I find books about health, the nature of the mind and body really fascinating, so this book by Jo Marchant was always going to be right up my street. In Cure, Marchant explores the concept of the mind influencing the health of the body, though phenomena like the placebo effect, the nocebo effect and hypnosis as well as softer influences like the value of empathy, a strong social circle and religion. The first half of the book very much focuses on the science, spending quite some time delving into the mysterious world of placebos, including knowing and unknowing placebos, the nocebo effect (where believing something will cause harm, causes harm) as well as alternative therapies such as homeopathy, meditation and acupuncture. This is a book very much on the fence about many of these therapies, most of which have been scientifically debunked and which are often dismissed by the scientific community. Yet Marchant keeps an open mind. She explores the effectiveness of the therapies, whilst maintaining an objective view on the question of why they work (which remains largely unknown). It’s an interesting concept especially as the Western view has become so polarised around the mind/body question, firmly in the camp of the two being almost entirely separated, with the medical community very focused on the body without necessarily being fully aware of, or accepting of, how the mind can knowingly or unknowingly influence it. It is this, I think, which is where the revolution in medical care needs to happen. Anyone who has used the NHS in UK will know how focused the medical profession are on fixing the body, but soothing the mind is still something which comes as something of an afterthought. As Marchant describes here:
“All too often when we receive medical treatment, our mental state is seen as a secondary concern, and our role as a patient doesn’t go much beyond signing consent forms and requesting pain relieving drugs. When I gave birth to my first child, I received state-of-the-art medical care, but I felt (as many women do) like an object on a conveyor belt, a passive recipient of a bewildering series of medical interventions that started with breaking my waters and ended in emergency surgery. We often focus on the importance of pain relief during childbirth, but I ultimately found the loss of control more distressing than the physical pain I felt when later giving birth without powerful drugs.”
And the mind is almost the forgotten part of the equation (and this pretty much echoes my own experience of childbirth). Treatment for mental illness and depression is not the best, and the idea that if there’s a problem with the mind that either drugs or ‘thinking yourself better’ will work is not an adequate response. I have seen first-hand how people feel they have ‘failed’ by succumbing to depression, as though the seeming absence of an external cause makes their illness less real or less justifiable. Yet if we cannot ‘think’ a broken leg better (though we can think ourselves to a quicker recovery, it seems) neither can we simply think our way out of a illness of the mind. I think this, too, is another area where we need to reshape the mind/body dichotomy. Because something exists in the mind, doesn’t make it less real. As Marchant describes here:
“Ultimately, the science is saying that rather than passively experiencing the world around us, as most of us assumes happens, to a large extent we construct and control that experience. ‘Our bodies are not only receptors of information,’ says placebo researcher Ted Kaptchuk. ‘We create the information.’ It’s something that psychologists and neuroscientists are already discovering in other fields, such as memory and vision. Memories aren’t faithful recordings but dynamic productions that we adapt and rewrite each time we access them, while our perception of colours and shapes is highly dependent on previous experience and what we expect to see.
Now it’s clear this principle holds true for health too: our thoughts, beliefs, stress levels and world view all influence how ill or well we feel. As fatigue researcher Tim Noakes told us in Chapter 4, ‘you don’t have to believe what your brain is saying’.
The really new idea here, though, is that when it comes to health, our minds determine far more than our subjective experience of the physical world around us. Through changes in gene expression, for example, and in the way our brains are wired, the way in which we see the world helps shape our bodies too. We play a role, then, in constructing not just our experience but our physical reality. And in turn, the health of our physical bodies influences the state of our minds. Inflammation induces fatigue and depression. Low blood-sugar levels make us short tempered. Calming our bodies – by slow breathing for example – improves our mood.”
I remember, once, my husband saying that the mind creates our reality from the information it receives, and I thought this mirrored the point above; that information comes to the mind from both within and outside the body, and our ‘perception’ of it is ordered only in the sense that the mind interprets information consistently. It is a matter of some interest to me, as a few years ago my son was diagnosed with Alice in Wonderland Syndrome, which affects his perception, and this opened my mind to many questions about how perception works, and how we determine what is ‘real’ and ‘unreal’. The idea that disease may not have a ‘real’ (a.k.a external) cause, but still be very real indeed is a leap which medical science seems unwilling to take, except in small pockets here and there.
I guess you may have guessed by now that this book was really interesting. The investigation into the placebo and nocebo effect was quite fascinating, to the point where I might get myself some placebos to take next time I have a headache, just to see if it works. I was particularly interested in the chapters covering the possible impact of meditation, particularly where Marchant explores HRV (Heart Rhythm Variability) biofeedback which seems to have real application for stress reduction and heart health. The sections around the extent to which stress and anxiety affect the body, and impact on health outcomes, was genuinely terrifying and explains so horribly why the poor often suffer reduced life expectancy even if their material conditions improve. Similarly the importance of community, of genuine friendship and supportive relationships, has important consequences for a world which is becoming more remote, and friendships more ‘digital’, and particularly for the elderly who may find themselves isolated after losing their friendships and support mechanisms over the years. In fact it reminded me of a similar point Olivia Laing made in The Lonely City, about how loneliness is life-shortening. Marchant fleshes the point out, but also offers an alternative way forward as described here:
“What if we reshaped our care for the elderly not around managing their decline, but harnessing their abilities? We could ‘use the ageing brain to give back to a society that’s in great need,’ says Carlson. The population is ageing, she points out; within 20 years we’ll have more adults over 65 than children under 18. ‘We don’t know what the message does to a person when they are told ageing is a time of deterioration. If we reframe it, and say ageing is a time to give back to others, it might actually help them age better.”
It’s all very fascinating. Throughout the book, Marchant is at pains to remind the reader that none of these therapies or approaches should be considered in isolation; rejecting recognised treatments that work is always going to be the best way forward. Yet those treatments can work better, at lower doses, if we treat the mind as well as the body (pain management, for example, was found to be more effective when used alongside hypnotherapy); and life chances can be improved if we consider our mental wellbeing as well as our physical. It left me with a lot to take away; a lot to think about in terms of managing my own health and the health of my family, at a time when GPs have less time for each patient (thank you, successive governments) and the focus is always on the money-making drugs as opposed to the less costly, less sellable, and less lucrative complementary therapies.
This book made me rethink a few things about homeopathy, about mental illness and how to age well. In some respects it’s been revolutionary. And overall I think Marchant has been balanced. She doesn’t dress up the acceptability of some of the practices she encountered, and neither does she pretend that thinking positively will cure all ills. It patently won’t. But it might help the drugs along, and it might help to make degenerative diseases or end of life care more caring, positive and liveable, and that, surely, can only be a good thing.
Cure is published by Canongate Books.