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The Positive Influence of Norman Cousins

TIMES HEALTH WRITER

Depressed over a recurrence of breast cancer, Flo Porter picked up the telephone one day in 1980 and called Norman Cousins.

“I was surprised that he had a listed phone number,” the Los Angeles woman recalled. “I told him I was 36. I had just had a mastectomy. I had two small children, and I was fearful of dying.”

Cousins invited her to his house.

“He looked me in the eye and gave me his undivided attention,” Porter said of their one-hour meeting. “He emphasized that it was important to have a good attitude; that it didn’t matter what the statistics were on my chances to live. It changed my whole life.”

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Cousins’ ability to promote healthy attitudes in the face of sickness is now legend. He died of heart failure at the age of 75 Friday at a hotel in Westwood where he had gone to meet a friend for tea.

While health experts had long suspected that negative emotions seemed to cause patients to fare worse, Cousins pondered the flip side of that relationship for 15 years.

“He came here already convinced that if negative feelings made it harder--something that had been known pragmatically for 2,000 years but only recently documented--then positive attitudes and feelings should improve your chances of coping with illness,” said Dr. L.J. West, a professor of psychiatry and bio-behavioral science who helped recruit Cousins for UCLA in 1978 as an adjunct professor.

“He wasn’t just thinking of survival rates but of improving the quality of life for people with illness.”

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While Cousins did not invent the idea that emotions can influence health, he popularized the concept for patients worldwide and rallied scientists who saw credibility in the idea.

“In a certain way, he legitimized it,” said Dr. Michael S. Goldstein, chairman of the department of community health sciences at UCLA.

Today, the field has a name--psychoneuroimmunology, the study of how psychological factors, the brain and the immune system interact to influence health. Although it’s an area of growing scientific interest, some health experts remain unconvinced of an association between attitude and health.

“I would say the evidence for it is growing,” said Dr. David Spiegel, an associate professor of psychiatry and bio-behavioral science at Stanford University. “But there are major bodies of evidence that are ignored by medical community,” such as studies that show elderly people with strong social relationships live longer than people the same age without social support.

Cousins believed in the concept first and pursued scientific validation of it later.

A journalist and longtime editor of Saturday Review, Cousins began his hunt for a way to cope with illness when he was stricken with a crippling disease in 1964. He sought conventional medical treatment for the ailment, a degeneration of the connective tissues in his body, but soon decided what he needed most was to be cheered up.

A lifelong prankster and humorist, Cousins spent hours each day watching funny TV and movie clips. He also began taking Vitamin C in large amounts. Within a few months, his symptoms began to recede and he returned to work.

Encouraged by his recovery, Cousins, who was highly regarded in the publishing world for his sharp intellect and humanitarianism, also took his message to a large audience of physicians.

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“I was greatly elated by the discovery that there is a physiological basis for the ancient theory that laughter is good medicine,” Cousins wrote in an article, “Anatomy of an Illness (as Perceived by the Patient),” published in the Dec. 23, 1976, New England Journal of Medicine.

The article became the basis for the first of 25 books Cousins wrote on emotions and healing and led to his appointment to UCLA.

Cousins’ 1983 book, “The Healing Heart: Antidotes to Panic and Helplessness” (Norton), followed his recovery from a heart attack. His last book was “Head First: The Biology of Hope” (1989, Dutton).

At UCLA, Cousins was ubiquitous. He wrote, lectured before medical students, assisted in clinical research and worked furiously to raise funds for basic research in immunology.

“Here was a man of 65 who had retired from publishing,” West said. “We thought he would teach and write and would be a delightful and valuable scholarly person to have on the faculty. We never reckoned that he would also be a demon fund-raiser.”

But Cousins had the greatest impact on individuals struggling with illness. He promoted a positive attitude and encouraged patients to participate with their physicians in the treatment of illnesses.

“I think Norman was the first one to really expound . . . on the fact that the individual could play an important part in the fight for recovery along with his or her physician,” said Harold Benjamin, founder of the string of nationwide Wellness Community centers, which provide support groups, counseling and informational resources to cancer patients.

“He also constantly spoke to physicians and health-care professionals about their obligations to deal with people as human beings.”

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Cousins was the honorary chairman of the Wellness Community and often delivered the keynote address at the opening of a new center, speaking with a kind of energy and sincerity that sent hopes soaring, Benjamin said.

“He was an inspiration. When he came to the Wellness Community to speak to our people, he changed their lives. They saw a man who himself had been afflicted by a life-threatening illness and who had come through it.

“But it was not a guru-like hope” that Cousins engendered, Benjamin said. “It was a hope based on thoughtful, well-considered knowledge of the psychology and the physiology.”

But Cousins’ message also irritated some. To some physicians, it appeared that he was promoting something that had not yet been scientifically proven.

Shortly after the publication of his book “Anatomy of an Illness” (1979, Norton), Cousins was criticized for suggesting that laughter could cure illness.

“He would say that is absurd,” Benjamin said. “What he did say is that pleasant emotions enhance physical well-being: laughter, love, success, camaraderie are all pleasant emotions. The more we can get of them, the better off we are.”

Cousins never espoused forsaking conventional medical treatment, another criticism that was sometimes pinned on him, Benjamin said. Instead, he encouraged patients to enhance their treatment with psychoneuroimmunological techniques, such as guided imagery, a process in which a cancer patient, for example, might imagine medication destroying cancer cells.

While Cousins was eventually able to distance himself from the laughter anecdote, he remained concerned that his messages would be misconstrued or simplified. Some critics charged that by suggesting an individual could have an influence on his or her own health, Cousins was placing “the burden of cure” on the patients with incurable illnesses and a burden of shame on them should the techniques fail.

“This was never like what he had in mind,” West said. “What he did try to tell them was that there is an important relationship between mind and body. Everyone has to die sooner or later, but the important thing is how you live and to get the most out of life.”

Medical professionals who listened closely to Cousins, said West, “could hardly argue with his message, no matter how conservative they were.”

Further, Cousins relished the opportunity to participate in clinical research that tested the relationship between emotions and health. He readily admitted that his own cure from disease did not prove anything scientifically. And although he had no formal science training (he did, eventually, receive an honorary medical degree from Yale University School of Medicine), Cousins delved into research and devoured complex information.

During his first few months at UCLA, West said: “I pointed out to him if he wants to convince physicians about something, the anecdotal method is not enough (even though) he knew you could learn a lot from single cases and can extrapolate to others. It was not long before I was able to provide him with opportunities to show him how studies can work in clinical research. He embraced that and went beyond it.”

At UCLA, Cousins assisted with a study that explored the effects of positive emotions on 75 patients with malignant melanoma. All the patients received the same medical treatment, but half also received information and counseling to promote emotional well-being. Researchers then studied the patients’ level of depression and level of interleukin cells, a measure of the body’s natural defense against disease.

By the third month, the patients receiving emotional support showed less depression and increased interleukin levels, while the control group subjects became slightly more depressed and had no increase in interleukin.

In similar work, Spiegel has shown that women with metastasized breast cancer who received counseling on coping and emotional well-being lived an average of 18 months longer than those who did not receive the psychological therapy.

The National Institutes of Mental Health recently granted Spiegel $1.5 million to repeat his study on breast cancer patients.

“I think a few years ago a proposal like that would have been laughed out of the study section,” Spiegel said of the board that selects projects for funding. “People are now saying, ‘OK, it’s a fair question. Lets study it impartially.’ ”

Other studies, however, have contradicted these findings, and relatively few specifics are known about how emotions might influence health, Goldstein said.

“There would be a lot of differences of opinion on that,” he said. “There is a lot of disagreement about those pathways (of influence).”

For instance, he said, a positive state of mind might trigger some action in the immune system to fight disease.

On the other hand, he said: “Maybe your state of mind leads you to do things that help. Perhaps happier people run more or happier people don’t smoke.”

It is also unclear whether attitude and emotions can have a greater effect on preventing disease than on curing disease, he said.

The many outstanding questions only motivated Cousins to raise more money for research and advocate more study, his colleagues say. His cheerleading cast a sense of value and urgency on the field.


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