19 Oct No Way to Measure It.
A few years ago, I read Jonah Lehrer’s article in Wired “Why Science Is Failing Us“. It was a lightbulb moment for me as he connected the dots to so many things that I had been thinking but didn’t have the words, or data, to pull together. The deepest connection was his illumination of the way in which the medical community has reacted to hundreds of tests that dispel the causal connection between pain and disc herniation. Many doctors have pretty much ignored these studies because – despite their fealty to the scientific method – they simply don’t buy this overwhelming evidence that contradicts so much of what they have been taught. In addition, because we are such visual creatures, we often believe things that we see, even if we see it in decidedly unscientific ways. Lehrer elaborates:
The view afforded by MRI led to a new causal story: Back pain was the result of abnormalities in the spinal discs, those supple buffers between the vertebrae. The MRIs certainly supplied bleak evidence: Back pain was strongly correlated with seriously degenerated discs, which were in turn thought to cause inflammation of the local nerves. Consequently, doctors began administering epidurals to quiet the pain, and if it persisted they would surgically remove the damaged disc tissue.
But the vivid images were misleading. It turns out that disc abnormalities are typically not the cause of chronic back pain. The presence of such abnormalities is just as likely to be correlated with the absence of back problems, as a 1994 study published in The New England Journal of Medicine showed. The researchers imaged the spinal regions of 98 people with no back pain. The results were shocking: Two-thirds of normal patients exhibited “serious problems” like bulging or protruding tissue. In 38 percent of these patients, the MRI revealed multiple damaged discs. Nevertheless, none of these people were in pain. The study concluded that, in most cases, “the discovery of a bulge or protrusion on an MRI scan in a patient with low back pain may frequently be coincidental.”
This is not the way things are supposed to work. We assume that more information will make it easier to find the cause, that seeing the soft tissue of the back will reveal the source of the pain, or at least some useful correlations. Unfortunately, that often doesn’t happen. Our habits of visual conclusion-jumping take over. All those extra details end up confusing us; the more we know, the less we seem to understand.
This was something of which I was acutely aware because of my understanding of Dr. John Sarno’s work. In the previous few years, I had seen many NY Times articles about a string of similar studies. Each article seemed to do almost nothing to change the way in which doctors practiced. I was extremely excited to find someone else who was noticing what I had seen, and whose work lent credence to what Dr. Sarno had struggled so hard to communicate. So much of science is based on unconscious assumptions and cultural frameworks, yet it cloaks itself in a veneer of rigor that belies the often hidden biases and funding realities that shape its output.
There are many in the science community who have loudly proclaimed that they won’t believe anything unless it can be proven in a lab. As such, they take such a skeptical view of anything that might be viewed as spiritual that they ridicule anyone who believes in this realm in any form. These scientists dismiss the people who believe there is spiritual realm with the word “woo”. Those who believe in “woo,” i.e. anything that involves the supernatural or the paranormal or which can’t be easily proven in a lab, are dismissed; and in a situation akin to the way Democrats and Republicans embed themselves so deeply in the soft womb of familiar and comfortable ideas, communication between the two groups is extremely limited.
While the divide between the people most invested in these ideas gets wider, the vast majority who perhaps have spiritual inclinations, are becoming more and more aware of the problems with a purely “scientific” approach to the world. The rapid rise in an acknowledgment of the importance of “mindfulness,” and the science that is emerging to bolster this importance, is a case in point. Ten years ago when we started to work on our documentary about Dr. Sarno, it was extremely difficult to discuss it. Things were so bifurcated that if I suggested to someone that their back pain might have a psychological basis I was generally met with anger / total disbelief. Since psychological factors are less clear than a herniated disc one can see on an MRI, it is much easier for a culture that subtly stigmatizes the show of emotions to recognize this visual indicator of pain than a psychic one. If one were to suggest that mediation might be more effective than pain medication or surgery over the long run in curing chronic pain, then it’s likely this solution would be referred to as “woo.”
Occasionally I would bring it up with someone who had already heard of Dr. Sarno (usually because of Howard Stern), and they would immediately understand what I was talking about. For the most part, though, if they weren’t already familiar with the ideas, I was met with resistance. Ten years later, things have shifted dramatically. While it’s clear that more people have heard of Dr. Sarno, I think the shift has a lot more to do with a general cultural awakening to the larger issue of the mind body connection. Now that scientific studies are emerging that back up the powerful effect of calming the mind in terms of the body, the idea seems less “woo”-like. However, if there are situations in which that which was once woo, become not woo, what does this tell us about the value of dismissing that which we do not understand?
As mentioned above, there has been a deluge of studies linking mindfulness mediation with positive health outcomes. However, what these studies can’t and don’t make clear is HOW the mindfulness is working. In other words, we can see the results of the practice, but this doesn’t mean we understand the exact chemical/biological/neurological/energetic actions that are taking place. It is true that we can see things happening in the brain due to FMRI machines that measure activity. However, just as MRI’s can give us insight as to what a physical structure looks like, it can’t tell us exactly what that means. However, in very simple terms, it’s clear that if we can calm down our bodies systems, our bodies have more energy to devote towards healing. There are many scientific tests that show that when we are less stressed, we heal faster.
This morning I was walking in the meadow behind my house with my daughter Harper where we saw the ants in the video above. A few years ago, Harper got strep throat A LOT. In my research for this film, I came to understand not only the connection between repressed emotions and pain, but the much deeper connection between repressed emotions and illness in general. Further, I became much more aware of how the emotions of parents affect children. Dr. Gabor Mate has a lot to say about this, and it’s given me a framework within which to better understand my own relationships with my parents and my own children. Harper was (and still is) extremely attached to her mother. Any form of separation, from a babysitter to daycare, caused her to be extremely stressed out. When she was very little, Harper developed an extreme constipation problem. Looking back, I realize it appeared at about the same time that she first started having an afternoon babysitter. When she entered day care, she started to repeatedly get strep throat. She also got strep when we traveled. This morning I realized that she most often got it when we traveled to visit my wife’s family. My sense now is that because my wife was stressed about both traveling and seeing her parents, the unconscious repression of those emotions was picked up by Harper and she too became stressed out, and subsequently less able to fight off illness. In the last couple of years, as we have helped Harper to be more conscious of her stress, and we have worked to become more conscious and in control of our own stresses ourselves, she has gotten ill much less often. In fact, the last time she got strep was almost a year ago, two days before my wife was set to go on a trip to NY.
As we looked at the ants, I was aware of the connection between the way the ants reacted en masse instantaneously to the threat that was represented by my stick. If we can extrapolate that same process to our bodies, it becomes a metaphor for how we respond to stress. First, it’s important to recognize that the ants were clearly communicating and acting in a unified way. While it may look like chaos to our untrained eyes, there is undoubtedly some form of order to their process. Each ant knows, in some fashion, what is expected of it, and it carries out its responsibility. We may not be able to discern the methods of communication, nor the function of their actions. This in no way means that they are not communicating, nor does it mean that they are behaving in an erratic way. In fact, if one were to return to the damaged mound a few hours later, they would find it rebuilt.
The same is true for our bodies when we react to both real and imaginary threats. In ways that we are often not aware, the cells in our bodies communicate in much the same was as these ants do. While we may not consciously perceive a threat, the cells react en masse, communicating in ways that we still do not understand. Imagine for a moment that you see a stick and think it is a snake. Your body goes into fight or flight mode. An uncountable number of chemical reactions take place simultaneously. Often times, though, the same reaction takes place, even if we don’t see a stick that looks like a snake, and we are largely unaware of the process. Perhaps we are going to visit an old boyfriend, or walking into class. If we slow down and pay attention to our bodies we might become more aware of how it reacts in different ways to a myriad of situations. When we are unconsciously stressed out about a certain situation, our body sees that situation as a threat and floods the system with chemicals designed to help us react to stress. Mindfulness practice helps us to become more aware of these responses, and retrain the body that it isn’t usually necessary to react in this way.
In a conscious realm, the incursion of my stick into the sanctity of the ants’ home was akin to a horsefly biting my arm. If we think about their reaction in terms of the unconscious, perhaps the stick was like a teacher announcing an upcoming exam. Perhaps we knew it was coming, and we were prepared for it, but still we feel queasy in our stomach and our shoulders tighten up. The good news is, when we bring the unconscious more into the conscious realm, we can begin to change this process. However, if we remain unaware, we have no tools or methods with which to fix the problem. The same is true of “illnesses” like chronic pain. When we treat symptoms without understanding their cause, then our problems become chronic. As doctor Sarno points out about back pain, if the cause is psychological then we must think psychologically to fix the problem. If instead we simply mask it with pain killers, or divert our attention with placebos like surgery, then the root cause, the repression of our emotions, will likely cause even worse problems in our bodies over time.
Over the last year, I have dedicated myself to learning how to meditate. It took some time before I began to feel the benefits of my practice. However, in the last few months those efforts have borne prodigious fruits. I have largely eliminated a long term level of unconscious anxiety that had a powerfully negative effect upon my life. I can also see evidence of a positive result not just in my relationship with my kids, but in my kids themselves.
From a science perspective, this is all anecdotal evidence. It certainly doesn’t “prove” that the meditation that my wife and I are practicing has helped either us or our kids. How might we even begin to measure this change in a meaningful repeatable way? Almost every indicator that I’m using is completely subjective. Science doesn’t give us a lot of tools we can use to make conclusive determinations about complex systems. Too often, due to these deficiencies, the scientific community doesn’t have the inclination or the resources even to entertain these ideas. Talk to anyone who has to apply for science grants, and you’ll find that complex experiments taking a myriad of subjective factors into consideration aren’t very easy to fund. When the results won’t yield any highly profitable drugs or create new markets like “restless leg syndrome,” the ask is that much harder.
However, the deeper I get into my awareness of how my own thoughts and behaviors affect those around me, the more conscious I am that there is a force that connects us all, just as there is a force that connects the ants in that sand mound. Malcolm Gladwell talked about this idea in “The Tipping Point.” It is my sense that we are getting very close to a tipping point in regards to cultural awareness about the importance of the mind body connection. I think that when this broader awareness comes, it will be swift and direct. I also think it will save this country from bankruptcy, because the cost of treating the symptoms of chronic pain account for a major percentage of the increase in health care costs across the board.
A number of years ago we filmed a discussion between E.O. Wilson and Sam Harris at the New York Public Library. There was not a lot of common ground between the extremely agnostic Sam Harris and the “scientific humanist” Wilson. However, recently Sam Harris wrote a book about how mindfulness is an important tool for becoming more self aware. He ties this to spirituality, but makes sure that we don’t call it “religion.” This is a pretty big indicator that the tipping point is nigh.