All his patient had to do was make sure her mouth was full of saliva and keep repeating to herself, 'My leg is anaesthetized'. A dry mouth is oneif the mind's first warning signals of danger. When the mouth is kept lubricated, the brain relaxes, assumes all is well and turns off its pain receptors, assured that anaesthetics have been given. In fact, her affirmation of intention was as powerful as any actual anaesthesia. Her body, which could not tell the difference between a lack of pain and the thought of a lack of pain, turned off its alarms so that even while her leg was being sliced open, she relaxed and slept.
Escudero's work is only the most extreme evidence of the power of the mind as the central mechanism in healing. Medical doctors already acknowledge the centrality of belief in healing through the widespread use of the placebo.
In the 16 December 2006 issue of New Scientist, orthodox French psychiatrist Patrick Lemoine, an expert on the placebo effect, made the astonishing admission that upto 35-40 per cent of all official prescriptions given to patients are 'impure' placebos. By this, he means that a pharmacologically inactive substance-a sugar pill-is 'contam-inated' by a tiny amount of active ingredient. The result is that the treatment is not sufficient to produce a clinical effect, but is just enough for doctors to claim that it does. In other words, more than a third of all prescriptions are dummy pills and, if they work at all, it's because of the power of the mind-the belief on the part of the patient that what the doctor has given him will work.
One recent hospital study estimates that 60 per cent of doctors regularly make use of placebos-some at least once a week-and over half find them to be highly effective (BMJ, 2004; 329: 944-6). The latest estimates are that placebo or sham treatments 'cure' between 30-70 per cent of all patients who receive them (JAMA, 1955; 159: 1602-6; Clin Psych Rev, 1993; 13: 375-91;J Am Dent Assoc, 1976; 92: 755-8).
However, doctors are themselves taking a placebo, in Lemoine's view. They prescribe impure placebos to fool themselves, at the same time as they fool their patients, that the treatment has predictable, scien-tifically tested effects.'
The placebo effect demonstrates that beliefs are powerful healers, even when the belief has no foundation. The placebo is a form of intention-the expectation that doing one thing will change something else-an instance of intention trickery.
When the doctor gives his patient a placebo, or sugar pill, he is counting on the patient's belief that the drug will work. It is well documented that belief in a placebo will create the same physiological effects as that of an active agent, so much so that it causes the pharmaceutical industry enormous difficulty when designing drug trials. So many patients receive the same relief and even the same side-effects with a placebo as with the drug itself that a placebo cannot be considered a true control for comparison. Our bodies do not distinguish between a chemical process and the thought of a chemical process.
Indeed, a recent analysis of 46,000 heart patients, half of whom were taking a placebo, made the astonishing discovery that patients taking the placebo fared as well as those taking the heart drug. The only factor determining survival seemed
to be a belief that the therapy will work and a willingness to follow it religiously.
Those who stuck to doctor's orders and took their pill three times a day fared equally well whether they were taking an active drug or just a sugar pill. Patients who tended not to survive were those who had been lax with their regimen, regardless of whether they had been given a placebo or an actual drug (BMJ, 2006; 333: 15-9).
Belief in the effectiveness of a drug-regardless of whether it is the 'true' drug or not-is enough to marshal the body's ability to heal.
The power of the placebo has been well illustrated in patients treated for Parkinson's disease, a motor-system disorder in which the body's mechanism for releasing the brain chemical dopamine is faulty. The standard treatment for Parkinson's is a synthetic form of dopamine. In a study carried out by the University of British Columbia in Canada, a team of doctors used PET scanning to demonstrate that, when patients given placebos were told they had received dopamine, their brain substantially increased the release of its own stores of the neurochemical (Science, 2001; 293: 1164-6).
In another dramatic example, at Methodist Hospital in Houston, Texas, Dr Bruce Moseley, a specialist in orthopaedics, recruited 150 patients with severe osteoarthritis of the knee and divided them into three groups. Two of the groups were given either arthroscopic lavage (which washed away any degenerative tissue and debris in the joint with the aid of an inserted viewing tube) or another form of debridement (which cleared out the joint using a tiny vacuum cleaner). The third group was given a sham operation: the patients were surgically prepared, placed under anaesthesia and wheeled into the operating room. Incisions were made in their knees, but no procedure was carried out.
Over the next two years-throughout which time none of the patients knew who had received the real operations and who had received the sham placebo treatment-all three groups of patients reported moderate improvements in pain and knee function. In fact, the placebo group reported better results than some of those who had been actually operated on (N Engl J Med, 2002; 347: 81-8).
The mental expectation of healing was enough to trigger the body's own healing mechanisms. The intention, brought about by the expectation of a successful operation, produced the physical changes. If the brain cannot distinguish between a thought and an action, would the body follow mental instructions to heal without the trick of a sugar pill? If I send my body a mental intention to calm down or speed up, will it listen to me? The literature on biofeedback and mind- body medicine says that it will.
It was in 1961 that Neal Miller, a behavioural neuroscientist at Yale University, first proposed that people can be taught to mentally influence their autonomic nervous system, and control mechanisms such as blood pressure and bowel movements, much as a child learns to ride a bicycle.
Initially, he conducted a series of remarkable conditioning-and-reward experiments on rats. Miller discovered that, if he stimulated the pleasure centre in the brain, the rats could be trained to decrease their heartrate at will, control the rate at which urine filled their kidneys, even create different dilations of the blood vessels in each ear (J Comp Physiol Psychol, 1967; 63: 12-9; Science, 1969; 163: 434-45).
If relatively simple animals like rats could achieve such a remarkable level of internal control, Miller figured, couldn't human beings, with their greater intelligence, regulate more of their bodily processes?
After these early revelations, many scientists found that information about the autonomic nervous system could be fed back to a person as 'biofeedback' to pinpoint where a person should send intention to his body.
In the 1960s, John Basmajian, a professor of medicine at McMaster University in Ontario and a specialist in rehabilitative science, began training people with spinal-cord injuries to use electromyography (EMG) feedback to regain control over single cells in their spinal cord (Basmajian JV. Muscles Alive: Their Functions Revealed by Electromyography. Baltimore: Williams & Wilkins, 1967).
The stupid brain
How can just the thought of a drug produce the same effect as the active ingredient? Some clues come from research into mental rehearsal in sport and intriguing brain research with electromyography (EMG).
EMG offers a real-time snapshot of the brain's instructions to the body-when and where it tells it to move-by recording every electrical impulse sent from motor neurons to specific muscles to cause a contraction. Ordinarily, EMG offers doctors a useful tool to diagnose neuromuscular disease and to test whether muscles respond appropriately to stimulation.
But EMG has also been employed to solve an interesting scientific conundrum: whether the brain differentiates between a thought and an action. Does the thought of an action create the same pattern in neurotransmission as the action itself?
This very question was tested by wiring a group of skiers to EMG equipment while they were carrying out mental rehearsals. As the skiers mentally rehearsed the downhill runs, the electrical impulses going to their muscles were just the same as those they used to make the actual turns and jumps when skiing the run (Behav Ther, 1985; 8: 155-9). The brain sent the same instructions to the body whether the skiers were simply thinking of a particular movement or actually carrying it out.
Thought produced the same mental instructions as action.
Research with EEGs has also shown that the electrical activity produced by the brain is identical whether we are thinking about doing something or actually doing it. In weightlifters, for instance, EEG patterns in the brain that would be activated to produce the required motor skills are activated even when the skill is simply being simulated mentally (Baroga L. Influence on the sporting result of the concentration of attention process and time taken in the case of weight lifters, in Proceedings of the Third World Congress of the International Society of Sports Psychology, vol 3. Madrid, Spain: Istituto Nacional de Educaci'on Fisica y Deportes, 1973).
Just the thought is enough to produce the neural instructions to carryout the physical act.
At roughly the same time, psychologist Elmer Green at the Menninger Institute in Topeka, Kansas, pioneered a method of bio-feedback to treat migraine headaches that is now an accepted form of therapy for the condition (Psycho-physiology, 1969; 6: 371-7; J Transpers Psychol, 1970; 2: 1-26).
Biofeedback is especially useful for treating Raynaud's disease, a vas-cular condition in which the blood vessels of the extremities are constricted when exposed to cold, causing the fingers and toes to grow cold, pale and even blue (Biofeedback Self-Regul, 1987; 12: 257-72)
During biofeedback treatment, a patient is hooked up to a computer. Transducers applied to different parts of the patient's body send information to a visual display, which registers activities of the autonomic nervous system such as brainwaves, blood pressure and heart rate, or muscle contractions. The audio or visual information fed back to the patient depends on the condition; in the case of Raynaud's, as soon as the arteries to the hands constrict, the machines record a drop in skin temperatureand a light bulb flashes or a beeper sounds. This feedback prompts the patient to send an intention to his body to adjust the process in question; in the case of Raynaud's, the patient sends an intention to warm up his hands.
Since those early days, biofeedback has become well established as a therapy for virtually every chronic condition, from attention-deficit/ hyperactivity disorder (ADHD) to menopausal hot flashes. Stroke patients and victims of spinal-cord injuries now use biofeedback to rehabilitate or regain the use of paralyzed muscles. It has even proved invaluable in eliminating the pain felt in a phantom limb (Am J Clin Biofeed, 1982; 5: 150-3). Even astronauts have used biofeedback to cure motion sickness while journeying to outer space (Aviation Space Environ Med, 1987;58: 34-41).
The more conventional view of biofeedback maintains that it has something to do with relaxation-learning to calm down the fight-or-flight responses of our autonomic nervous system. However, the sheer breadth of control would argue that the mechanism has more to do with the power of intention. Virtually every bodily process measurable on a machine-down to a single nerve cell controlling a muscle fibre-appears to be within an individual's control. Volunteers in studies have achieved total mental mastery over the temperature in their bodies (Psychother Psychosom, 1988; 50: 22-8) and even the direction of blood flow to the brain (Am J Psychiatry, 1981; 138: 1182-7).
Hypnosis can be used as a type of healing intention-an instruction to the brain during an altered state. Hypnotists continually demonstrate that the brain or body is particularly susceptible to the power of directed thought when under subconscious direction.
A dramatic example of the power of mental suggestion involved a small group of people with a mysterious congenital condition called 'ichthyo-siform erythroderma', also known disparagingly as 'fish-skin disease' because of the unsightly fish-scale-
like crusts that cover most of the sufferer's body. In one study, five patients were hypnotized and told to focus on a part of their body and visualize the skin becoming normal. Within just a few weeks, 80 per cent of each patient's body
had completely healed, with the skin remaining smooth and clear (Br J Dermatol, 1966; 78: 101-5).
Through hypnotic intention, spinal-surgery patients about to undergo their operations have reduced blood loss by nearly half simply by directing their blood supply away from the site of the surgery (Advances, 1985; 2: 11-21). Pregnant women have been able to turn their babies from breech positions, burn victims have sped up their healing and people suffering haemorrhages in the gastrointestinal tract have willed their bleeding to stop (Dienstfrey H. Mind and mindlessness in mind-body research, in Schlitz M et al., eds. Consciousness and Healing: Integral Approaches to Mind-Body Healing. St Louis, MO: Elsevier Churchill Livingstone, 2005). Clearly, during an altered state that roughly corresponds to the hyperalert state of intense meditation, conscious thought can convince the body to endure pain, cure many serious diseases and change virtually any condition.
Mental intention has been used to produce actual physiological changes-and not only in athletes' bodies. Guang Yue, an exercise psychologist at the Cleveland Clinic Foundation in Ohio, carried out research comparing participants who went to the gym with those who performed a virtual workout in their heads. Those who regularly visited the gym were able to increase their muscle strength by 30 per cent. But those who remained in their arm-chairs and ran through a mental rehearsal of the weight training in their minds increased muscle power by almost half as much.
Volunteers between 20 and 35 years of age imagined flexing one of their biceps as hard as they could during daily training sessions carried out five times a week. After ensuring that the participants were not doing any actual exercise, including tens-
ing their muscles, the researchers discovered an astonishing 13.5 per cent increase in muscle size and strength after just a few weeks, an advantage that persisted for three months after the mental training stopped (J Neurophysiol, 1992; 67: 114-23).
In 1997, Dr David Smith at the University of Chester in the UK came up with similar results: participants who worked out could achieve 30 per cent increases in strength, while those who just imagined themselves doing the training achieved a 16 per cent increase (Smith D et al. The effect of mental practice on muscle strength and EMG activity. Proceedings of the British Psychological Society Annual Conference, 1998; 6: 116).
One study demonstrated that, under hypnosis, women increased the dimensions of their breasts simply by visualizing themselves on the beach with the sun's rays warming their chests (Barber TX, Changing 'unchangeable' bodily processes by [hypnotic] suggestions:
A new look at hypnosis, cognitions, imagining and the mind-body problem, in Sheikh AA, ed. Imagination and Healing. Farmingdale, NY: Baywood Publishing, 1984).
The healing contract
But what about the role of the healer? Studies show that the effect is enhanced when the practitioner, as well as the patient, believes that the the treatment will work. In nearly 40 per cent of such cases, the placebo proved effective (Clin Psych Rev, 1993;13: 375-91).
Lemoine disclosed that doctors also grow to believe in the power of their own placebo 'sorcery', and the power of their minds appears to be involved in the healing process. It's not uncommon, says Lemoine, for a doctor to lose respect for a patient when the patient fails to respond to treatment.
"He may decide the patient is imagining or faking his symptoms." The doctor's lack of respect is then transmitted to the patient who, in turn, is less likely to believe in the doctor. "Any treatment he then prescribes is less likely to be effective and may even produce unpleasant side-effects," says Lemoine.
This is called the 'nocebo' effect and it refers to the power of the mind to believe that an inert substance causes harm. So, what conditions optimize the placebo effect? The power of the mind appears to have the best effects through a 'wellness contract' between doctor and patient-a mutual belief that the treatment will work.
A healer optimizes results when he himself is healthy and well in every way.
This was discovered by University of Arizona psychologist Dr Gary Schwartz in a study of healing intention involving 14 Reiki practi-tioners. Schwartz and his colleagues used Escherichia coli bacteria that had been subjected to a sudden blast of heat. The Reiki practitioners were asked to heal the bacteria that survived by transmitting a standard Reiki treatment for 15 minutes. Initially, the Reiki apparently made no difference to the overall survivalof the viable bacteria. On closer examination, however, the researchers found that the Reiki practitioners seemed to be successful on certain days, but not on others and, in some instances, the healers actually had a deleterious effect on the bacteria.
The scientists decided to admin-ister the Arizona Integrative Out-comes Scale (AIOS)-an ingeniously simple visual means of assessing spiritual, social, mental, emotional and physical wellbeing-during the 24 hours before and after the healers had given their Reiki.
Using these test data, the research-ers found an important trend. On the days when the healers felt really well in themselves, they had beneficial effects on the bacteria. In contrast, on days when they did not feel so well, not only did they score lower on the test, but they actually had a deleterious effect on the E. coli.
Those practitioners who began the healing with diminished wellbeing actually killed off more bacteria than had naturally died in the controls. Evidently, the physical and emotional condition of the healer has an effect on results: a practitioner's own overall health is an essential factor in his ability to heal others.
The healer himself has to believe and send his own healing intention.
Schwartz and his fellow researchers carried out a double-blind study of distant Johrei healing on cardiac patients (J Altern Complement Med, 2005; 11: 455-7). After three days, the patients were asked if they had had a sense, feeling or belief that they had received Johrei. In both the treatment and control groups, certain patients strongly believed that they had received treatment, and others had a strong feeling they had been excluded. When Schwartz and his co-workers tabulated the results, a fascinating picture emerged. The best outcomes were among those who had received Johrei and believed they had received it. The worse outcomes were those who had not received Johrei and were certain they had not. The other two groups-those who had received it but did not believe it, and those who had not received it but believed they had -fell somewhere in the middle.
These results tended to contradict the idea that a positive outcome is entirely down to a placebo response, as those who wrongly believed that they received the healing did not do as well as those who rightly believed they had received it. The belief of the patient in his treatment-backed up by a healing intention sent by the healer-had the strongest effect.
A meaningful or special 'healing' relationship between healer and healee may help the healing response.
Mind-body psychologist Jeanne Achterberg of the Institute for Transpersonal Psychology in Calif-ornia, carried out a study at a hospital in Hawaii using experienced healers, who selected as their 'patient' a person with whom they had a special connection. Each healer was isolated from his patient, who was placed inan MRI scanner. At random intervals, the healers sent healing intentions to their patients. Achterberg discovered significant brain activation in the same portions of the brains-mainly the frontal lobes-of all the patients during the times that healing energy was being 'sent'.
When the same procedure was tried with people the healers did not know, there was no effect on the patients' brain activity. Some sort of emotional bond or empathetic connection may be crucial to the success of both prayer and healing intentions (J Altern Complement Med, 2005; 11: 965-71).
Both the energy and intention of the healing itself and the patient's belief that he has received healing promotes actual healing. A belief that the particular treatment or modality works on the part of both doctor and patient is another important factor.
Perhaps the most remarkable case of the placebo effect, recounted by Lemoine, concerned Annie, a woman whose severe depression landed her in Lemoine's psychiatric hospital for more than a decade. Most of her days were spent curled up in an armchair in her ward. After Lemoine struck up a friendship with her, he persuaded her to take part in a trial of a new antidepressant. She agreed and res-ponded so well to the drug that she was able to leave hospital. Eventually, she found both an apartment and a boyfriend. Her case, in fact, may have helped put the drug on the market.
Much later, however, Lemoine found the pills that Annie was suppos-ed to have taken buried deep in the folds of her armchair. On counting them, he found that she hadn't taken a single one. So, either she didn't want to disappoint him, or-more likely-she got better to avoid taking that new drug.
Instances like this make a powerful statement about the healing contract. Just the expectation of-or, in this last case, the desire to avoid-being given a healing drug by the doctor did the trick.
It may well be that we don't need drugs, but just our sincere trust-as doctors and patients-that what-ever it is we most believe in-drug, alternative therapy or divine intervention-will work.