Mind-body link enters mainstream
By Shari Roan
Los Angeles Times
Dr. Marc Feldman thought he could help sick people get better — if only he could get them into his office. But patients often canceled their appointments upon arriving at his Duke University clinic, and Feldman soon figured out why. It was the sign on his office door: "Psychosomatic medicine."
Advertiser library photo • October 23, 1999
"They were convinced that I was going to tell them, 'It's all in your head,' " the psychiatrist said.
Yoshi Akiba mediates daily in the Zen temple on her property in Oakland, Calif. Doctors now recognize the mind-body connection.
That was the late 1980s. Since then, patients and doctors alike have come to understand better how the mind and emotions affect physical illness, a field known as psychosomatic medicine. In March, the American Board of Medical Specialties will
decide whether to create the medical subspecialty. The designation would lead to more specific training, easier identification of experts and improved insurance reimbursement.
Hundreds of psychiatrists have asked for the designation, which they say is a first step in helping patients get appropriate treatment. "When you make a specialty official, you increase the likelihood of people finding you," said Dr. Nada Stotland, a professor of psychiatry and obstetrics-gynecology at Rush Medical College in Chicago.
In Hawai'i, Kaiser Permanente offers a periodic course that uses mind-body techniques to help people with chronic health conditions. "Managing Ongoing Health Conditions" teaches skills and offers tools to use in creating a body-mind-spirit treatment regimen. It includes nutrition and exercise, relaxation methods, setting goals and a focus on turning negative thoughts into positives.
The Kaiser course is based on the psychosomatic medicine model, but spokeswoman Jan Kagehiro said the term "psychosomatic" is not used, because it tends to confuse patients who think they're being labeled as mentally ill.
Many people don't understand psychosomatic medicine, often mistaking it for imaginary illnesses; few hospitals and doctors know where to send patients who may need it; insurers often don't pay for it; and even experts aren't sure what methods work best for specific illnesses.
But scientists now have proof that the mind-body connection exists. Studies have revealed that around 20 percent of people with heart disease also have depression, that stress exacerbates gastrointestinal disorders, and that attitude can influence survival time for the terminally ill. Experimental programs have demonstrated that techniques such as relaxation, group support, imagery, meditation and prayer can alter the course of some illnesses, decrease symptoms and reduce hospital stays and medication. Brain imaging studies and other body scans have shown that relaxation can slow blood flow, while frightening emotions can trigger spasms in the gut.
"This is cool stuff that you can't argue against anymore," said Marc Schoen, an assistant clinical professor of medicine at the University of California, Los Angeles. "We can now say, arguably, that almost everything becomes psychosomatic."
Not only in your head
Several studies in the past two decades have demonstrated the strong link between body and mind. • Italian researchers writing in the Journal of Rheumatology found that in 61 patients with osteoarthritis in the knee, depression levels predicted disability and pain more accurately than did the extent of physical damage. • In 198 patients with heart disease, University of Washington researchers found, anxiety and depression predicted patients' health status a year after cardiac catheterization better than did the severity of narrowing in the coronary arteries. • A Duke University study of 107 heart disease patients found that relaxation, cognitive therapy and reduced hostility cut the risk of further heart problems by 75 percent over patients given conventional medical care and medications. • In a University of California-Davis study, 335 patients who were to undergo surgery were randomly assigned to listen to audiotapes before and afterward. The group that listened to guided imagery, music and specific suggestions of diminished blood loss and rapid healing had 43 percent less blood loss and left the hospital a day earlier than people who listened to three other kinds of tapes. • A landmark 1991 study in the Journal of the American Medical Association found that women helped in childbirth by a trained support person (a doula) during childbirth had greatly reduced rates of caesarean section and anesthesia.
Psychosomatic conditions are real disorders caused or exacerbated by mental or emotional state. They can include:
Power of the mind
• Body symptoms caused by psychological distress, such as stomach aches in a child who doesn't want to go to school.
• Disease that results from, and whose course is influenced by, unhealthy behavior.
• Diseases such as arthritis, heart disease, cancer and AIDS that are affected by stress, coping skills and social support.
After years of battling severe asthma, Mary Ann Marcuzzi, 44, a human resources executive in San Diego, found that the most effective treatments used both traditional medication and psychological techniques. Diagnosed at 19, Marcuzzi came upon a doctor who prescribed biofeedback and stress management in addition to medication. Later, Marcuzzi learned to use self-hypnosis and guided imagery when she felt her lungs beginning to spasm.
"My asthma tends to kick up when I'm frustrated or angry," she said. "I go to my office, close the door and go to a special place in my head. I picture myself in a meadow, sitting in the grass, breathing in the healing air."
The need to use psychosomatic principles in everyday healthcare is greater than ever, experts say. More emphasis on the psychological impact of illness might help patients comply better with treatment and reduce hospitalizations and other services that fuel rising healthcare costs.
About a quarter of people who visit the doctor have symptoms caused most likely by their emotional state, Sobel said. And as many as 80 percent show significant psychological distress resulting from physical ailments.
Castle Medical Center recognized the connection last year with the launch of a Wellness and Lifestyle Medical Center and Center for Attitudinal Healing in a new building on the campus. The center offers a variety of programs aimed at mind-body-spirit wellness; up next is a three-day workshop, "Change Your Attitude, Change Your Life," March 6-9, featuring Dr. Gerald Jampolsky and Diane Cirincione focusing on the power of attitude in health and wellness and how to change to facilitate healing ($150 or $275 for couples; credit card registration, 263-5400).
A 1999 study developed by the Kaiser HMO in California and Stanford University placed patients with chronic conditions in two-hour group sessions with a trained leader over seven weeks. Participants reported fewer hospitalizations, shorter hospital stays, more time spent exercising, better communication with doctors and less fatigue, disability and other limitations than those who did not participate.
Blame hurts
However, some doctors bungle attempts to apply mind-body medicine by appearing to blame patients for their symptoms, Stotland said. This can be true especially for disorders that are poorly understood and difficult to diagnose, such as chronic fatigue syndrome or fibromyalgia.
"The minute you say, 'You have an anxiety disorder on top of your cardiac disorder,' it becomes a stigma," Stotland said. "We all know perfectly well that emotions affect the body. But there is a way to make it make sense to people and take away the stigma."
Efforts to bring mind-body medicine to the public also have been hampered by lack of insurance coverage. Although about half of his patients are referred by other doctors, UCLA's Schoen said he often has to battle insurance companies to obtain coverage.
"There is no coverage for stress management unless there is some sort of definable mental disorder you can attach to it," he said.
More evidence
Psychiatrists say they hope approval of a new specialty that would create psychosomatic doctors would lead to better insurance reimbursement rates and more inclusion of psychosomatic doctors on hospital and clinic staffs.
Although psychosomatic medicine addresses both physical and mental health, many insurance plans have separate reimbursement systems for physical and mental care, which can create problems for patients and their doctors.
Insurers also may be reluctant to cover psychosomatic treatments, said Sobel, because of a shortage of evidence about which approaches work best for particular conditions, and because not all therapies work for every patient.
Nevertheless, he said, there is now overwhelming evidence that people frequently recover faster and spend fewer healthcare dollars when treatment encompasses behavior, thoughts and feelings.
He offers a comparison. "If this were a drug that produced these kinds of effects, wouldn't we be using it?"
