Review of Mind Over Medicine

Mind over med

My latest read was Lissa Rankin’s Mind Over Medicine: Scientific Proof That You Can Heal Yourself. The title pretty much summarizes it. The first part includes a number of empirical and case studies that demonstrate the connection between the mind and physical health. The second part was more of a self-help guide for people who are ill and want to take control of their health, which was when I realized that I really am not the intended audience. But it was interesting nonetheless.

Rankin’s main point is that positive mental states cause the brain to release chemicals that put the body in a state of physiological rest, controlled mainly by the parasympathetic nervous system. In this state, the body’s natural self-healing processes can take place. However, when the mind experiences stress or negative mental states of any kind, the a stress response is triggered. The body goes into “fight or flight” mode, activates the HPA axis, triggers the sympathetic nervous system, and shuts down the immune system, paving the way for disease.

Although she doesn’t explicitly say this, a big theme throughout the book is the importance of context for physical health. For example, the placebo effect: In medicine, in order for any practice or medication to become accepted, it must be significantly more effective than a placebo. A lot of randomized, double-blinded, placebo-controlled trials of drugs are preceded by a “washout phase,” in which patients who react positively to an inert pill are eliminated from the study, since these patients may also react highly to the placebo in the study and therefore decrease the treatment’s chance of outperforming the placebo.  Rankin questions this practice by writing:

“In conventional medical wisdom, we call anything that doesn’t outperform placebo ‘quackery.’ But haven’t we lost sight of the real goal?… If the patient is getting better, does it really matter whether the treatment is better than the placebo?”

She also talks about a number of reasons why placebos may be effective, and again it really boils down to context. It seems that the context of receiving a treatment may matter more than the actual treatment. The efficacy of a treatment can be altered by the optimism of the patient, trust in his physician, the doctor’s beliefs about the efficacy of that treatment, and his personality toward the patient. Even a supposedly (empirically-proven) “effective” treatment can fail if these conditions are not met, emphasizing the importance of the whole picture rather than a treatment in isolation.

The book focuses a lot on the power of our mental health in affecting physical health as well. She reminds us that happy people live longer and get sick less often, but she focuses on a range of contributors to mental health, saying that “our bodies are mirrors of our interpersonal, spiritual, professional, sexual, creative, financial, environmental, mental, and emotional health.” For optimal health, she argues, we must be healthy in all of these areas.

A final quote that I think drives home the importance of many different contexts in determining physical health:

“I envisioned something more intertwined, where all aspects of health were interrelated, and the body was the sum total of the balance of all aspects of a wholly healthy life.”

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