Do Not Dismiss What You Don’t Understand: The Hubris of Mechanistic Medicine

Do Not Dismiss What You Don’t Understand: The Hubris of Mechanistic Medicine

 Maps of the lymphatic system: old (left) and updated to reflect UVA's discovery. Credit: University of Virginia Health System

Maps of the lymphatic system: old (left) and updated to reflect UVA’s discovery. Credit: University of Virginia Health System

This morning a friend sent me an article about a “stunning new discovery”. Scientists at the University of Virgina discovered that the lymphatic system, which is central to our immune response, is directly connected to the brain. Previous explorations of the well mapped lymphatic system had missed the vessels that surround the brain. This study is both inspiring and frustrating to me, especially the response from both the media and the scientists who discovered these lymph vessels.

“Instead of asking, ‘How do we study the immune response of the brain?’ ‘Why do multiple sclerosis patients have the immune attacks?’ now we can approach this mechanistically. Because the brain is like every other tissue connected to the peripheral immune system through meningeal lymphatic vessels,” said Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA’s Center for Brain Immunology and Glia (BIG). “It changes entirely the way we perceive the neuro-immune interaction. We always perceived it before as something esoteric that can’t be studied. But now we can ask mechanistic questions.”

The above is a quote that appears in several articles so I am going to assume that is is part of the press release. The reason that I find it frustrating is that the scientists who found the vessels see this as a chance for mechanistic medicine to save the day, rather than recognize that it was the failure of mechanistic medicine to find this physical system which left many of them unable to believe there was a connection between emotions and health. Many of these same mechanistically focused physicians called any suggestion that our emotional response to a situation affected our immune response “woo” because they had not found a mechanistic pathway to describe it. If they could not measure it, or see it, it did not exist. At the same time, people like Dr. Gabor Mate, Dr. Sarno, Dr. Clarke, Dr. Weil, and many others who were faced with clear evidence of how powerfully our emotions affect our health (in the form of their experience with their patients), have been largely ignored by the bio-mechanistically focused medical system. The mechanistic model, with its awareness of these new connections, might be able to find new treatments. Hopefully it will do so in a manner that recognizes the patient’s power and role in this process.

This is not to argue that emotions are THE causative factor in the above described auto immune diseases. Instead, that they are one part of a complex chain of events in which our emotional response is connected to our physical response and vice versa, as Ashok Gupta so eloquently points out above. The current model of medicine – and especially the training of doctors – does not recognize emotions in a significant way. It’s the training that is most significant because doctors are not being given this information and they are also not given the time or the framework within which to use it. Part of my frustration stems from my own personal experience with my doctor who dismissed my discussion of Dr. Sarno’s work and my own understanding that my stress was the primary driver of my pain. It also has to do with the struggle that I have faced over the past 10 years trying to get our film about mind body medicine made and funded.

In the clip above Dr. Gabor Mate points out that through simple observation, scientists at the turn of the century were aware of how powerfully our emotions affected our health. Over time, because their observations were not followed up and “proven via the scientific method”, this knowledge disappeared with the rise of the mechanistic model of medicine. This bio-mechanical model became so powerful that anything that could not be proven in a laboratory was dismissed. When we zoom out further and we look at the process by which studies get funded and approved, it becomes clear that anyone presenting ideas that run completely counter to the system from which they seek approval will face stiff resistance. On the most basic level, young scientists whose continuation in their study program depends on the approval and support of their supervisors are unlikely to even propose research that directly challenges the work that those supervisors have done, let alone find funding to do it. Further, in a system focused on profits funding tends to get poured into things that will pay back the investment. When I talked with Dr. Roy Seidneberg, a dermatologist whose debilitating back pain was cured by both reading Dr. Sarno’s book “Healing Back Pain” and going to see him, he explained that he had integrated Dr. Sarno’s ideas into his own practice. He joked that it was bad for business because once people recognized the connection between their stress and many of their common skin conditions, they improved permanently.

At the same time that Dr. Sarno was recognizing the powerful connection between the psyche and pain, there were studies, like the ACE study, being done that showed the powerful effect that stress had on the body. In this study 17,000 people were asked to answer 10 questions about possible adverse events they had faced in childhood. These included things like parental drug abuse, violence, divorce, and sexual abuse. One of the takeaways of this study was that people who had faced 4 or more adverse events were 4 times more likely to develop cancer or heart disease. At the time, the bio-mechanistic model had a firm grip on the medical system that it took nearly two decades for the scientists to get their study done. They had the idea for it in 1981, and when they published the results in 1999, the medical establishment didn’t have a framework that would allow them to integrate this knowledge into their practice. Like Dr. Sarno’s observations, and Dr. Clarke’s observations, and Dr. Mate’s observations, it was largely ignored and dismissed. However, it has recently started to get a lot more attention, because awareness of the import of our emotions is gaining traction.

This current article about the discovery of a previously unseen part of the lymphatic system came out with a whimper but it should have repercussions for decades. The first thing I thought about when I read it was Jonah Lehrer’s first book, “Proust Was A Neuroscientist”. In that book, he illustrates how at the turn of the century neuroscientists’ imaginations were penned in by their mechanistic understanding of how the brain worked. Artists at the time used their own observation and intuition to describe their understanding of how the brain worked, which was often at odds with the science of the time. However, as Lehrer points out, with our more advanced means of peering into the brain, scientists have come to see that these artists were closer to what we now believe to be true than the scientists of the day. The key takeaway is that all of us – artists, scientists, and street corner preachers – need to make sure not to capitalize the “T” in truth, for hubris is the enemy of knowledge.

This essay is not designed to argue that our emotions cause our illness. Instead, I want to suggest that to ignore the integral role our emotions and fears and beliefs play in our health and immune response is short sighted. When we outsource all of our healing to others, we give them too much power. In college I studied philosophy, religion, and art. One of the main themes that ran through all of the disciplines is balance. When the mechanistic model came into being, it brought great insight and progress. However, over time, it did so at the expense of a balanced understanding of how our bodies and our brains interact. Hopefully, as this study suggests, the discovery of the direct connection between the brain and the immune system will help to restore some balance to the practice of medicine. When we believe that we have found the answer it often slips out our grasp without our awareness. I am not suggesting that I have the answer, but I do believe that things are still out of balance in terms of how our society tends to separate the mind and body when it comes to health.

– UPDATE- A friend of mine who is a doctor was frustrated by this piece because she felt like it was too angry, and not fair to the mechanistic model which has contributed to great advances in medicine. I agree with her that the mechanistic model has paved the way for some incredible leaps, and I also do not dispute that things are changing. I did not mean to imply that nothing is being done to recognize the mind body connection. In fact I am aware that a lot is being done. Instead I was referring to my own experience with doctors which has not been very positive as well as the trends that I have observed, and discussed with a wide range of doctors, many of whom were ostracized for challenging the system they were a part of. One of my points of reference is discussions with many older doctors (older than her) who got no training whatsoever dealing with emotions, and have expressed to me that not enough is being done to recognize this connection currently. However, my friend is not alone, many other doctors involved with the connections between the emotions and pain do not think it is wise to also make the connection to auto-immune issues. They feel that it makes it that much harder for people to accept the data that supports the connections between emotions and pain.

While Dr Sarno first made the leap to understanding the psychological basis of back pain because his patients tended to have a history of psychosomatic issues like ulcers and migraines, many doctors who deal with mind body syndrome don’t like the comparison to ulcers because they don’t believe there is clear proof that the emotions are a causative factor in ulcers.

However, my own experience of my father’s health issues, while anecdotal, illuminates a clear connection between the repression of emotions and a wide range of issues. When I was very young my father was hospitalized with a bleeding ucler. Shortly after he recovered he got whiplash, which he struggled with for years. He also had low back problems. When he discovered Dr. Sarno’s book he immediately understood how the repression of his emotions had contributed to his pain and rapidly went away. He had occasional pains and stomach problems but his health improved a great deal. He loved to talk with others about their lives and their problems, but I don’t think that worked too hard to get to the bottom of his own.

Dr. Sarno talks about the transition from work to retirement as a very difficult process for some people. When my father retired he began to have a host of health issues. He had been the head of his department at the University for many years, and the loss of his position and his status was hard on him, like it is for many people. Doctors thought he might have rheumatoid arthritis, then they thought it was ALS. He started to have wasting in his muscles and his balance deteriorated. He was frustrated by these developments. He continued to follow Dr. Sarno’s recommendations in terms of thinking emotionally rather than physically. He did meditation, yoga, and he worked out. He continued to see patients buyt not as many as he might have liked.

While the symptoms grew worse he never got a definitive diagnosis and none of the treatment, like steroids, seemed to help. My father was never a good patient, and he hated to be taken care of. Instead he liked to be the one taking care of things. This was probably a part of his problem. One morning he was told by his doctor something to the effect that whatever he was doing (ostensibly in reference to his mind body program and supplements like fish oil) wasn’t helping. That night my mother dropped him off near the college basketball arena while she went to park car a little farther away. On his way across the street he walked in front of a car and died instantly. He was 72.

It doesn’t make sense to me to think that only his whiplash and back pain were mind body related. Despite the fact that he was a psychologist who helped countless people with their issue, he was unable to get to the bottom of some of his own. Part of the reason that I am making this film is to help me get to the bottom of mine. I also want to create a platform to discuss these ideas. I don’t think that I have the answers, but I do have opinions, and I’ll continue to use this platform to discuss them.

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