Patient, Heal Thyself : Personal Health: Doctors know that some patients resist getting well because being sick may serve some purpose. New research suggests that’s also true for those with major illnesses.
Dennis David saw every doctor he could think of: general practitioners, immunologists, gastroenterologists.
But nothing--not the various medications, not the prescribed diets--seemed to relieve his ulcerative colitis, a painful inflammation of the large bowel.
Because his symptoms seemed to worsen under stress, David suggested to each doctor that perhaps psychological counseling might help. “I asked if there was a psychological aspect to this disease,” says David, a Culver City insurance agent.
“I would go see doctors and they would say, ‘No. You just have to learn to live with this.’ One doctor told me, ‘You can spend as much time as you want on the couch. It’s not going to help you with your disease.’ ”
But David decided to go with his instincts and sought the help of Marc Schoen, director of the psychoneuroimmunology program at Cedars-Sinai Medical Center, which focuses on the connections between mind and body.
Using hypnosis and other psychoanalytic techniques, Schoen says he found that David had an attitude that may play an important role in illness: an unconscious part of David didn’t want to get well.
Schoen calls his theory “resistance to health.” And, in a scientific paper published in July, he suggests that the phenomenon might be common.
Doctors have long recognized that some people with psychosomatic illnesses--physical ailments such as ulcers or back pain that are thought to be exacerbated by stress or emotions--appear to have a resistance to getting well because the illness serves some purpose. But Schoen’s work suggests that even major illnesses, such as cancer or immune disorders, can be affected by the same psychology.
Schoen has not studied resistance to health in people with mild, temporary illnesses. But he and others have studied a psychiatric disorder called Munchausen syndrome, in which people who are not sick fake an illness for some gain.
Schoen’s latest research suggests that the same benefits some people experience by faking an illness--such as getting attention, sympathy or escaping their responsibilities--might also be a factor in the recovery of people who are actually ill.
In his study, Schoen found that 40% of 110 patients being treated for such illnesses as cancer or immune system disorders stated while under hypnosis that they didn’t really want to get well.
Schoen says the three most common reasons behind a wish to remain ill are being nurtured, withdrawing from responsibilities and commitments, and serving as punishment.
“For some people, the only way for them to pay attention to their own needs is to hold onto the illness,” Schoen says. For example, one patient under hypnosis told Schoen that he didn’t want to get well because that meant he would have to return to working 70 hours a week.
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Forced to grow up quickly and assume responsibility for his younger siblings after his father’s death, Dennis David says being ill made him feel he was the center of attention--a nice emotion he had never experienced in his childhood.
“When you get sick, someone is paying attention to you,” he says. “I was setting myself up for a process whereby I was receiving attention and wanting to keep myself sick. I had to break those patterns by acting differently in getting my emotional needs met.”
Taking care of his emotional needs has helped him with his colitis, David says. His pain and need for medication has decreased, and he no longer needs to follow a strict diet.
Stella Burman, 45, a Los Angeles social worker in children’s services, began receiving therapy from Schoen after she suffered a relapse of breast cancer last April, four years after a double mastectomy.
Burman underwent chemotherapy and tried many alternative medicines. But what she learned while in hypnosis therapy with Schoen was that a part of her was resisting recovery.
“I am the ultimate care-giver,” Burman says. “I spend a lot of time taking care of other people. I did not have a way for nurturing myself. And there was a component of me that said, ‘I need to get nurtured.’ ”
Burman says she is dealing with her need for nurturance by remaining in therapy even though her cancer is in remission.
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Schoen’s study is yet another advance in the field of psychoneuroimmunology, says Dr. David Spiegel, a renowned researcher in the field at Stanford University. Psychoneuroimmunology is the study of how the thoughts and emotions can influence the immune system, the part of the body that fights illness.
“There is growing evidence that the immune system is influenced by psychological and neurological factors,” Spiegel says. “Ten years ago, psychoneuroimmunology was considered a strange preoccupation. Now, it’s taken seriously as a developing area of research. But we need to learn more about it.”
Few experts in the field believe that attitudes cause serious illness. And there is no evidence that people who address their emotional needs recovery more quickly. But Spiegel and other researchers have shown that people with serious illnesses live longer if they are receiving psychological support to become less anxious or depressed about their illnesses.
“We have to be cautious with each step of this research,” says Spiegel, whose research is summarized in the new book “Living Beyond Limits.”
“Just because we may say there is an interesting connection between mind and body doesn’t mean that every illness and every attitude will tap into that connection,” he says.
Schoen agrees that there is no proof that addressing emotions or thoughts helps in recovery. But, he argues: “I think the resistance makes it harder for people to recover from illness. We can see from a whole chunk of psychoneuroimmunology literature that beliefs can create physical changes. To me, it’s a small leap to suggest that resistance to health can also effect a physical outcome.”
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Jon, a university professor who asked that his name not be used, called Schoen for help while under treatment for a life-threatening blood disease that required a bone marrow transplant. In therapy, Jon discovered that he felt guilty about events in his life and that his illness might be serving as his punishment.
“There was a side of me, deep inside, that was very angry with myself,” Jon says. “My father had polio when I was a child, and I was very hurt that he, all of a sudden, left us and went to the hospital. I interpreted that as him not caring about us. But then I would feel sorry for my father, and I felt guilty about being angry.”
While hospitalized after his transplant, Jon worked with Schoen to face these feelings. Meanwhile, Jon’s blood levels were checked twice a day to see if his immune system was recovering from the transplant.
“We would have a session and we would sometimes see a jump in my cell counts,” Jon says. “We thought we were seeing some actual connection.”
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Many patients are shocked to learn that a part of them doesn’t want to get well, Schoen says.
“People say, ‘I can’t believe I said that (while under hypnosis),’ ” Schoen says. “Saying that they don’t want to get well would totally contradict why they come to see me.”
Schoen acknowledges that some health experts might reject his work because of his use of hypnosis. The paper was published in the American Journal of Clinical Hypnosis.
But when hypnosis is used carefully, it’s a credible tool for delving into a person’s unconscious beliefs or attitudes, Stanford’s Spiegel says.
“Hypnosis is not a truth serum,” Spiegel says. “But if someone can be keeping something out of consciousness for a salient reason, that can sometimes be uncovered with hypnosis.”
Schoen’s study would appear to endorse what some medical professionals have long thought to be true.
While working with cancer patients in the mid-1970s, Dr. Bernard Siegel says it occurred to him that some people didn’t want to get well.
“Some of them felt they were being punished and that they were supposed to have cancer. Others felt, ‘If I get well I may have to go back to the old me,’ ” says Siegel, the author of several books and papers on emotions and health, including “How to Live Between Office Visits.”
When he suggested to his patients that their attitudes may be interfering with their recovery, he says, “People got mad at me. And doctors were saying, ‘You are making people feel worse.’ ”
On one occasion, Siegel says, he saw a woman who said she couldn’t lift her arm due to breast cancer surgery. Siegel agreed to sign a letter authorizing disability leave.
The woman got off the exam table, and before leaving the room, took a comb from her purse and ran it through her hair--using the disabled arm.
“It was so dramatic. I said to her, ‘Do you realize what’s happened?’ ” Siegel recalls.
The woman accepted his observation that she might have been using her illness to avoid work.
“She was not a rotten person trying to get unemployment,” he says. “It was just that job she hated. We were dealing with an unconscious issue.”
Some physicians, however, reject the idea that attitudes could affect patients’ recovery.
Medical students learn to listen to a patient’s attitude, “and good doctors do this,” Spiegel says. “But as medicine has become more technological, we have ignored those components of medical treatment. We have tended to focus on the disease, not the person with the disease.”
