patients do, Ms. Baquero decided to incorporate a religious phrase in this mental focusing exercise. Since I encourage people to pick a focus that pleases them, she adopted a Spanish blessing, "Jesu Christo ayudame, ampárame y curame," which means "Jesus Christ, help me, protect me, and cure me." Her mother said a similar blessing to her and her siblings as children before they left for school each day. And over the course of months in which she used this familiar prayer to elicit the relaxation response, Ms. Baquero began to feel liberated from the worry and strain that had bothered her incessantly before. "I started to feel better. I started looking at people and life in a different way. I put less pressure on myself," she says.
Surely, Ms. Baquero was experiencing the wonderful physical solace of the relaxation response, the opposite effect of the edgy, adrenaline rush we experience in the stress-induced fight-or-flight response. But she also spoke of a more emotional comfort, which the symbolism and meaning of her mother's blessing inspired. The emotional and spiritual balm seemed to affect her as much as the chemical and physical changes that occur during the relaxation response.
Not only was her body soothing itself but Ms. Baquero seemed to be reclaiming her identity -- the essence of which was called into question when the threat of cancer was introduced to her. Each time she invoked this powerful prayer, she recalled her mother's faith in God's protection, and the faith instilled in her as a child. By introducing this tender comfort into her daily experience, she began to regain confidence both in her body and in herself to face the twists and turns of life.
Maybe Ms. Baquero's surgeon didn't know that the simple, preventive act of surgery he suggested would cause her so much long-term distress. In our society, doctors often prefer -- and presume that patients want -- to "do something" and "act" to treat or prevent illness or injury. But in Ms. Baquero's case, the diagnosis and the act of "doing something" undermined her faith in the strength of her body. Eliciting the relaxation response with her prayer, she regained a mental equilibrium and undoubtedly helped to ward off disease by doing something to calm her body and her fears.
Remembered Wellness
I learned a lot from these two observations of simple human healing. It turns out that by tracking the contribution a person's desire for health had on his or her health, and by cherishing the right of the individual to choose his or her own outlook, I found the clues of a scientifically profound source of healing. I call this source "remembered wellness." Like my shipmates, all of us project our intense desire for wellness onto the medicine we take. And like Ms. Baquero, all of us have the ability to "remember" the calm and confidence associated with health and happiness, but not just in an emotional or psychologically soothing way. This memory is also physical.
Remembered wellness isn't particularly mysterious. The evidence of its substantial, positive influence over the body has existed for centuries. It's known in the scientific community as "the placebo effect." But I hope to replace the term with "remembered wellness" not only because it more accurately describes the brain mechanics involved but because "the placebo effect" has become pejorative in medical usage. Members of the medical community often refer to its successes as "just the placebo effect" in much the same way as we tend to dismiss ailments as being "all in your head."
Most of us think of a placebo as a sugar pill, which, when dispensed by a physician, plays a kind of trick on a patient's mind, producing benefits for the body. And we know that researchers often rely on placebos -- inert substances or procedures -- to contrast results between a control group and those receiving an experimental therapy. But perhaps less well promoted is that an individual's belief empowers the placebo. The fact that the patient, caregiver, or both of them believe in the treatment contributes to better outcomes. Depending on the condition, sometimes affirmative beliefs are all we really need to heal us. Other times we need the collective force of our beliefs and appropriate medical interventions.
Yet, despite the fact that physicians have always acknowledged this phenomenon, we haven't heralded its efficacy or explored its therapeutic applications. As the ultimate insult, a placebo has often been called a "dummy pill." But the human body, with its propensity to turn a person's beliefs into a physical instruction, is not dumb. I first began reviewing the scientific literature on the placebo effect in the mid-1970s, and shortly thereafter began publishing and speaking on its potential therapeutic benefits. Together with colleagues, I found that in the patient cases we reviewed, the effect I call remembered wellness was 70 to 90 percent effective, doubling and tripling the success rate that had always been attributed to the placebo effect.
As my research has progressed, I have learned that as long as humans have roamed the earth, we have entertained beliefs. We have always called upon God or gods to sustain us. We have named and given meaning to nearly everything, sometimes simply in our own quiet contemplation of life, sometimes on a larger scale to stir the thoughts of whole populations, as happens in art, literature, and philosophy. We see the world in the unique way our socialization, life experiences, and cultural and religious upbringing permit us to see it. We are not all equally analytical or compelled to find deep meaning in the events of our lives, but we human beings cannot help but color our reality with hopes, emotions, philosophies, and convictions. It is our nature.
But neurological research reveals that before we consciously color the world around us with our thinking and acquired beliefs, brain mechanisms mark our perceptions, forming opinions and assigning emotional values. Before we even have a chance to mull over the presence of a new sight or sound, regions of our brain react by assigning an initial but influential value to it. These automatic attitudes make us incapable of utter objectivity or neutrality, in more profound ways than we've ever suspected.
Western science and all of its brilliant discoveries have been built on the tenet that we can and should want to achieve objectivity, and that objective facts can be distinguished from intangible or subjective aspects of life. And because beliefs and emotions are ephemeral and imperceptible, Western medicine has largely assumed that their effects are not physical or measurable. But neurological researchers and those of us delving into the considerable, measurable effects that beliefs can have on the human body are painting a very different portrait of human physiology and human life, with discoveries destined to change the way health care is conducted.
A Book About Beliefs
I could not have predicted that I would write an entire book about the fact that beliefs have physical repercussions, or that the human spirit was relevant, much less that it was influential, in the treatment and prevention of illnesses. But in my thirty years of practicing medicine, I've found no healing force more impressive or more universally accessible than the power of the individual to care for and cure him- or herself. But different from the message often championed in the public realm, it isn't belief in one's self, or a simple matter of positive thinking, that reaps the greatest health rewards. Nor is it as simple as turning away from Western medicine to rely on unconventional healers and their seemingly more sensitive healing arts.
I believe the ideal model for medicine is that of the three-legged stool. The stool is balanced by the appropriate application of self-care, medications, and medical procedures. One leg, that which patients can do for themselves, is the most disparaged and neglected aspect of health care today. The other two legs are things the health care profession can offer or do for patients -- resources that medicine relies on almost exclusively today, and that are splendid for the problems they actually solve. In this book, we'll focus on remembered wellness, which can enhance all three legs of the stool. Doctors and other caregivers dispensing medication or performing procedures must believe in their efficacy and communicate this confidence to patients to engender remembered wellness. But we'll pay special attention to the self-care leg of the stool, not so much on physical exercise and nutrition, which we all know are good for us, but on the inner development of beliefs that promote healing.
I'll lead you through the hypotheses and findings that propelled my process of discovery and show why we need greater balance among the three legs of the stool. Throughout my search and in this book, I have applied objective measurements to prove very subjective points, and used empirical data to draw conclusions about "intangibles" -- about people's expectations, hopes, and fears. That these findings say so much about us as emotional, spiritual, and intellectual beings, and not just about our physicality and health, is a strange and wonderful by-product of a traditional scientific pursuit.
But my search also exposed the inherent weaknesses in Western thought and medicine, which has failed to appreciate the consistent power of remembered wellness. It's uncanny that medical science, in its passion to preserve life, has neglected the motivations that drive humankind forward, the meaning of life that makes people thirst for health and longevity.
There's a great deal of practical advice to come in this book that pays attention to these primal instincts. We'll explore the role beliefs play in your health and well-being, and strategies you can employ to "remember" wellness. We'll talk about the impact remembered wellness can have on medical conditions and illnesses, and suggest more appropriate use of medications and medical procedures for problems that cannot be solved by remembered wellness alone. Then I'll make recommendations about how to choose healthily from a menu of self-care, conventional, and unconventional healing options.
I'll conclude with a blueprint for optimal medicine and health that I believe takes full advantage of remembered wellness and the visceral nature of human beliefs. But when mobilized, the wisdom inherent in our bodies will not only transform individual health, it will reform medicine, saving our nation billions of dollars per year in unnecessary health care expenditures.
Many years have passed since I was a medical student, eager to use the science I was learning to help patients. Since then, as the pages of this book will describe, I have found a source of healing that is timeless. A basic instinct, this belief often transports people from pain and illness and, yet, to our detriment, Western science and society often dismisses it. This visceral truth is something we can count on, something that remains the same despite the dramatic changes we often experience in our public and private lives. We don't acquire it from textbooks; it is part of our physical endowment from the day we are born. This was true of my father and all the generations before him, it is true of you and your family, and it will be true of all our descendants. Eternally and internally true, it is an entrenched fact of human life that, when exercised and appreciated, has enormous power to heal us -- mind, body, and soul.
Copyright © 1996 by Herbert Benson, M.D.
