The interactions between behavior,
the nervous system, and the immune system.
Psychoneuroimmunology
Vladimir Huber, M.A. Master’s en Psicología
Creator of the Huber Four-Level Growth & Healing System
University of Santa Monica, California 1997
Abstract:
It is reported in different types of literature throughout history, that many people of different professions have mentioned the connection between body and mind, that they affect one another, and that in order to have complete health, both have to be in harmony. As science progressed, the attention paid to this connection has grown in scope, as well as in depth. Today, thousands of scientific studies are showing the interconnection between body and mind. Here are some of them.
History of psychoneuroimmunology
As time goes by, scientific research becomes more and more sophisticated, yet it was almost four centuries ago, in 1680 to be exact, when the Transylvanian physician Papai Pariz Ferenc reiterated Aristotle and anticipated psychoneuroimmunology in saying that, «When the parts of the body and its humors are not in harmony, then the mind is unbalanced and melancholy ensues, but on the other hand, a quiet and happy mind makes the whole body healthy.»1 Modern science is explaining in detail what this visionary doctor was saying centuries ago.
It has been clearly established that there is a relationship between the body and the mind, or said in more concrete terms, between the immune system and the psyche, yet this relationship, as studies deepen our knowledge of it, has been changing, turning it into something richer and more encompassing. Roger Booth and Kevin Ashbridge recently stated, «There is a need to reassess and perhaps redefine the concepts, symbols and languages of immunology and psychology in ways which allow the relationships between immunological and psychological processes to be expressed in terms of a coherent teleological perspective. In order to make sense of psychoimmune relationships we must be open to modifying some of our preconceptions about the nature of our immune system and our psyche.»2
Pre-contemporary psychosomatic medicine, which dates to the late 1930’s and early forties, was ahead of pre-contemporary immunology. One of the pioneers was Franz Alexander, who in the early 1940’s expressed that psychosomatic pathology was the result of the physiological concomitants of conscious or repressed emotions.
An enormous step was taken when Hans Selye expressed in the 1940’s that stress («strain» or «distress») was interrupting the inner physiological balance called homeostasis. If the person has a positive or adaptational response to this stress, then it becomes psychological growth («eustress» or good stress). If the person doesn’t respond positively, it becomes a negative health change. So, the greater the stress and the more negative the response of the person experiencing that stress, the greater the health damage.
The way people cope with stress became an important factor in the studies of mind/body medicine. People who were competitive, hostile, time-pressured were usually associated with coronary artery disease, and have been labeled as «Type A» pattern of coping. Also, people with the autoimmune disease rheumatoid arthritis showed more compliance, difficulty in expression of anger, sensitivity to the anger of others, conservatism, and self-sacrifice, as well as being more anxious and depressed.3 In comparison, their siblings, who didn’t have rheumatoid arthritis, had healthier behavioral characteristics.
The research on Psychoneuroimmunology has advanced enormously in the later years, specially in the 1990’s at several medical research institutions based at universities, usually done by medical doctors and psychologists, an unusual alliance of former competitors. One of the main promoters in the field was Norman Cousins, a Professor at UCLA School of Medicine, even though he didn’t graduate as an M.D. He actually received the only honorary M.D. ever awarded by Yale. He actually saw his mission as healing the medical profession, and that is what he did, training medical students and doctors so they could become more humane practitioners of their profession. Not an easy task, but one for which he was greatly praised for his enormous contribution.4
Cases of how emotions have affected the body’s health
An interesting case of somatization, which is the case when the body expresses physically what the person has not expressed emotionally, is when women repress their anger due to social conditioning. It can result in a great variety of altered patterns of wellness, migraines, headaches, gastrointestinal problems, obesity, substance abuse, coronary problems, and others. In terms of feelings it can produce low self-esteem, depression, self-deprecation, self-doubt, powerlessness, emptiness, guilt, and self-hatred. It also interferes with the way women who repress their anger relate with other people, creating problems with relationships, affiliation roles, horizontal violence, work, and home abuse/violence.
Women’s anger
Patricia Munhall, ARNP, in her study, «Women’s Anger and its Meanings: A Phenomenological Perspective,» states that «After 5 years of collecting experiential descriptions and ‘becoming the question,’ I have come to understand that the most important quality of women’s experience of anger is that if the anger goes unrecognized, it is left in silence and is transformed into something more ‘acceptable,’ and that acceptable condition is what is treated. In other words, the experience is often the transformation of anger in women into social acceptable pathology. The implications of this are critical. In concrete language,
1. Unrecognized anger makes women sick.
2. Anger then is transformed into an acceptable condition.
3. The acceptable condition is treated.
4. Anger is unresolved.
5. The acceptable condition returns.»5
Munhall recommends to release that anger with a safe person, and she says that that safe person is a mental health care professional. In terms of expressing the anger, she considers that «verbal expression with affect is essential. The actual expression of anger out loud seems to release toxic energy.»6
Aggressive mice
A study done with mice is somehow related to the previous one. The idea was to genetically create two groups of mice with typical behavioral characteristics. One of the groups of mice had isolation-induced aggression, but they appeared as socially inhibited (NC100). The other group was made of aggressive mice (NC900). The study done by a group of six researchers and published in the journal Neuropsychopharmacology showed that «These results demonstrate that selective breeding for genetic differences in social behavior resulted in marked differences in tumor susceptibility and natural killer (NK) cell activity between the NC100 and NC900 mouse lines. Consistent with the hypothesis that the socially inhibited (NC100) line would be more vulnerable to tumor development, all of the NC100 mice tested developed tumors compared with only 44% of the aggressive (NC900) mice. Tumor burden among NC100 mice was also substantially greater than among NC900 mice. This latter finding is highlighted by the observation that while 30% of the NC100 mice had tumors that weighed more than three grams, no mouse of the NC900 line developed a tumor of this size.»7
The previous study shows the negative effects to our physical health when we repress our emotions, which is the same that the study on women’s anger was showing.
Women and cancer
A study done on cancer and psychoneuroimmunology in Scotland among 157 women comes to the conclusion that «Fundamentally, cancer is a breakdown of normal growth control mechanisms. By promoting a sense of control, psychological interventions can undoubtedly reduce stress, minimize psychiatric morbidity, and enhance quality of life.»8
The relationship between the brain and immune system was clearly explained by expressing that, «It is well known that the brain can influence the immune system via the hypothalamic pituitary axis, the neuroendocrine system (neuropeptides), the autonomic nervous system (lymphoid organs), and the release of cytokines.»9
Psychological techniques
There are several psychological techniques used to enhance the strength of the immune system. These techniques give concrete results when used adequately, and so the authors explain by saying that «Various psychological interventions such as hypnosis, relaxation training, and guided imagery have, in some studies, reversed or attenuated the effects of stress in normal volunteers. In a controlled study, Kiecolt-Glaser et al found that special relaxation techniques used over 4 weeks increased natural killer (NK) cell activity and decreased circulating antibody titres to herpes simplex virus in geriatric residents living in independent facilities.»10
The research done in psychoneuroimmunology is fairly new, even though a group of pioneers have been working with it for some decades. In general, this type of research has been ignored by most of the major medical schools and universities, which is where research usually takes place. Susan Bauer, RN, in a study published in the Journal of Advanced Nursing, titled Psychoneuroimmunology and cancer: an integrated review, expresses that «The effectiveness of psycho-behavioral interventions in improving immune function and overall survival in cancer patients has been demonstrated although relatively few studies have been done to date. Although these studies are few in number and have methodological flaws, they hold promise for growth in behavioral immunology and cancer research.»11
Long term effect of stress
In terms of the lasting effect of stress, how long is a person physically affected after the distress is alleviated? Quite a long time, according to studies done by Janice Kiecolt-Glaser, Ph.D., and Ronald Glaser, M.D. of Ohio State University. According to a report in the Journal of the National Cancer Institute, the team of researchers «studied the immune systems of people who cared for loved ones suffering from Alzheimer’s disease. The stress of caring for an Alzheimer’s patient depressed the care-giver’s immune system, even 2 years after the patient had died.»12 In the same publication, it is reported that «A study by David Spiegel, M.D., of Stanford University, Calif., showed that women with metastatic breast cancer who participated in support groups lived nearly twice as long as women who received treatment without group therapy.»13
Psychotherapy and survival
The survival of cancer patients has been found to be connected to several activities, one of them being psychotherapy. Adriaan Visser and Karl Goodkin write in the journal Patient Education and Counseling that «There exists some evidence that psychotherapy may prolong survival in selected cancers. Prolongation of survival may be related, in part, to an increase in selected measures of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth.»14
Psychosocial factors and periodontal diseases
Cancer seems to be one of the main diseases studied in relation to psychoneuroimmunology, but for sure it is not the only one. A study done by Monteiro da Silva, Newman, and Oakley in London and published in the Journal of Clinical Periodontology reveals a possible relationship between psychosocial conditions and inflammatory periodontal diseases. They express that «Reviewing the literature concerning the possible role of psychosocial factors in the aetiology of inflammatory periodontal diseases, it may be concluded that there is evidence which strongly suggests that emotional stress is one of the predisposing factors to acute necrotizing ulcerative gingivitis (ANUG).»15
Psoriasis and stress
Dermatology is another specialty in medicine paying attention to psychoneuroimmunology. One of the main diseases being studied is psoriasis, yet it is not the only one. Others are urticaria, pruritis, alopecia areata, acne vulgaris, and eczema, and they are all considered, according to what the studies show, to have strong psychogenic causes.
Psoriasis is a common chronic, inflammatory skin disease characterized by scaly patches, and one of the main researchers is Eugene Farber, M.D., of the Psoriasis Research Institute in Palo Alto, California. Dr. Farber has proposed, «A role for the neuropeptides as mediators of neurogenic inflammation and hypothesized that release of substance P and other neuropeptides from sensory nerve fibers in the skin causes local inflammatory responses, which trigger psoriatic lesions.»16
In another study on psoriasis conducted by Dr. Farber with Lexie Nall, Ph.D., reported that, «Stress that occurs from anxiety, depression, marital or financial problems, or ‘near-death’ experiences has been identified as a triggering factor in the appearance or exacerbation of psoriasis in 33%, 39%, and 42% of patients in combined studies involving more than 6,300 patients.»17 They add that «Although it is well known that stress can trigger and exacerbate psoriasis, the exact mechanism by which it occurs is unknown.»18
In terms of reducing the stress that creates a negative chain reaction from the psychology to the neurology to the immunology of the individual, there are quite a few recommendations. The main tips are a healthy diet; exercise (including Yoga, Tai Chi, expressive movement, and other similar practices) adjusted to the age and fitness of each person; Reiki; acupuncture; hypnosis; relaxing techniques such as meditation; various forms of massage; network chiropractic; guided visualizations; breathwork (cathartic breathing); individual and group psychotherapy; and support groups.
Hospital patients and their needs
Many studies have shown that the attitude of the patient is a great factor in affecting the outcome of the treatment for a particular ailment. One of the factors affecting the state of mind of a patient in a hospital is how they are treated by the staff. A study done in England by six researchers showed how the treatment of the patients by the staff gave the patients the feeling that their needs were met or not. In relation to the group of cancer patients studied, it was concluded that «Although most patients were able to describe a situation in which their needs were met by the staff, 23% also described a situation in which this was not the case. These latter incidents were often related to anxiety, confusion and a wish to severe links with the hospital. Patients who reported that their needs were not met requested more staff time and further information about their diagnosis and treatment.»19
Relationships and the immune system
Relationships have been shown to affect the immune system. Janice Kiecolt-Glaser and six other researchers did a study of 90 newlywed couples admitted to a hospital research unit for 24 hours. Subjects who showed more negative or hostile behaviors during a 30-minute discussion of marital problems showed a weakening of the immune system, while relatively low negative subjects remained with their immune systems in a much stronger state. In addition, «The discussion of marital problems also led to larger increases in blood pressure that remained elevated longer in high negative subjects than low negative subjects.» And they later add that, «These data provide additional support for the link between personal relationships and immune function.»20
The personality of the cancer patient
Several researchers have reported observing similarities in the personality of cancer patients. Susan Moss in her book, «Keep Your Breasts!» expresses that «Dr. O. Carl Simonton, who overcame cancer when he was seventeen and has worked with cancer patients throughout his career, has noted the following traits which make up his «cancer personality» profile:
1. A great tendency to hold resentment and a marked inability to forgive.
2. A tendency toward self-pity.
3. A poor ability to develop and maintain meaningful long-term relationships.
4. A very poor self-image.» 21
Dr. Simonton finds the underlying factor to be «basic rejection.»
Humor and the immune system
One of the most pleasant ways to reduce stress and strengthen the immune system is to use humor in its many forms. Norman Cousins, a leading researcher in the field of psychoneuroimmunology who worked for many years at UCLA Medical School, did research on the relationship between humor and the immune system, and established the Humor Research Task Force. Patty Wooten, RN, writes that «Laughter stimulates the immune system, offsetting the immunosupressive effects of stress.»22
The holistic approach to healing
As scientific research is showing, the human being is one unit, one wholeness. The specialization of medicine, and the separation of the different professions that deal with the health of an individual have produce many advances in the health professions, yet the divisions no longer make as much sense as they did some decades ago. The road that scientific research is charting is of unity, of integration. As we prepare ourselves to start a new millennium, a new approach to medicine and psychology is bringing us all closer to each other, so we may work in an integrated way for a healthier life at the four levels of human expression: physical, mental, emotional, and spiritual.
References
1. Ferenc, P.P. About the Peace of the Spirit. Kolozsvar, Transilvania, 1680.
2. Booth, R.J. & Ashbridge, K.R. A fresh look at the relationship between the psyche and immune system: teleological coherence and harmony of purpose. Advances, 9:4-23, 1993.
3. Alexander, F. & French, T.M. Studies in Psychosomatic Medicine. An Approach to the Treatment of Vegetative Disturbances. Ronald Press. New York, 1948.
4. Solomon, G.F. Norman Cousins: healer of the medical profession. Advances 7:67-69, 1991.
5, 6. Munhall, P. Women’s anger and its meanings: a phenomenological perspective. Health Care for Women International, 14:481-91, 1993.
7. Petitto, J.M.; Lysle, D.T.; Gariepy, J.L.; Clubb, P.H.; Cairns, R.B.; Lewis, M.H. Genetic differences in social behavior: relation to natural cell function and susceptibility to tumor development. Neuropsychopharmacology, 8:35-43, 1993.
8, 9, 10. Walker, L.G.; Eremin, O. Psychoneuroimmunology: a new fad or the fifth cancer treatment modality? The American Journal of Surgery. 170:2-4, 1995.
11. Bauer, S.M. Psychoneuroimmunology and cancer: an integrated review. Journal of Advanced Nursing, 19:1114-20, 1994.
12, 13. Flach, J.; Seachrist, L. Mind-body meld may boost immunity. Journal of the National Cancer Institute, 86:256-8, 1994.
14. Visser, A.; Goodkin, K. Current perspective on cancer education and counseling. Patient Education and Counseling, 28:115-119, 1996.
15. Monteiro da Silva, A.M.; Newman, H.N.; Oakley, D.A. Psychosocial factors in inflammatory periodontal diseases. Journal of Clinical Periodontology, 22:516-526, 1995.
16. Farber, E.M. Psychoneuroimmunology and dermatology. International Journal of Dermatology, 32:93-4, 1993.
17, 18. Farber, E.M.; Nall, L. Psoriasis: a stress-related disease. Cutis, 51:322-6, 1993.
19. Kent, G.; Wills, G.; Faulkner, A.; Parry, G.; Whipp, M.; Coleman, R. Patient reactions to met and unmet psychological need: a critical incident analysis. Patient Education and Counseling, 28:187-190, 1996.
20. Kiecolt-Glaser, J.K.; Malarkey, W.B.; Chee, M.A.; Newton, T.; Cacioppo, J.T.; Mao, H.Y.; Glaser, R. Negative behavior during marital conflict is associated with immunological down-regulation. Psychosomatic Medicine, 55:395-409, 1993.
21. Moss, Susan. Keep Your Breasts!, Re:Source Publications, p. 255, 1992.
22. Wooten, P. Humor: an antidote for stress. Holistic Nursing Practice, 10:49-56, 1996.
