From Abracadabra to Zombies
W. W. Norton (2008)
I'll begin with the complaint that many skeptics will probably have with this book. The author takes more of a phenomenological and historical approach than a critical analysis aimed at determining whether the mind-body cures she examines are based on anything more than the placebo effect. She is more interested in building bridges between the humanities and the sciences, mind and body, East and West, than she is in making enemies by reducing one to the other or attacking all approaches that do not rely on a strictly physicalist, materialist view of the body in the world. "Do we humans really divide neatly in two," she writes, "as so many academic campuses seem to imply: 'This way for the body, please, that way for the mind'?" (p. 251)
Harrington's interest is in how culture and history affect the body. Ideas about things like hypnosis change over time, for example, but those ideas have a feedback effect and in turn change the way the body reacts to hypnosis. Chapter one explores the way the power of suggestion evolved from the days of possession and exorcism to Mesmer, Charcot, and Bernheim to modern work on the placebo effect. (None of this history ever goes away, of course, as the widespread continuance of belief in possession attests.) She calls "the power of suggestion" a narrative template for a variety of stories that have distinctive features that help us both classify them and distinguish them from other stories that follow different narrative templates. She begins this chapter with a story that, to this reader anyway, seems too good to be true. Unlike a lot of other such medical mystery stories, though, the featured character in this one has a name: Mr. Wright.
The story is that in 1957 or thereabouts Mr. Wright was diagnosed with lymphosarcoma (cancer of the lymph nodes). Conventional treatment failed to the point that his doctors had given up all hope of saving him. Then, Mr. Wright heard about a wonder drug called Krebiozen (actually a quack remedy) and knew he'd be cured if only he could get some Krebiozen. He didn't qualify for the clinical trial but he persisted in badgering his doctor. The doctor relented, obtained Krebiozen, and injected Mr. Wright. His "tumor masses ... melted like snow balls on a hot stove...." Then, Wright heard that Krebiozen isn't what it was cracked up to be and his tumors returned. Wright's doctor then lied to him and told him a story to placate him. The doctor promised to inject him with an extra-potent dose of Krebiozen, which elated Mr. Wright. The doctor injected Wright with distilled water rather than Krebiozen. The tumors receded. Then, Wright read that the American Medical Association had declared Krebiozen to be worthless. Wright relapsed and died two days later.
The only part of the story that I know is true is that Krebiozen is worthless as a cancer drug. According to Harrington, the story was published in "a psychiatric journal" by Bruno Klopfer, a "Rorschach test pioneer" (p. 32). Her source is a 1991 book by Kathyrn Montgomery Hunter called Doctors' Stories. The Wikipedia article on Klopfer claims that Wright's doctor was Philip West and that the article referred to is "Psychological Variables in Human Cancer" and was published in the Journal of Projective Techniques (December 1957, Vol.21 No.4, pp.331-340). In any case, the basic elements of the story seem to be based on fact: there was a Mr. Wright who was treated around 1957; he was diagnosed with terminal cancer; he was injected with a worthless drug and he seemed to improve for a while; he became despondent when he found out the drug was not a miracle drug; he became elated and seemed to improve when he was injected with water that he thought was a better version of the wonder drug; he found out that Krebiozen was worthless; he deteriorated and soon died.
Harrington writes about this story: "Skeptics may or may not believe it or may scoff that it is just one case and in itself proves nothing" (p. 32). Here is this skeptic's take on it. The story has been told many times with many variations. One story, for example, says Wright's doctors only gave him a few days to live before giving him the drug. Harrington says he didn't qualify for clinical trials because you had to have a life expectancy of under three months to qualify. My guess is that this story has been tweaked a number of times to frame it according to the author's beliefs or purposes. I'll do the same. My story is that the fundamentals are true but that the bit about large tumors shrinking to near nothing is probably an error or an exaggeration. Wright would have died about the time he did die whether he heard the bad news from the AMA or not. The story is a classic example of the placebo effect. It is not a story that shows that if you believe you will live, then you will live; otherwise you will die. The story shows that belief affects mood and mood affects one's sense of well-being. It might also show that belief affects perception: the doctor who declared the tumor shrunk like a snowball on a hot stove might have been seeing what he wanted to see, or he might have just made a mistake. More important, many of the advocates in mind-body medicine, of whatever type, often don't seem to care whether the stories they tell are true or false, as long as they seem to support the particular narrative they are propounding.
In addition to the power of suggestion, Harrington divides up mind-body stories into five other narratives.
The "body that speaks" is a narrative that covers stories from hysteria to shell shock to childhood traumas (real and imagined) to anxiety and psychosomatic medicine. The chapter that examines these issues goes from Freud to Bernie "happy people don't get sick" Siegel. The latter sold millions of books with made-up stories about how cancer is the patient's fault for not thinking correctly and how patients could and should heal themselves. For some reason, the lines are always long to worship at the feet of peddlers of such unsubstantiated nonsense.
Other narratives include "the power of positive thinking," which begins with Suburban Myth 83, a story told by Siegel involving an alleged study published in the Western Journal of Medicine that showed changing the letters EPHO (each letter representing a drug being used to treat small-cell lung cancer) to HOPE led to a spectacular increase in positive response to the treatment. (Obviously, these narratives overlap and run into each other.) This chapter covers faith healing, Lourdes, Mary Baker Eddy, William James, New Thought, Henry Ford, Napoleon Hill, Émile Coué, and, of course, Norman Vincent Peale. A good part of the chapter is devoted to Norman Cousins, a man with no medical background who helped medicalize positive thinking. There is also a discussion of placebo effect studies that demonstrated the role of classical conditioning. Sad stories about attempts to cure AIDS and cancer by positive thinking fall into this narrative. Harrington also covers the recent trend in neuroscience to try to back up claims about mind-body medicine with fMRI brain scans showing how some part of the brain is tweaked when the patient thinks of this or is told of that.
"Broken by Modern Life" is a narrative we are all familiar with. Stories of the rat race, the grind, the horror and the stress of it all permeate the medical literature and the media. The development of the concept of stress as one of the main causes or aggravating factors of disease is now accepted as an eternal truth. How the idea originated and developed with Walter B. Cannon and Hans Selye is fascinating and the subject of chapter four. This is the area of Type A personalities, post traumatic stress disorder, and how biofeedback can cure these and other ills. The chapter concludes with an interesting description of the history of the belief that stress harms the immune system.
There is also a chapter on "Healing Ties," which explores the history of the idea of how being loved and cared for, having emotional ties with people who care, being part of a community that can share your burdens and joys, is seen as conducive to health and healing. Epidemiologist Sydney Cobb called it "social support." One of the most curious facts mentioned by Harrington is of "children living in institutional settings whose material needs are all met, but who nevertheless are physically stunted and developmentally retarded because they lack a secure bond with a loving caretaker" (p.252). [Studies with infants show a positive effect from touching,* and some researchers think this may account for the poor development of some institutionalized children.] The story that group therapy can help cancer patients live longer emerges out of this narrative. This is the chapter where David Spiegel's work is discussed. His study of the effects of group therapy on breast cancer patients was published in 1989 in The Lancet. The study included 86 women and found that women in group therapy lived significantly longer than the controls (36.6 months versus 18.9 months). A lot of hoopla followed, but the study needed to be replicated and when it was the results were quite different. In 2001, a larger study found no evidence that group therapy extended the lives of breast cancer patients. Spiegel rationalized the results. He said that improvements in conventional cancer treatment since the 1980s might be masking the independent impact that group therapy really does have on the course of the disease. He also claimed that since most patients have probably heard that group therapy increases longevity, even those assigned to the control group would look outside the group for social support and group therapy. In fact, Spiegel did another study but is still sitting on the data because they don't support his hypothesis. He asked for more funding to extend the study for an additional five years (p. 202-203). That was eight years ago.
"Eastward Journeys" is the narrative that brings us face to face with the Deepak Chopras of the healing world, though the man himself is not mentioned by Harrington. The Dalai Lama and tests on meditators, including transcendental meditators (TM), gets a lot of play in this chapter. Herbert Benson is mentioned for his early work on TM, but no mention is made of his prayer studies that failed to find any significant difference between cardiac patients who were prayed for and those who weren't. In fact, healing prayer stories and studies are not discussed by Harrington in any of her narratives.
The opening of China to the West about the time Mao lifted his condemnation of traditional Chinese medicine (not because it was as good as scientific medicine, but because it was efficient and the country folk believed in it) is discussed. (Bill Moyers's* intellectually-challenged analysis of Chinese medicine is discussed in an earlier chapter.) One of the more interesting parts of this chapter is the story of the on-again-off-again attempt to scientifically study g Tum-mo ("tummo" or inner heat). The work of Richard Davidson and Matthieu Ricard is discussed in this chapter. A book that has come highly recommended to me but which I have yet to read, The Monk and the Philosopher, is also discussed.
Overall, Harrington tries to make sense of mind-body medicine rather than make judgments as to the truth or falsity of the many claims made on its behalf. Mind-body medicine, she says, offers a lot of resources to disparate groups of people. She thinks one of its most valuable qualities is the "set of narratives that offer people a diverse set of cultural resources to make sense of their experiences" (p. 245). Somehow, this is not enough for her students, who, she says, are impatient and want to know if there is anything to this stuff. As a teacher of some 32 years, I can agree with her stance of letting the material speak for itself and having the students make up their own minds.
Harrington notes often how she has been struck by the wealth of stories we tell about our bodies and minds, about health and disease, about sickness and well-being. The stories are interesting and revealing but she leaves it to the reader to determine what they reveal, which is fine by me. Many of the narratives have sub-narratives, like energy medicine, which overlaps with the power of suggestion, positive thinking, and Eastward journeys. The word 'energy' and its cognates are at least as pervasive these days as 'stress' and its cognates. Anyway, there does seem to be a profound difference between hypnosis and therapeutic touch, both of which would be stories about the power of suggestion. Therapeutic touch, reiki, chi kung, and the like might seem to deserve their own shelf in the library in the collection of stories about magic powers but in this they are very similar to Mesmer's story of animal magnetism. Another sub-narrative (probably of the "body that speaks" narrative) would be the food faddists, those who think health and illness are mainly affected by the food we eat, the water we drink, and the air we breathe. The mind-body medicine stories are many but they can be reduced to a few main themes and variations on those themes. As an exercise, after reading the book, one might try to figure out which narrative best fits the UK's National Health Services latest advice: sexercise yourself into shape.
One might quibble with Harrington's categories, but the basic idea is fruitful and provides an interesting way to get at one of the most complicated issues humans have to face: bodies that begin to die the minute they are born and seem to house minds that want to live forever.
Robert Todd Carroll
February 18, 2008