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Mind/Body Medicine

Mind/body medicine

Definition

Mind/body medicine, also known as behavioral medicine, is the field of medicine concerned with the ways that the mind and emotions influence the body and physical health.

Origins

There was a time not long ago when Western medicine believed that health depended solely upon the physical mechanisms of the body. That is, a person is made up only of physical and chemical reactions that can be measured and manipulated scientifically. The notion that the mind and body live in separate compartments, so to speak, goes back to certain philosophers of classical antiquity. This concept of mind/body separation was also present in such religious groups as the Gnostics and some sects on the fringes of medieval Christianity. The scientific version of this split between mind and body is generally traced back to the seventeenth-century French philosopher Rene Descartes, whose thinking aided the development of science. It has taken a lot of time and research, three centuries after Descartes, for mainstream medicine to begin to accept that the mind plays a major role in health and disease.

The idea that the mind and body interact is not new, however. It can be traced to the Wisdom literature in the Old Testament and to Hippocrates, the father of Western medicine. The ancient Hebrews attributed some physical illnesses to grief or anger. Hippocrates believed that health depends upon a balance of the body, mind and environment, and that disease is caused by imbalances in these areas. As modern science progressed, the mind and emotions became neglected, since researchers found it difficult to measure and quantify mental states with the scientific methods and equipment that were so highly valued.

In the early 1900s, Harvard physiologist Walter Cannon coined the term "fight-or-flight response" for the body's reaction to threats, a response that causes increases in heart rate, blood pressure, blood sugar, muscle tension and respiration. During the 1950s, Hans Selye of McGill University pioneered research in what he called stress . Selye determined that the fight-or-flight response could be triggered by psychological factors as well as by physical threats. Stress includes having fight-or-flight reactions in situations where there is no immediate threat except mental perceptions and worries. Stress is not necessarily negative, except when people fail to cope with it effectively. Selye's work laid the groundwork for researchers to determine that stress and reactions to it play an integral role in health and disease.

ANDREW WEIL 1942


Dr. Andrew Weil, a Harvard-educated physician, adds credibility and expertise to the natural healing methods he espouses in his best-selling books, on his Internet Web site, in his talk show appearances, and in his popular audio CD of music and meditation . Weil's Spontaneous Healing spent more than a year on the best-seller list, and his 1997 book, Eight Weeks to Optimum Health, also was a runaway best-seller. Perhaps the best-known proponent of naturalistic healing methods, Weil has been trying to establish a field he calls integrative medicine. He is director of Tucson's Center for Integrative Medicine, which he founded in 1993. In 1997, he began training doctors in the discipline at the University of Arizona, where he teaches.

After getting his bachelor's degree in botany from Harvard University, Weil applied for admission to Harvard Medical School in 1964. During his second year, he led a group of students who argued they could succeed better studying on their own than going to classes; in fact, the group got higher scores on their final exams than their classmates. After graduating from Harvard Medical School, he volunteered at the notorious counter-cultural Haight-Asbury Free Clinic in San Francisco, CA. Later in 1969, Weil got a job in Washington, DC, with the National Institute of Mental Health's Drug Studies Division. From 1971 to 1975, he traveled extensively in South America and Africa, soaking up information about medicinal plants, shamanism , and natural healing techniques. He never returned to the practice of conventional medicine.

His approach to alternative medicine is eclectic, mingling traditional medicine with herbal therapy, acupuncture, homeopathy, chiropractic , hypnotism, cranial manipulation, and other alternative healing methods. Though his books discuss the benefits of everything from healing touch to herbal cures, Weil doesn't dismiss the benefits of standard Western medicine when appropriate.

Other mind/body relationships became apparent to medical researchers. The so-called placebo effect has been studied by doctors and psychologists for years. In clinical experiments, people who are given inert substances made to look like medicines, such as sugar pills, often experience the same improvements as those patients who are given real medications. It is estimated that nearly one out of every three patients improves with medication simply because of the placebo effect, and not because of the drug itself. Researchers have also noted that some conditions and illnesses have no physical explanations. Doctors termed these conditions psychosomatic illnesses, as they seem to be caused by the psyche, or mind.

Researchers then theorized that certain personality types are susceptible to particular conditions. For instance, "Type A" personalities tend to be aggressive, ambitious, and always rushed. They tend to cope with stress by getting angry and upset. Researchers have found that these personalities are more prone to heart disease , high blood pressure, and other stress-related conditions. "Type B" personalities are those who cope with stressful situations with communication and balance instead of anger and aggression, and have been found to be less prone to stress-related conditions. Researchers have added a "Type C" personality, who tends to suppress emotions and has trouble with self-expression. Some clinicians have proposed a link between suppressed emotions and the development of cancer .

In the past few decades, researchers have begun to unravel the complex ways in which the mind and body interact. Many findings have demonstrated that the mind and body are intimately interconnected. Medical science has shown that the nervous system works closely with the immune system, systems that were at one time believed to be separate. Nerve endings have been found that connect directly to important components of the immune system called lymph nodes. This connection demonstrates that there is a physical link between the mind and the immune system. Studies have also shown that thoughts and emotions alone can influence the activity of immune system cells.

In the 1970s, Dr. Herbert Benson at Harvard Medical School discovered what he called the "relaxation response." Benson observed that trained yoga specialists (yogis) could control bodily functions that had previously been believed to be autonomic, or beyond the control of the mind. During meditation , these yogis could reduce their heart rates, blood pressure, metabolism, body temperature, and other physiological processes to surprising levels. Other people who were then taught meditation were able to reach deep states of relaxation and calmness as well. This relaxation response, as Benson termed it, is essentially the opposite of the fight-or-flight response. The relaxation response reduces blood pressure, respiration, heart rate, oxygen consumption, muscle tension, and other bodily processes that are elevated by stress. Researchers soon began to theorize that if stress could have harmful effects on health, then the relaxation response might have the opposite effect. It wasn't long before the Harvard Mind/Body Medical Institute was founded, and other major medical clinics followed by integrating mind/body practices and studies into their health programs. A new field opened up in academic medicine called psychoneuroimmunology (PNI), which is the study of how the mind and nervous system affect the immune system. Studies have since shown that the mind and emotions play roles in many diseases, including cancer, diabetes, heart disease, gastrointestinal problems, and asthma .

In 1993, Dr. David Eisenberg wrote in the New England Journal of Medicine about a study that showed that one out of every three adults in America had used some form of unconventional medicine. Of those alternative treatments, mind/body practices were used most often. The popular PBS series by journalist Bill Moyers, called Healing and the Mind, brought mind/body medicine into millions of homes. Dr. Benson of Harvard claims that mind/body medicine should no longer be considered alternative. Despite the acclaim and success, however, there is still resistance to the simple idea that the mind is an important part of health, and many mainstream doctors still adhere to the belief that medicine is just a matter of "drugs killing bugs."

Benefits

Mind/body therapies have shown promise in treating cancer, heart disease, hypertension , asthma, and mental illness. They have been used as effective complementary therapies alongside such conventional treatments as surgery and chemotherapy. Mind/body therapies have also been shown to increase quality of life, reduce pain , and improve symptoms for people with chronic diseases and health conditions. They may also help control and reverse certain diseases, particularly those that are stress-related. By reducing stress, mind/body therapies may even prevent many diseases. Another benefit of mind/body therapies is that they pose very little risk. Some are inexpensive, and most have few side effects.

Description

There are many alternative techniques that draw upon the interconnections between mind and body. These include art therapy , assertiveness training, autogenic training, bioenergetics, biofeedback, breath therapy , mental imagery, dance and movement therapy , dreamwork, Gestalt therapy, group therapy, hypnosis, meditation, mindfulness training, Jungian psychoanalysis, postural integration, prayer and faith healing, progressive relaxation, psychodrama, psychotherapy , Reichian therapy, support groups, and yoga. Some of the most widely used techniques are meditation, mindfulness training, biofeedback, breath therapy, hypnosis, mental imagery, and movement therapies, which are discussed below.

Costs can vary widely for mind/body treatments, depending on the type and the medical training of the practitioner. Many insurance companies will reimburse some mind/body treatments and training sessions; consumers should be aware of their insurance provisions.

Meditation

There are many forms of meditation, but they all have the same goal, which is to calm and focus the mind. As beginning meditators find out, however, calming and clearing the mind of thoughts and worries is easier said than done. When performed on a regular basis, meditation is an efficient way of promoting the relaxation response. Meditation is used to ease the discomfort of many health problems, including stress-related conditions, chronic pain, panic disorders, tension headaches, and asthma. A 2002 report stated research shows that transcendental meditation can reduce hardening of the arteries, eventually helping reduce risk of heart attack and stroke .

Meditation can be practiced anywhere, but a quiet and peaceful setting is recommended. Meditators should sit or lie in a comfortable position. Sitting with the spine as straight as possible without straining is the most commonly recommended position. Breathing during meditation should be deep, calm and slow. The meditator may concentrate on the breath or on a still object such as a flower or candle flame. The meditator often may repeat a soft sound, word, or phrase, known as a mantra. Mantras can be affirmative statements, prayers, or humming sounds. The goal of the meditator is to concentrate deeply in order to reduce the amount of thinking, and to calm the worries and thoughts that typically fill the mind. When thoughts or distractions arise, the meditator should allow them to pass without directing attention toward them.

Meditation should be done twice a day, for 20 minutes at a time, preferably at consistent times to develop discipline. It can be learned from books or tapes, but instruction is widely available and recommended, as beginners can find properly meditating and quieting the mind to be difficult at first.

Mindfulness training

This form of mental discipline was made popular by Dr. Jon Kabat-Zinn, a psychologist at the University of Massachusetts Medical Center, who has written some popular books on mind/body medicine. Kabat-Zinn uses mindfulness training to help patients deal with chronic illnesses and pain. Mindfulness training is also good for stress-related conditions, and those undergoing difficult treatments like surgery or chemotherapy. Practitioners of mindfulness claim it helps them experience more pleasure and less stress in their everyday activities.

Mindfulness training originates from a Buddhist practice called vipassana. Its basic idea is that deep awareness of the present moment is the essential discipline. Lack of awareness and attention can lead to stress and bad health habits. To be mindful is to participate fully in whatever one is doing at the present moment, whether reading, walking, working, eating, exercising, relaxing, etc. When a person pays full attention to the present moment without judgment, then worries about the past and future tend to disappear, and stress levels are also significantly reduced.

Mindfulness training teaches that painful situations and emotions should be experienced with full attention as well, which helps people to confront and accept them. Mindfulness training also uses techniques like the body scan, in which the patient focuses full attention on each part of the body in succession. This technique helps people become more aware of their bodies and learn to control their reactions to stress, change, and illness.

Biofeedback

Biofeedback uses special instruments that measure and display heart rate, perspiration, muscle tension, brain wave activity, body temperature, respiratory patterns, and other indicators of stress and physiological activity. Patients can observe their measurements and learn to consciously control functions that were previously unconsciously controlled. Biofeedback also helps people learn how to initiate the relaxation response quickly and effectively.

Biofeedback is used to treat hypertension, stress-related headaches, migraine headaches, attention-deficit disorder, and diabetes. Biofeedback is used often in physical therapy to rehabilitate damaged nerves and muscles. It is also an approved treatment for a vascular disorder called Raynaud's syndrome . Patients with this syndrome experience blanching and numbness in their hands and feet in response to cold or emotional stress. A 2002 study showed that biofeedback helped children with a disease called vesicoureteral reflux (an abnormal backflow or urine from the bladder to the ureter) learn to correct reflux. This helped the children avoid surgery and prolonged antibiotic therapy.

Breath therapy

Breath therapy works on the premise that breathing plays a central role in the body and mind. People who are under stress tend to breathe rapidly and shallowly, whereas slow and deep breathing has been shown to reduce stress and promote the relaxation response. In Ayurvedic medicine and traditional Chinese medicine , the breath is considered the most important metabolic function. In yoga, there is a science of breathing techniques known as pranayama, which is designed to reduce stress and promote health.

Breath therapy is often used in conjunction with meditation and other mind/body techniques. It can be learned from books and tapes, or can be learned from a yoga or mind/body specialist. It is an inexpensive treatment, and once learned can be practiced easily anywhere.

Hypnosis

Hypnosis is deeply focused attention that brings about a trance state that is somewhere between waking and sleeping. During hypnosis, the mind is very open to suggestion. Mental imagery is often used in conjunction with hypnosis to maximize positive thinking and healing.

Hypnosis, or hypnotherapy , is used to reduce stress, anxiety , and pain, and help patients suffering from chronic diseases. It is also used to assist people in overcoming bad health habits, and addictions to nicotine, alcohol and drugs. Some dentists use hypnosis to help patients relax during dental procedures. Research continues to show the benefits of hypnosis. In 2002, a summary of recent studies included one that evaluated the effectiveness of selfhypnosis for patients undergoing angioplasty and other medical procedures. They required half the sedation of patients in control groups, and their procedures took less time. Pregnant adolescents who were counseled on hypnosis needed less anesthesia during delivery, needed less pain medication after delivery, and left the hospital sooner than patients in the control groups. Hypnosis is best performed by trained hypnotherapists, who can teach techniques of self-hypnosis to the patient.

Mental imagery

This technique uses the imagination to stimulate healing responses in the body, as studies have shown that the imagination can cause the same activity in the brain and immune system as real events. Patients are taught to imagine places or situations in which they have felt happy, healthy, or safe. Patients can also focus on images that increase confidence, reduce stress, and promote healing. Cancer patients are taught to imagine that their immune cells are eliminating cancer cells from their bodies. Heart attack sufferers are taught to imagine their hearts getting healthy and strong. Women can mentally rehearse childbirth , and patients imagine themselves successfully going through surgery as preparation for the real event.

Mental imagery has shown promise treating immune system problems, and is used often in cancer treatment and AIDS cases. It has been used to treat irritable bowel syndrome and asthma. Mental imaging techniques are also used in conjunction with many other mind/body techniques like meditation and hypnosis, as it is an efficient means of promoting positive mental attitudes. Mental imaging techniques can be learned from books, audiotapes, videos, and from professional therapists and teachers.

Movement therapy

Movement routines such as dance therapy have been shown to have a significant mind/body element. In these therapies, which also include martial arts , yoga, and tai chi, strict routines of physical movements are designed to involve high levels of mental concentration and awareness of the body. Movement therapies are good for people who have trouble sitting still for meditation, and are an excellent way of improving physical strength and mental health at the same time.

Precautions

Mind/body practices are safe and have few side effects. They should not, however, be relied upon solely when other medical care is required, particularly for serious conditions like heart disease, cancer, or diabetes. Consumers should also seek out reliable and properly trained practitioners, particularly in those practices and states for which certification is not required by law.

Research & general acceptance

Because of its increasing acceptance by mainstream medicine, mind/body medicine has been the subject of intense research. Studies have shed new light on everything from the minute interactions of the immune and nervous systems to the effective results of individual therapies like meditation and guided imagery . Other studies have indicated relationships between stress and disease. Some eye-opening results have been observed as well, such as studies that have shown that cancer and heart disease patients utilizing mind/body techniques had significantly longer survival rates on average than those patients who did not use mind/body therapies. Despite increasingly proven benefits to mindbody medicine, few health plans pay for the treatments.

Training & certification

Training programs and certification criteria tend to vary with individual therapies and states.

The Biofeedback Certification Institute of America lists certified biofeedback practitioners. Address: 10200 W. 44th Ave., Suite 304. Wheatridge, CO 80033. (303) 420-2902.

The American Society of Clinical Hypnosis is the largest organization for certifying hypnotherapists. Address: 2200 East Devon Ave., Suite 291. Des Plaines, IL 60018. (708) 297-3317.

The Wellness Community provides information on support groups organized throughout the country. Address: 2716 Ocean Park Blvd., Suite 1040. Santa Monica, CA 90405. (310) 314-2555.

The Academy for Guided Imagery provides resources for mental imaging treatments. Address: PO Box 2070. Mill Valley, CA 94942. (800) 726-2070.

The Vipassana Meditation Center is a resource for those interested in mindfulness training and meditation. Address: PO Box 24. Shelbourne Falls, MA 01370. (413) 625-2160.

Resources

BOOKS

Benson, Herbert, MD. The Relaxation Response. New York: Random House, 1992.

Borysenko, Joan. Minding the Body, Mending the Mind. New York: Bantam, 1988.

Cousins, Norman. Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York: Viking, 1990.

Goleman, Daniel, and Joel Gurin, eds. Mind/Body Medicine. Yonkers, NY: Consumer Reports Books, 1993.

Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Dell, 1990.

PERIODICALS

Advances: The Journal of Mind-Body Health. 9292 West KL Ave. Kalamazoo, MI 49009. (616) 375-2000.

"Hypnosis: Theory and Application Part II." Harvard Mental Health Letter (June 2002).

Jesitus, John. "Mind and Body Medicine: Putting Mind Over Health Matters (Feature Story)." Managed Healthcare Executive (April 2002): 33.

Morain, Claudia. "Biofeedback Speeds Resolution of Reflux in Children." Urology Times (April 2002): 23.

"Research Briefs: Meditation Reduces Atherosclerosis." GP (May 13, 2002):4.

ORGANIZATIONS

The Mind/Body Medical Institute. Deaconess Hospital. 1 Deaconess Road. Boston MA 02215.

Center for Mind-Body Medicine. 5225 Connecticut Ave. NW, Suite 414. Washington, DC 20015. (202) 966-7338.

Center for Attitudinal Healing. 19 Main Street. Tiburon, CA 94920. (415) 435-5022.

Douglas Dupler

Teresa G. Odle

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