by Yohan J. John
What is the mind? And what is its relationship with the body? Philosophers, psychologists, cognitive scientists and neuroscientists have all attempted to bring their professional heft to bear on the “mind-body problem”, but consensus remains elusive. At best, mainstream academics and researchers share a metaphysical commitment: the belief that the seemingly immaterial mind emerges from ordinary matter, specifically the brain. This position — known as materialism or physicalism — has replaced mind-body dualism as the mainstream academic position on the mind-body problem. According to dualism, mind and matter are completely separate substances, and mind (or soul, or spirit) merely inhabits matter. Dualism is a problematic position because it doesn’t offer a clear explanation of how the immaterial mind can causally interact with the material body. How can the immaterial soul push the buttons in the body’s control room… if it doesn’t have hands?
Recent studies linking epigenetics, neuroscience and medicine reveal that subjective experience can have a profound impact on our physical and mental well-being. Mounting evidence is telling us something that was often neglected in the incomplete transition from dualism to materialism — that the mind is a crucial material force that influences the body, and by extension, the world outside the body.
Even a committed reductionist shouldn’t have to wait around to find microscopic neural correlates for every mental phenomenon in order to take the mind seriously. We can know that something happens without knowing how it happens. Right now I think it is important for people to realize that the mind matters, even though we don’t know exactly how, just yet.
“Your subjective experience carries more power than your objective situation.” This is the conclusion of UCLA researcher Steve Cole, interviewed by David Dobbs in his masterful essay on stress, social isolation, and health [1]. The article deals with the various ways in which stress and social isolation can lead to poor health outcomes, including increased susceptibility to cancer, depression, AIDS and other diseases. Cole tells us that “Social isolation is the best-established, most robust social or psychological risk factor for disease out there. Nothing can compete.” However, social isolation does not seal your fate. How you respond to social isolation — in other words, your attitude towards what is happening to you — is a bigger factor in many situations than your “objective” genetic or environmental circumstances. This is not the same as asserting magical “mind over matter” powers. Your attitude is unlikely to save you from Ebola. But in borderline situations, your body’s ability to fight disease and decay seems to be invigorated by the power of the mind.
If the phrase “the power of the mind” makes you uncomfortable, you need only examine the intricate causal web that links the brain with the rest of the body. The prefrontal cortex is frequently described as the brain’s “executive” or “higher cognitive” area; it is widely believed to be the neural substrate of conscious mental processing. A journal article once symbolized prefrontal functionality with a jaunty drawing of an orchestra conductor. Several crucial sub-regions of the prefrontal cortex have strong anatomical links with emotion-related subcortical areas, including the amygdala, the nucleus accumbens, and the hippocampus. This cognitive-emotional network is connected with the hypothalamic-pituitary-adrenal axis of the endocrine system, which modulates the body’s response to stress — also known as the fight-or-flight response. Signals from the hypothalamus trigger activity in the pituitary gland, which in turn sends signals to the adrenal glands, which sit on top of the kidneys. In response to signals from the pituitary gland the adrenal glands release the stress hormones cortisol, adrenaline and noradrenaline. The stress hormones enter the bloodstream, where they can influence a whole host of processes in the body and the brain. Cortisol, for instance, can increase blood sugar levels, suppress the immune system, and enhance the breakdown of fat. Cortisol also has pronounced effects on the hippocampus, a part of the brain involved in memory, navigation, and emotional processing. It can cause the dendrites of neurons to shrink, reduce the rate of birth of new neurons, and even enhance the rate of neuron death.
The network linking higher brain areas with the immune system and with metabolic processes is just one mechanism through which mental phenomena can influence basic bodily function. Through this complex web of causes, something as ephemeral as an idea or a mood can trigger physical changes in the body — changes that have real consequences for the health and well-being of the person. Importantly, the way in which a stress hormone like cortisol affects the brain can depend on higher mental processes. As it turns out, stress can sometimes be beneficial. Mild stress may contribute to increased longevity [2]. Stress hormones are also released during periods of excitement. There appear to be two kinds of stress: distress, which is a free-floating anxiety, and eustress, which is a form of motivated arousal that may improve performance on goal-directed tasks. Cortisol is released during both kinds of stress, but its levels rapidly drop if you’re enjoying yourself, or achieving a specific goal. Concepts like excitement and enjoyment depend on your higher mental processes. After all, what is exciting for you may be distressing for someone else. Similarly, your attitude towards goals depends on a variety of factors including your upbringing and your socioeconomic context. Mental processes in the brain are like lenses that magnify, shrink, reflect and refract signals from the outside world, influencing how the rest of the body reacts.
The impact of the mind on the body is vividly revealed by the placebo effect. A placebo is supposed to be an ineffective but harmless medical treatment, like a cleverly disguised sugar pill, used to deceive a patient into thinking she has been treated. One of the earliest definitions of the placebo described it as “any medicine adopted more to please than to benefit the patient” [3]. Any improvement shown by a patient given a placebo is attributed to the patient’s imagination — in other words, to her mind. When a new medical treatment is being clinically tested, patients given a placebo treatment serve as controls that are compared to patients given the real treatment. The new treatment is deemed ineffective if its effects are no better than a placebo. The underlying assumption here is that the placebo effect is the same as no effect. But right from its discovery in the 18th century, placebos were recognized to be powerful. In 1799, the British physician John Haygarth, one of the first to study the placebo effect, wrote that his findings “prove to a degree which has never been suspected, what powerful influence upon diseases is produced by mere Imagination” [4].
This attitude — how can mere imagination do all this? — has been carried forward through two centuries of medical and psychological advancement; our astonishment at the power of the placebo effect seems undiminished in the 21st century. Part of our continued bewilderment comes from the peculiar details that emerges when we examine the effect closely. A 2009 article in Wired magazine documents some of these peculiarities [5]. Research suggests that the shape, size, color and branding can all impact the effectiveness of a placebo pill. Drug companies may have used some of these insights in the design and marketing of their (ostensibly non-placebo) medications, and this may be one of the reasons that the placebo effect seems to have gotten stronger in recent years. The drug companies seem to have convinced us of the effectiveness of their pills, strengthening the ability of our minds to synergize with the drugs. But they may be victims of their own success: since the placebo effect is used as a baseline against which to compare a treatment’s efficacy, an enhanced placebo effect makes it harder for these same drug companies to get approval for new drugs.
The power of the mind, as revealed by the placebo effect, is a limited power that seems often to be outside our control. We cannot invent placebos for ourselves, because we would know that they were placebos. The mind is not like Baron Münchhausen — it cannot always pull itself out of the swamps it finds itself in. The mind’s power is strengthened by the society it is part of. Integrating the strangeness of the placebo effect with the lessons from stress and social isolation, a somewhat sobering picture emerges. In order to have a sound mind and body you might need to know that the people around you are willing to intervene. Stress is most taxing on people who are socially isolated [1]. Conversely, people with strong social support networks are better able to deal with stress and recover from its ill effects. Perhaps the placebo effect reflects some deep need on the part of those who suffer be taken seriously enough for medical attention. The body can take care of itself in many situations, but in order to recruit the healing power of the mind, there must be some sign that someone out there cares. Perhaps the size, shape and branding of a pill convey its expense, and therefore, in our money-denominated value system, the degree of concern offered by the person administering the drug. Perhaps we can alleviate a great deal of suffering without new wonder-drugs. Perhaps there is a renewable resource at our disposal that we have barely made use of: empathy.
This line of thinking is speculative, but I think it can only contribute positively to the way we treat the sick and the distressed [6]. The body is not a biomechanical vehicle, and medical practitioners are not mechanics. More importantly, the mind is not a passive detector of signals from the body and the world. The mind actively integrates these signals, and the results of this integration spread out into the body and from there into the world. But a mind cannot access all its powers in isolation, because it cannot generate all the signals that it integrates. A solitary mind is just one node in a network of other minds, bodies, objects and forces. The health of each individual node depends at least in part on the health of the network as a whole. And perhaps our social networks need to take up more responsibility for the mental and physical health of each of their nodes. A society that leaves huge numbers of its most weak and disadvantaged to fend for themselves is truly a sick society.
The power of the mind suggests that we should care about it, even though we don't completely understand how it works. But its vulnerability in the face of isolation and disregard suggests that we should care about each other’s minds too. If the mind matters, then surely compassion matters too.
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References:
[1] Dobbs, David (2013), The Social Life of Genes, Pacific Standard.
[2] Minois, Nadège. (2000), Longevity and aging: beneficial effects of exposure to mild stress. Biogerontology.
[3] Shapiro, Arthur (1968), Semantics of the Placebo, Psychiatric Quarterly.
[4] Wikipedia entry on Placebo.
[6] As I was finalizing this essay I chanced upon a Wired article that suggests that the idea of empathy being crucial to health outcomes may not be so speculative after all! “What Kaptchuk demonstrated is what some medical thinkers have begun to call the “care effect” — the idea that the opportunity for patients to feel heard and cared for can improve their health. […] Suffering people reflexively seek care, but in mainstream medicine, “care” tends to mean treatment and nothing more. Many patients who really need empathy and advice are instead given drugs and surgery.” – Johnson, Nathaniel (2013), Forget the Placebo Effect: It’s the ‘Care Effect’ That Matters. Wired.