The Mind/Body Connection

Real People, Real Stories

Sam Hamilton received a diagnosis of prostate cancer on a routine physical exam. His way of coping was obtaining as much information on the disease as possible. He researched treatment options and sought the advice from physicians as to which surgeons had the most experience with this type of surgery. As he shared his diagnosis with friends and colleagues, he found several men who had successfully survived without a cancer recurrence. Sam used the time between his diagnosis and surgery to finish projects and delegate work responsibilities. He attended a support group with his wife and obtained valuable advice on handling his emotional responses to what would happen. When the time came for his surgery, Sam was apprehensive, but he felt that he had done everything humanly possible to prepare for it. The actions he took before surgery reduced his stress. (Arnold and Boggs, 1999)

“A sound mind in a sound body is a short but full description of a happy state in this world” John Locke, philosopher, 1693

Over 300 years later, Locke’s insight into health and happiness still has relevance for us. We may have widely differing experience with stress, yet one thing is for sure; what is going on with your mind and emotions is at least as important, if not more so, than what is happening in your body. In fact, what is going on in your mind determines what is happening in your body.

Psychological health, which includes both emotional and mental health, is vital in determining physical health. Emotional health helps us to understand our feelings and achieve emotional balance. Mental health is a state in which your mind is engaged in lively, healthy interaction both internally and with the world around you. Psychologically healthy people develop awareness and control of their thoughts and feelings. The outcome is a healthy, fulfilling, satisfying life.

When you look in the mirror, what do you see? You see your body, your hair, your skin, your muscles, your face. You can see and you can understand how your body works. We can measure blood pressure and hormones and heart rate, but what about your mind? Can you measure an emotion? Can you see a thought? Can you prove that your outlook changes your level of stress? For decades scientists have studied how stress affects the body. There is substantial evidence supporting the physical reaction to mental stress. More recently researchers have been studying the mind-body connection to understand how thoughts and emotions relate to our experience with stress.

We know today beyond question that the mind and emotions have a powerful and very real impact on the body. “The mind clearly can have a profound effect on every aspect of physiologic functioning,” says James Gordon, M.D., Director of the Center for Mind-Body Studies in Washington, DC. “Individuals who are chronically pessimistic, angry, anxious or depressed are clearly more susceptible to stress and illness, including heart disease and cancer.” Similarly, almost every medical illness affects people psychologically as well as physically (Hales, 2003).

It is clear that stress affects your body, your physiology. The stress response activates a specific physiological process in your body. But what part does your mind play in your experience with stress? How amazing it is that the complex physiological process that is the stress response, starts with a single thought. Your thoughts, your feelings, and your emotions have a profound impact on the quality of your life.

Dr. Esther M. Sternberg – Physician and Scientist

For so many thousands of years, the popular culture believed that stress could make you sick, that believing could make you well. People believe what they feel. But scientists needed evidence, and there really wasn't any good, solid scientific evidence to prove these connections. Nor was there a good way to measure them. Scientists only believe what they can actually measure. Once scientists and physicians believed that there was a connection between the brain and the immune system, you could then take it to the next step: that maybe there is a connection between emotions and disease: between negative emotions and disease, and positive emotions and health. And we can then say, “okay, maybe these alternative approaches that have been used for thousands of years – approaches like meditation, prayer, music, sleep, dreams – all of these approaches that we really know in our heart of hearts really work to maintain health... Maybe there is a scientific basis for it”. The Role of Stress in Disease

Have you ever heard someone say, “She’s not really sick. It is all in her head?” For years the common perception of psychosomatic illness was that it was not real. Somehow the person just imagined that they were sick or didn’t feel well. Illness was caused by things like germs, radiation, tobacco, or diet. We thought that there was simply no way that our mind or our thinking could actually be the cause of our ill-health.

Thankfully, we have come a long way in our understanding of “psychosomatic conditions”. Psychosomatic originates from the core words psyche, meaning the mind, and soma, meaning the body. So, conditions that have a mind and body component are often called psychosomatic. Today psychosomatic conditions may also be called psychophysiological to avoid some of the negative connotation that it is somehow imagined.

Hundreds of studies over the last 20 years have shown that stress contributes to a significant percent of all major illness, including the number one cause of death in America, cardiovascular disease. Cancer, endocrine disease, emotional disorders, and a vast array of other stress related diseases and disorders account for many visits each year to health care providers. See the FYI -The Impact of Stress for some powerful statistics.

FYI – The Impact of Stress

According to Healthy People 2000, a report from the U.S. Department of Health and Human Services, stress has a great impact on our health. Did you know that:

 70-80% of all visits to the doctor are for stress-related and stress-induced illnesses

 Stress contributes to 50% of all illness in the United States

 The cost of job stress in the U.S. is estimated at $200 billion annually, including costs of absenteeism, lost productivity, and insurance claims

Chronic Stress and Disease Chronic stress can result in exhaustion, the final stage of the general adaptation syndrome. If the fight or flight response remains activated for an extended period of time, we start to experience certain physical and emotional effects. Medium-term Effects of Chronic (Long term) Stress

 Tension, or migraine, headaches  Cold, or sore throat  Difficult time going to sleep  Rashes, hives, skin irritation  Upset stomach, problems retaining  Increased blood pressure food  Always tired - Fatigue  Change in appetite  Excessive sweating  Tightness in chest, back, shoulders  Menstrual problems, missed  Aching jaw, tight forehead menstrual periods  Shortness of breath, dizziness  Sleep disturbances  Sweaty palms  Feelings of anxiety  Tingling sensation in fingers toes  Muscle tension and muscle pain  Nervous tension all over; heart  Anger palpitations  Concentration problems  Diarrhea or constipation  Depression  Constant low grade fever  Lack of interest in food  Increased appetite

Muscle Tension and Pain: Do you ever feel like your muscles are so tight that your shoulders are pulled up around your ears? Do you ever experience pain and stiffness from tight neck muscles? A muscle is not normally in the contracted state for prolonged periods of time. A muscle is supposed to contract only when it receives a message to contract. When a muscle is told to fight or run for prolonged periods of time, it will remain in the contracted state longer than necessary. When this happens, we notice two obvious results. One of these is pain and the other is fatigue. When a muscle stays contracted, it activates nervous system pain receptors that deliver the message of pain.

Headaches: A headache may result from muscles that tighten in response to a threat. If those continually contracting muscles are on our head, the result is a headache. This explains why people take muscle relaxants to help them ease the pain of the headache. A headache can provide important feedback that the way we are thinking about what is happening in our environment is causing tension.

Fatigue: The other effect of continued contraction of muscles is fatigue. Have you ever come home from a rough day at work or school and you find yourself totally exhausted, yet, you have exerted little physical effort? When a muscle is continually receiving the message to be ready for action, fatigue will result. It requires considerable energy for muscles to stay active. Upset Stomach: We do not need the digestive system when we are running from the big bear. The digestive system ceases to effectively coordinate all of the processes necessary to break food down. It won’t transport the food from the digestive system to the bloodstream as effectively when the stress response is continually activated.

Difficult time going to sleep: It should not take more than a few minutes to fall asleep. We should also sleep comfortably through the entire night without waking up several times. Sleeping is a natural experience. If we are having a hard time falling asleep, it may be because our minds are thinking too much of other things. One physiological response of fight-or-flight is increased or altered brainwave activity. When we go to sleep, we want to decrease brainwave activity. That can only happen as we are able to turn off the stress response.

Cold or sore throat: Another system that is turned down during the stress response is the immune system. The immune system is our internal defense mechanism that keeps us from contracting the cold or latest flu that is going around. Without a strong immune system, the virus can get the upper hand and we are in bed for a week recovering. We do not need the immune system to run from the big bear so it turns down its high functioning protection. Have you ever noticed that you tend to get sick more frequently after you go through a stressful experience? Since the immune system is unable to work as effectively when you are stressed, you are more susceptible to every disease and illness that crosses your path.

Research Highlight – The Cold, Hard Facts

The common cold is not an equal-opportunity attacker, according to recent research from psychologist Sheldon Cohen. Why is it that some people seem to rarely catch a cold in spite of being exposed to hoards of sneezing, sniffling cold-sufferers, while others seem to catch every bug that comes along? There is a growing body of evidence that suggests that factors such as personality, stress, and social life can all affect our vulnerability to the common cold. Cohen’s research at Carnegie-Mellon University involves exposing volunteers to colds by dropping rhinoviruses into their noses. Following five days of quarantine, medical exams and questionnaires reveal the following:

*Happy, relaxed people are more resistant to illness than those who tend to be unhappy or tense. Adults with the worst scores for calmness and positive mood are about three times more likely to get colds than the more relaxed and contented adults. When happy people do get sick, their symptoms are milder.

*Serious work-related or personal stress for at least a month increases the chances of catching a cold. The longer people live with bad stress, the more likely they were to catch cold in the lab. Looks like you can add “less colds” to your list of stress management benefits (Elias, 2003).

This list of annoying maladies is the result of the stress response causing imbalances throughout normally functioning systems in the body. Again, these provide feedback to us that we should make some changes. It is important to keep in mind that whatever system turns on or off is in direct response to what we would need in order to run from or fight the big bear. When this happens for an extended period, our health suffers.

Research Highlight – Psychoneuroimmunology Finds Acceptance As Science Adds Evidence

According to Margaret Kemeny, an associate professor of psychiatry and biobehavioral science at the University of California, LA, psychoneuroimmunology (PNI) research has exploded in the last decade. Recent work has demonstrated that hormones and neurotransmitters released under stress can change immune cell behavior. These various cells actually have receptors to “hear” the signals, allowing the nervous, endocrine, and immune systems to “talk”.

For example, studies with a group of medical students focused on the effects of academic stress and a response to a hepatitis B vaccine, which would mimic response to an infectious agent. These studies showed antibody and immune cell responses were diminished in those with more anxiety, higher stress and less social support.

(The Scientist 10 (16):14, Aug. 19, 1996)

The affects of a compromised immune system are far-reaching including everything from susceptibility to the common cold, to the rate of wound healing, and even a link with breast cancer development. Following is a brief summary of several studies linking stress to its effect on the immune system.

 PNI research has shown that traumatic stress, such as the death of a loved one, can impair immunity for as long as a year.  Studies of university students and staff in the United States and Spain have implicated stress and a generally negative outlook as increasing susceptibility to the common cold (Takkouche, et al., 2001).

 By inflicting small cuts in volunteers who were then subjected to controlled stressful situations, researchers have shown a significant delay in healing among those under stress (Rubin, et al., 2000).

 In research on women with metastatic breast cancer, psychiatrist David Spiegel found that stress hormones played a role in the progression of breast cancer. The average survival time of women with normal cortisol patterns was significantly longer than that of women whose cortisol levels remained high throughout the day (an indicator of stress) (Turner-Cobb, et al., 2000)

Research Highlight - Chronic Stress and Immunity

Researchers at Ohio State University in Columbus, have discovered a link between chronic stress and a body chemical that is associated with the development of serious and even deadly conditions.

Dr. Janice Kiecolt-Glaser, a professor of psychology and psychiatry, and colleagues studied a group of 119 men and women who were dealing with the stress of caring for a spouse with dementia. These caregivers were compared with a control group of 106 individuals of similar age and health status who did not serve as caregivers. Over the six-year study, blood tests showed that a chemical known as interleukin-6 (IL-6) dramatically increased in the caregivers as compared to the non-caregivers. IL-6 is a chemical known as a cytokine that is involved in the body’s immune system. Overproduction of IL-6 has been associated with the development or progression of a number of medical conditions, including heart disease, type 2 diabetes, certain types of cancer, osteoporosis, arthritis, and functional decline. Even is the spouse of the caregivers died, the increased levels of IL-6 persisted for several years in the group of caregiving spouses.

This research may offer one possible explanation for the link between stress and illness by suggesting that stress may increase the risk of many typical age-associated diseases by altering the immune response. This data underscores the need for stress management and control of chronic stressors (Kiecolt-Glaser,et. al., 2003). All of the following disease conditions have been shown to have a stress component:

abnormal heart beat (arrhythmia)  HIV  alcoholism  hives  allergies  hypertension  angina pectoris  hyperthyroidism  arteriosclerosis  immune system disturbances  asthma  impotence  atherosclerosis  infertility  birth defects  insomnia  breast cancer  irritable bowel syndrome  bruxism  kidney diseaseloss of interest in normal  burnout activities  cancer  many autoimmune problems  carpal tunnel syndrome  many endocrine problems  cholesterol levels elevated  memory loss  chronic backache  menstrual problems  chronic fatigue syndrome  migraine headache  chronic obstructive pulmonary disease  multiple sclerosis  chronic tension headaches  myasthenia gravis  chronic tuberculosis  night eating syndrome  cold sores  OCD (obsessive-compulsive disorder)  common cold  PMDD (premenstrual dysphoric disorder  coronary heart disease  pancreatitis  coronary thrombosis  premature aging  depression  psoriasis  diabetes  Raynaud disease  eczema  respiratory ailments  epileptic attacks  rheumatoid arthritis  erection problems  shingles  fertility problems  stroke  fibromyalgia  systemic lupus erythematosus  gastritis  TMJ (temporomandibular joint) syndrome  gastroesophageal reflux (GERD)  ulcerative colitis  headaches  ulcers  heart disease  high blood pressure

As you can plainly see, we pay a heavy price when we have too much stress in our lives.

Culture Connection – In a Climate of Overwork, Japan Tries to Chill Out. Karoshi in Japanese means death-by-overwork. Karoshi is a rising social concern that has resulted directly from the well-known Japanese hard-working society that produced the highest productivity for its economy in the late 20th century. In 2001, the government reported a significant increase in fatal heart attacks and strokes due to overwork, with the hardest-hit professions being information technology experts, doctors, teachers, and taxi drivers. They also reported a record high number of suicides, many related to the economic downturn. In its evaluation of working practices in the 6 months before death, the Japanese Health, Welfare and Labor Ministry found that the karoshi victims were working an average of more than 80 hours each week.

The good news is that many Japanese workers and businesses are starting to look for options to help relieve sutoresu – the Japanese word for stress. English gardening, aromatherapy, reflexology, pets, and herbs have joined the traditional leisure pursuit of hot-spring bathing in a boom in iyashi, a word that conveys a mixture of healing, calming, and getting close to nature. Until 10 years ago, the word iyashi was largely unknown outside the psychiatric profession where it was used to denote a form of healing and relaxation for those who were overworked and overstressed. Now, however, many Japanese, especially young women, want to relax and enjoy the fruits of their labor.

The bad news is that the ingrained belief that personal wellbeing should be sacrificed for one’s company means that compromises have to be made even for the most iyashi-conscious consumer.

Despite the iyashi boom, Japan seems to be working harder than ever. Labor statistics show that the average worker takes only 49.5% of their 18-day vacation allowance. Interestingly, this hard work is creating economic as well as psychological problems because many of the workforce do not have enough free time to spend their money, which slows economic activity. (Watts, 2002)

The Role of Stress In Health

What about stress and health? You now have a good understanding of how stress can result in disease and poor health, but is this an inevitable process? One thing the stress research shows beyond any doubt is that stress alone will not cause illness. How a person reacts to stress is the critical factor on whether the outcome is positive or negative. Personality and an individual’s way of viewing the events in life will determine the impact of stress. While it is interesting and important to explore the role of stress in disease, our focus in Stress Management for Life is on promoting optimal health.

Why is it that in a world full of stressors, some people seem to be immune to the ravages of stress? Why is it that when two people are exposed to identical stressors one will experience stress-induced symptoms while the other will come through in a positive and healthy manner? Too often we ask why someone became ill, when the more profound and important question might be, “How did this person manage to stay healthy?” We know that some individuals come through periods of great chronic stress, not only without disease, but actually with more physical and mental vigor than they had before. What is it about these people that makes then different?

We know that our behaviors influence health. Every day lifestyle choices like what you eat for breakfast, whether you get adequate sleep, how you choose to exercise your body, and whether you smoke and drink have a profound impact on health. But could there be other factors, in addition to our behaviors, that play a role in our ability to withstand stress and stay healthy? Research indicates that personality may be a key determinant in how well we are able to resist the negative influences of stress.

Personality and Stress

Do you think there is such a thing as a stress-resistant personality or a stress-prone personality? And is this personality a result of heredity or environment? In other words, were you born with a personality that makes you more or less prone to stress? If so, is it really possible to change your personality? You all know that behaviors influence health. Eating a balanced diet, including daily exercise in your schedule, and sharing quality time with your friends are examples of some of the behaviors that clearly relate to better health. But is it possible that something other than behavior could play a role in your ability to manage stress and maintain health? An impressive body of research indicates that personality is a major determinant in how well you deal with stressors in your life. Understanding the personality traits that contribute to good health will help you determine what works for you in stress management. Our intention is not to open a discussion on the validity of the many personality theories, but rather to get you thinking about your personality traits and how they contribute to your ability to successfully manage stress. The cumulative results of studies conducted over the past few decades show beyond a doubt that certain personality traits keep us well, boost our immunity, and improve our immune system (Karren et al., 2002).

Conclusion

In this chapter, we explored the fascinating relationship between the mind and the body to better understand the role of stress in both disease and health. Scientific studies provide a solid foundation of undeniable scientific evidence explaining the connection between the body and the mind. You can use this information not only to prevent disease, but also to promote optimal health.

Key Points

* Psycho-physiological conditions have a mind and body component and are supported by science.

*Chronic stress is a contributing factor for a large number of illnesses and diseases.

* Medium-term stress results in an array of unhealthy signs and symptoms including muscle pain, headaches, fatigue, and sleep disturbances.

* Long-term stress results in serious health problems including cardiovascular disease, compromised immune function, and digestive disorders.

* Psycho-neuro-immunology seeks to understand the complex communications between the nervous system, the psyche, and the immune system, and their implications for health.

* Certain personality traits can play a role in how we deal with stress to promote health QUESTIONS: