Originally published 1/25/11 on The Doctor Weighs In
Today’s NYT carries an interesting op-ed titled “A Fighting Spirit Won’t Save Your Life” by Richard Sloan a professor of behavioral medicine at Columbia University Medical Center, and author of “Blind Faith”.
Sloan makes the point that Representative Giffords remarkable recovery has nothing to do with her being “a fighter.” He is right, up to a point.
American Belief in the Power of the Mind
Our culture is steeped in the strong belief in the western rugged individual (a Hollywood-created myth), pulling oneself by the bootstraps (a physical impossibility), conquering a disease (the image of good vs. evil), and other uplifting cliches. Where did this come from?
Phineas Quimby (picture on the right, in case you didn’t recognize him at first sight),is not exactly a household name nowadays. He was a 19th century New England philosopher, magnetizer, mesmerist, healer, and inventor (he was a clock and watch maker) who promoted his idea that illness was the product of mistaken beliefs, that it was possible to cure yourself by correcting your thoughts. For a time Mary Baker Eddy, the founder of Christian Science, was a patient of Quimby’s and shared his view that disease is rooted in a mental cause.
William James (January 11, 1842 – August 26, 1910) was a pioneering American psychologist and philosopher who was trained as a medical doctor. He wrote influential books on the young science of psychology, educational psychology, psychology of religious experience and mysticism, and on the philosophy of pragmatism. He was sickly most of his life and suffered from bouts of depression. When treatment of “consumption” failed, he decided to treat himself through the power of positive thoughts and avoiding negative ones. This would have been the end of it if it weren’t for the fact that his influence reached wide and deep. His circle included Ralph Waldo Emerson, Bertrand Russell, John Dewey , Oliver Wendell Holmes, Mark Twain, Sigmund Freud, Horatio Alger. His students at Harvard included Theodore Roosevelt, George Santayana, W.E.B. Dubois, Walter Lippmann, Gertrude Stein, to name a few. With such a list of followers and friends, is it any wonder that his views on the healing power of positive thoughts took root in our national psyche? In the 50’s “The Power of Positive Thinking” took the nation by storm, culminating in the latest New Age somewhat anti-science beliefs.
So there we have it, a history of the idea that being “a fighter” can affect the outcome of any disease, even brain trauma.
What’s happening on the brain level?
The National Institute of Neurological Disorders and Strokes website summarizes what’s going on in the brain following a traumatic event:
One of the most pervasive types of injury following even a minor trauma is damage to the nerve cell’s axon through shearing; this is referred to as diffuse axonal injury. This damage causes a series of reactions that eventually lead to swelling of the axon and disconnection from the cell body of the neuron. In addition, the part of the neuron that communicates with other neurons degenerates and releases toxic levels of chemical messengers called neurotransmitters into the synapse or space between neurons, damaging neighboring neurons through a secondary neuroexcitatory cascade. Therefore, neurons that were unharmed from the primary trauma suffer damage from this secondary insult. Many of these cells cannot survive the toxicity of the chemical onslaught and initiate programmed cell death, or apoptosis . This process usually takes place within the first 24 to 48 hours after the initial injury, but can be prolonged
In the healthy brain, the chemical glutamate functions as a neurotransmitter, but an excess amount of glutamate in the brain causes neurons to quickly overload from too much excitation, releasing toxic chemicals. These substances poison the chemical environment of surrounding cells, initiating degeneration and programmed cell death.
The brain attempts to repair itself after a trauma, and is more successful after mild to moderate injury than after severe injury. Scientists have shown that after diffuse axonal injury neurons can spontaneously adapt and recover by sprouting some of the remaining healthy fibers of the neuron into the spaces once occupied by the degenerated axon. These fibers can develop in such a way that the neuron can resume communication with neighboring neurons.
Obviously, there is no room here for a fighting personality to make a difference. This process is completely mechanistic, controlled solely by biochemical and cellular events.
The difference a “fighting spirit” makes
Anecdotal stories of the advantage of hopefulness, of determination to fight on, are easy to come by; we all heard them. My own favorite is from my medical school days. I used to follow Professor Dunphy, chairmen of Surgery, on his evening rounds. He was one of those legendary giants of surgery whose wisdom was reverently transmitted from one generation to the next. He would engage in conversation with patients who were scheduled for surgery the following day, assessing their mental state. Patients who were depressed, who expressed hopelessness, or who had low faith in the outcome where dropped from the schedule. “Their morbidity and mortality following surgery makes it a very risky proposition”, he would say.” Any data”?, the skeptical scientist in me inquired. ”No, just forty years of experience”, was the answer.
Well, now we have data. The field of neuroimmunolgy has provided extensive evidence that the brain controls the immune response, and that depression results in suppressed immunity. The immune response keeps tumor cells in check; suppression of immunity results in an explosive growth and spread of the cancer. Depression and anxiety result in release of stress hormones that are immunosuppressive. Even proper wound healing is retarded as a result.
What about brain injury? On the very basic level, immunity suppresses infection –one of the major complications of brain trauma. But more to the point: at the stage of rehabilitation, which Representative Giffords is now entering, creation of new neuronal connections, laying down new circuits to replace damaged ones, teaching the brain to utilize alternate pathways to detour the injured areas, all those are not purely mechanical –they require, well, a fighting spirit. Christopher Reeves, the actor of Superman fame, fell off his horse and fractured his C1 and C2 vertebrae. He could not breathe on his own and was hooked to a ventilator. Reeve had occupational therapy and physical therapy in rehab. In the therapy gym, Reeve worked on moving his trapezius muscle. Electrodes connected to him sent out readings to therapists, and every day he would try to beat his numbers from the day before. The most difficult part of rehabilitation was respiratory therapy. The therapist, Bill Carroll, used a hose to see how much air Reeve could inhale, measured in cubic centimeters as the vital capacity. In order to even consider getting off the artificial respirator, a patient needs a vital capacity of 750 cc’s. Initially, Reeve could hardly get above zero. By the end of October, he was able to get around 50 cc’s. This inspired him, and he felt his natural competitive edge coming back. The next day, he went up to 450 cc’s. He reached 560 cc’s the day after. Bill Carroll said, “I’ve never seen progress like that. You’re going to win. You’re going to get off this thing.” On December 13, 1995, Reeve was able to breathe without a ventilator for 30 minutes. Could that be accomplished without his fighting spirit?
Reeves extraordinary tenacity inspired neurobiologists and rehabilitation experts to rethink what the brain is capable of, given a “fighting spirit”. The remarkable progress in the field is evident today in the rehabilitation of soldiers with head injuries sustained on the battlefield; this was thought to be biologically impossible. It gives an inspiring new meaning to “nothing is impossible”!
So yes, Professor Sloan is right, but only partly so. Once the initial, purely mechanistic processes of cellular healing are completed, a “fighting spirit” can make all the difference. That’s why Rep. Giffords will prevail.
Dov Michaeli, MD, PhD writes at The Doctor Weighs In.