The reason this man was so filled with hope was that he had been waiting for medical science to discover a cure, and now he believed that this was accomplished. He had read about Krebiozen, and now he knew that the hospital where he lay dying had been chosen to test it. He wasn't really eligible to be included in the research, since one of the requirements was that patients on whom Krebiozen was tried must have a life expectancy of at least three, and preferably six, months. But he was so enthusiastic and begged his physician for what he called a "golden opportunity," that the physician felt he had to include him.
The first injection of Krebiozen was given to him on a Friday, and on the following Monday, the physician thought that his patient might be dead, and his supply of Krebiozen could be transferred to someone else. When the patient had received the injection, he was completely bedridden, gasping for air. On this Monday morning, he was walking around the ward, happily showing everyone he could find how wonderfully well he was doing with this new miracle drug. The tumor masses had "melted like snowballs on a stove" and were less than half their size already. His physicians said that this was a more dramatic change than could be expected from radiation treatment given each of these three days. Very excited, the doctor rushed to see the other patients who had received Krebiozen injections, but none of them had changed. Very soon, the man was recovered completely, left the hospital, and even resumed flying his airplane with no discomfort, even though only a few short weeks before he had been gasping in an oxygen mask.
He continued to do just fine until controversy about the drug's usefulness began to appear in the papers, as clinic after clinic was finding no results. He began to lose faith in his last hope, and in spite of two months of practically perfect health, he became gloomy and miserable. At this point his tumors came back with full force, and he again appeared before his physician in almost the same terminal condition.
As if this was not amazing enough, the second chapter of this story is even more amazing His physician, seizing upon a golden opportunity of his own, told this patient that it had just been discovered that the reason Krebiozen had been failing to achieve its initial promise was that it had a very short shelf life, quickly losing potency. He said that now there was available some Krebiozen that was very new and potent and that a shipment was expected in the next day or two. The man's faith was restored, and he was very excited and hopeful. A couple of days later, when his expectancy was very high, the doctor administered an injection of sterile water. The man's recovery was even more dramatic than the first time. His tumors melted, his chest fluid vanished, and he went back to flying once more. As long as the water injections continued, he remained symptom-free. When the final judgment of Krebiozen by the American Medical Association appeared in the press, finding the drug worthless in treating cancer, he was readmitted to the hospital and soon died.
How are we to understand this? Did the man have two "spontaneous remissions"? This case clearly demonstrates the wondrous power of the mind when, bolstered by faith and expectation, it visualizes an outcome. That is exactly what the placebo effect is--the effect of a visualization, one that is thoroughly believed in. Isn't this what we should be trying to engender in all patients and in ourselves as well? The placebo effect as a visualization was discussed by Elmer Green in his Presidential Address to the Biofeedback Society of America titled, "Psychophysiologic Correlates of Expectancy." In the paper, he brought together converging information from ethology, psychodynamic theory, autogenic training theory, the psychology of perception, and neuroanatomy and the neuropysiologic correlates of sensory discrimination. Speaking of the placebo effect, he said,
It is now clear, at least to me, that what is called the placebo effect is a subdivision of the self-regulation effect.
Humans, through visualization are able to self-trigger physiological behaviors that in animals are associated, as far as we know, only with external perceptions of some kind. It is this fact in humans, of course, which gives rise to the placebo effect. The placebo, by definition, is something false by means of which a patient is tricked into using his or her own visualization powers for physiological manipulation. Not everyone has yet thought of it this way, I know, but if a placebo is put into a cup of coffee with instruction to a patient, "Drink this and it will slow your heart rate, " it can happen. If the same sugar pill is slipped into the coffee unknown to the patient, however, nothing happens. This is because the visualization and the expectancy associated with that visualization are not triggered off.
As a species, we have probably been using this general effect since we differentiated from the animals, but now, for the first time in the history of humanity, it has become possible to get the information from inside the skin. Information before biofeedback was normally fed back only to subcortical brain centers for unconscious autonomic and homeostatic regulation. Now, for the first time in human history, this information is coming back to the cortex, and because we can visualize changes in the body, biofeedback is making it quite easy to regulate many heretofore involuntary processes.
The Vital Role of Biofeedback in Self-Regulation
In the Cancer Journal for Clinicians, Norman Cousins wrote a guest editorial titled, "Cancer and Placebos." Because of his own experiences in self-healing, Cousins was appointed Adjunct Professor in the Department of Psychiatry and Behavioral Medicine in the U.C.L.A. School of Medicine. In the editorial, he examines the role of mind in healing and the relationship between mind and medicine in every way.
Cousins noted that recently the placebo is being studied in terms of its ability to change human chemistry. A bibliography of placebo research by three of his colleagues in the Neuropsychiatric Institute at U.C.L.A. listed 674 studies, many of which showed that people who respond to placebos release secretions in their brains that in turn produce specific physiological effects in their bodies. What Norman Cousins wanted to share with doctors was this: if a placebo is an emotional experience that can trigger a biochemical response, there is an important therapeutic value in a patient's belief in the healing power of the physician. What a physician communicates to a patient and how he communicates it can have a powerful impact on the treatment outcome.
Perhaps every illness we ever have is in response to a problem of some type and is an attempt at a solution. A life-threatening illness like cancer may be a response to loss and despair, or it may be an unconscious attempt to replace something or to escape from some perceived or imagined inadequacy. Human reactions to stress and loss can cause cancer. This should not be interpreted as saying, "I caused this cancer"; however, the illness can act like an attention getter. Something internal needs to be dealt with.
Faced with a diagnosis of cancer, patients react in a number of different ways. Many patients would like to get well but want the doctor to invest all the energy and effort, seeing themselves as passive recipients of treatment. To a large extent, our culture fosters this. We are taught to believe that everything--or almost everything--can be resolved by popping a pill or by having something taken out. In fact, there is a tendency to be insulted and outraged when we discover that there is no easy cure for something that we have. Often physicians encourage us to take a passive role, follow instructions, and be compliant. In fact, patient compliance is a very large issue in both psychiatric and physical medicine. So the patient may expect to be cured, or hope to be cured, but wants the doctor to take all the responsibility. Physicians often don't know how, or are afraid, to tap patient potential for self-healing and encourage patient participation in the healing process.
A much smaller percentage of people seem quite ready to give up the moment the diagnosis is delivered, if not before. Once they discover they have cancer, it becomes the central focus of their lives. All their plans are organized around having cancer, and consciously or unconsciously they think of themselves almost as though they were already in the grave. Their self-image is that they are dying, and as if following a script they act out this role to the finish.
Another group of patients is willing to do anything to get well. No effort seems too great. This is a characteristic shared by survivors of catastrophic and life-threatening illness. Most importantly, it is an attitude that can be acquired. One thing that survivors have in common is a practice of envisioning themselves getting well.
A young man who experienced this type of change in a dramatic way told of his experience to a national audience on the television program "Good Morning America." He was a graduate student at Harvard when he was diagnosed as having cancer and began treatment with chemotherapy. After a few months, he felt he could no longer go on with the treatments. He felt tired, weak, and depressed, and he told his physician he was withdrawing from chemotherapy. His doctor told him he would be signing his own death warrant, and he said he did not care. He went home and, feeling entirely frustrated and angry, put on a pair of running shorts and went for a run. Then he exercised, swam, and finally returned home, exhausted but happier than he had been for some time. He became aware that he felt better for the first time in a long time and decided it was because he had taken charge of his life. During the ensuing months, he took up rowing, boxing, running, racquetball, and swimming, and he filled his life with taking care of his body and building strength. When he felt strong and positive and wanting to live, when he could envision himself getting well, he returned to chemotherapy and this time completed it with very little difficulty, maintaining his active life. That was more than six years ago, and he has been free of cancer ever since.
As beliefs and expectations have biological consequences, so do attitudes. There are definite neuroendocrine and neurohormone accompaniments to a good mood, to a strong positive attitude.
Lisa is one of the people who illustrates this power of attitude. She is one of the most lively, fun and laughter loving, vivacious people I know. She is also a person with strong values and beliefs, and her life and her profession give her ample opportunity to put them into practice. She has defied all the odds and is considered by some to be a medical miracle.
In the fall of 1972, just after she turned seventeen, Lisa was diagnosed as having acute myeloblastic or myelocytic leukemia. Her older brother had been killed in an automobile accident sixteen months earlier, and the stresses and pain in her family had been considerable ever since. Her parents were told that she had only three weeks to live, but she was treated with chemotherapy and gained a long remission. When she began to recover, they were told that the first relapse would mean an automatic death sentence, but she was not told this. She entered college in Des Moines and made arrangements to continue her chemotherapy treatments there. She was told by a physician there, when she had been in remission for over four years, that she was almost to the point of five year's remission, which was a good thing since if she had a relapse, she could not live through it. At the time, she believed this pronouncement totally.
In the fall of 1978, she had that first relapse. She was in the second year of law school. She had had a close group of friends as an undergraduate, everything had gone well for her, and she began to think of herself as invulnerable. When she went to law school, she left these friends behind and got into a round of very hard work. As she became somewhat tired and lonely, she began to think the cancer could come back. She came down with a fever and sore throat, and she knew immediately what it was. She went back and started chemotherapy all over again and achieved a substantial remission for about nine months. In her words, this was the first medically impossible thing that happened. At the time, she remembered that she had been told she could not survive a relapse, but once she had relapsed, she didn't believe it and felt inside that she did not have to accept that outcome.