The Journal of Alternative and Complementary Medicine

There are key differences between mind–body medicine and alternative medicine. A central tenet of mind–body medicine is the recognition that the mind plays a key role in health and that any presumed separation of mind and body is false. Alternative medicine, however, does not focus on the role of thoughts and emotions in health and, therefore, is separate from mind–body medicine. Also, while there has been little scientific research on alternative medicine, the literature on mind–body medicine comprises more than 2000 peer-reviewed studies published in the past 25 years. The groundwork for understanding the physiology of mind–body interactions was established by pioneering studies in the 1930s by Walter Cannon, and in the 1950s by Walter Hess and by Hans Selye that led to an understanding of the fight-or-flight response. Later work by Holmes and Rahe documented measurable relationships between stressful life events and illness. Other research has shown clinical improvement in patients treated with a placebo for a variety of medical problems. The effectiveness of placebo treatment can be interpreted as compelling evidence that expectation and belief can affect physiological response. Recent studies using spectral analysis and topographic electroencephalographic (EEG) mapping of the relaxation response demonstrate that by changing mental activity we can demonstrate measurable changes in central nervous system activity. These, and other, studies demonstrate that mind–body interactions are real and can be measured. S-83 I is an honor to be here to represent Harvard Medical School, Harvard Medical International, and the Mind–Body Medical Institute at Harvard Medical School. It is also an honor to address our friends, colleagues, and gracious hosts here at the Asan Medical Center. In my first talk, I’d like to talk about the physiology of mind–body interactions. First of all, let me define mind–body medicine. Yesterday, mind–body medicine was described as part of complementary medicine. In fact, there are some key differences between mind–body medicine and complementary or alternative medicine. First, one of the key definitions of mind–body medicine is that the mind—that is, thoughts and emotions—affects health. So one of the central tenets of mind– body medicine is the recognition that the mind plays a key role in health and that Cartesian dualism—that is, separation of mind and body—is false. The media, the public, and health care professionals, however, often conceptualize mind–body medicine as alternative medicine, and include mind–body medicine with therapies like acupuncture or herbal remedies. In fact, most alternative medicine Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts. treatments, such as acupuncture or herbal remedies, have nothing to do with mind–body medicine because they do not focus on the role of thoughts and emotions in health. A second difference between mind–body medicine and complementary or alternative medicine is that alternative medicine is not only young in terms of a science, but there is comparatively little research on alternative and complementary medicine relative to mind– body medicine. In fact, mind–body medicine is based on more than 2000 scientific studies that have been published in peer-reviewed journals in the last 25 years. My contention is that, because mind–body medicine involves this kind of empirical research base, it should not be considered alternative and, in fact, should be considered mainstream. For example, in the United States, we have half a dozen journals—scientific peer-reviewed journals—that are specifically devoted to mind–body medicine. Some of the journals include biofeedback and self-regulation, behavioral medicine, psychosomatic medicine, and health psychology. There are dozens of other journals including the Journal of the American Medical Association and even the New England Journal of Medicine that publish studies on mind–body medicine. Another difference between mind–body medicine and alternative medicine is the concept of self-care. In fact, Herbert Benson of the Harvard Medical School, who is one of the pioneers in mind–body medicine, uses the model of what he terms the “three-legged stool,” in which mind–body medicine is not intended to replace standard medical care, such as surgery and drugs, but should be used in conjunction with it. In Dr. Benson’s model of the threelegged stool, each leg—pharmaceuticals, surgery and procedures, and self-help techniques in the form of mind-body interventions—all work to support health (Benson, 1996). One of the pluses of mind–body medicine’s self-help techniques is that patients are actually given techniques that they learn and practice independently from an external agent or a healthcare professional. Once they have learned the techniques, they can use the techniques on their own. That empowers the patient and increases the patient’s sense of self-control, which, as I will talk about in my second lecture, is actually important for health maintenance. Developing a sense of control is an attitude and a belief that is associated with improved health and longevity. I’d like to talk next about some of the scientific underpinnings of mind–body medicine by starting with what is called the fight-or-flight response, which, in a very real sense, formed the basis of the physiology of mind–body interactions. First, mind–body medicine is the result of a long history of research on the psychophysiological connections between the brain and the nervous, hormonal, and immune systems. This research initially focused on stress and its effects on the body. The first person to conduct research in mind-body medicine, although they didn’t term it mind–body medicine then, and who studied the fight-or-flight response—or what we now term the stress response—was Walter Cannon, a physiologist at Harvard Medical School who conducted his research in the 1930s. Cannon documented the physiological effects of what he termed the “emergency reaction,” which he defined as an acute physiologic reaction that prepares the organism for fighting or fleeing. Cannon described the physiologic changes associated with the fightor-flight response as being characterized by increased sympathetic nervous system activity, increased central nervous system arousal, and increased skeletal-muscle activity. He went on to define specific correlates of these physiologic changes, including reduced blood flow to the gut and extremities during fight or flight; increased blood flow to the muscles, heart, and lungs to aid in fighting or fleeing; and increased blood sugars among many other changes (Cannon, 1932). Interestingly, Cannon also hypothesized that stress not only induces these physiologic changes, but he also believed that stress precipitates sudden death via ventricular fibrillation based on his studies on voodoo death. Later in the 1950s, the Swiss physiologist, Walter Hess, was awarded the Nobel Prize for his research on electrical stimulation of the hypothalamus in cats. Hess initially documented what he termed the “ergotropic responses,” which was his term for the emergency reaction. JACOBS S-84