Caroline Leavitt's Blog, page 49
January 25, 2016
Can the mind help heal the body? Award-winning science writer and journalist Jo Marchant talks about Cure: A Journey into the Science of Mind Over Body, how placebos can actually create biological change, training our immune system to respond to scents and
<!-- /* Font Definitions */ @font-face {font-family:"ＭＳ 明朝"; mso-font-charset:78; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1791491579 18 0 131231 0;} @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-alt:Cambria; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1073743103 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page WordSection1 {size:595.0pt 842.0pt; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.WordSection1 {page:WordSection1;} </style><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I'm fascinated with the mind-body connection, and award winning science writer and journalist Jo Marchant has written a revolutionary and fascinating book about her research on the subject. From the placebo effect (yes, it's real) to how our psychological state influences our illnesses, CURE could change the way you think about modern medicine. I'm honored to host Jo Marchant here. Thank you, Jo</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="mso-bidi-font-weight: normal;">Why haven’t more doctors embraced the neuroscience of mind-body therapies? Is it a fear that people will fall prey to charlatans and not get the medical care that they need? Or is the simply the way alternative healers present their cures?</span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think there are several intertwined reasons for this. Much of the skepticism does seem to come from a fear that if we acknowledge a role for the mind in health, this will encourage people to believe in the vastly overblown claims of some alternative therapists. The mind cannot shrink a tumor, banish a life-threatening infection, or mend a broken spine. To pretend otherwise raises false hope and put patients at risk if they don’t get the conventional treatment they need. (I agree that we need to be clear about the limitations of the mind in health, but underestimating it is dangerous too. When scientists and doctors ignore or deny evidence that alternative therapies do help some people, this damages trust in science among the millions of people who feel they benefit from these therapies, and pushes them towards pseudoscientific explanations.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Another reason for the reluctance to accept research in this field is that science in general is based on a reductionist, materialist worldview that goes all the way back to Descartes, in which subjective elements – thoughts, feelings, experiences etc – as seen as less “real”, and less worthy of scientific exploration, than measurable physical matter. For many fields of research this is a useful distinction, it helps us to get rid of observer bias in experiments, for example. But in medicine the way we <i style="mso-bidi-font-style: normal;">feel</i> is of crucial importance, and I think we have to find a way to take this more seriously. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Then there’s the fact that our medical system is based on evidence from clinical trials. We compare treatments against placebos (fake medicines) to make sure they work. That’s important, and works well for physical interventions such as drugs. But it means we underestimate the value of other components of care. This is partly because most trials are funded by drug companies. A more fundamental problem is that placebo-controlled studies are specifically designed to discount any effect of the mind – pathways such as expectation, stress reduction and social support – because these elements are all present in the placebo group too. Any approach that harnesses these mechanisms will automatically fail the trial, no matter how much it benefits patients.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">We’re left with medical systems that spend more and more on physical drugs, while cutting staff numbers and squeezing appointment times. A lot of doctors would probably acknowledge that this is counter-productive, but they’re working in a system that doesn’t give them much choice.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What was the most astonishing finding for you – and why?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">There were many findings that surprised me. Placebo responses trigger biological changes. Reducing stress slows the progression of HIV. Loneliness shows up in the activity of our genes. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But perhaps the one that astonished me most was that we can train our immune systems to respond to taste and smell. This works through a process called conditioning, in which we learn to associate a psychological cue with a particular physiological response. The most famous example is Pavlov’s dogs: the Russian physiologist Ivan Pavlov repeatedly fed his dogs at the same time as sounding a buzzer, until they salivated just in response to the sound.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Similar processes work in humans too, with many aspects of physiology including the immune system. If you take a few doses of a drug that suppresses the immune system, for example, subsequently taking a look-a-like placebo will trigger the same response. Researchers hope conditioning can reduce drug doses (and therefore side effects and costs) in situations such as organ transplants, arthritis and cancer.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I started to research CURE, I was intrigued by the ability of the mind to influence subjective symptoms such as pain and fatigue. But to discover that our perception of the environment can have immediate and dramatic effects on something as fundamental to our survival as the immune system – that blew me away.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What fascinated me was your writing about sometimes placebos actually perform as well or better than the traditional med they are replacing. How the, could an individual wean themselves off meds by trying a placebos – I know there is a company that makes placebos, but isn’t part of why they work believing that they are other than what they really are?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">In many situations we are better off taking conventional medicine. Drugs generally work better than placebos because when we take them, we benefit from both the direct effect of the medication and any associated placebo response. There are lots of things we can do to maximize the placebo responses we experience with the drugs we take, from actively engaging with our treatment to finding a doctor we respect and trust.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">However in situations where drugs aren’t very effective (and/or come with risks such as side effects and addiction) and where placebo responses are strong, then some patients might do better on placebo. Examples might include chronic pain, irritable bowel syndrome, depression, and the side effects of chemotherapy.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Scientists have generally assumed that for a placebo to work, we must be fooled into thinking it is a real treatment. But there is now evidence, in conditions including migraine, ADHD, depression and IBS, that placebos can still work even when we know we’re taking them (although perhaps not as well). </div><div class="MsoNormal"><br /></div><div class="MsoNormal">This may be because believing that a placebo will help us works even if we know it contains no active drug. Or there’s evidence that if receiving medical treatment makes us feel safe and cared for, this can ease symptoms such as pain regardless of what pill we take. A third mechanism is physiological conditioning (as described above), which works regardless of our conscious beliefs. Researchers suggest that for chronic conditions from pain to asthma to ADHD, alternating an active drug with a placebo should give the same therapeutic benefit with a lower dose of drug.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Alternative medicines offer another way to take advantage of placebo effects without active medication. For example, a German trial published in 2007 followed 1162 patients with chronic back pain. Some of them received real acupuncture, and some received placebo acupuncture (where the needles are placed at incorrect points, and don’t fully penetrate the skin). There was no difference between the two: a result that would traditionally be cited as evidence that acupuncture is worthless. But in this trial there was a third group. These patients received conventional care – a combination of drugs, physiotherapy and exercise – and they did barely half as well as those in the acupuncture groups. Acupuncture, whether real or fake, was a much more effective treatment than conventional care.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Ultimately, instead of relying on dummy pills and treatments we should be developing evidence-based interventions that harness the mind. In CURE, I describe some effective examples, from hypnotherapy for irritable bowel syndrome (IBS) to virtual reality therapy for burns victims in severe pain. But so far, few patients have access to these approaches. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">Aren’t all disorders and diseases stress-related – or at least exacerbated by stress?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s hard to think of a condition that isn’t directly or indirectly exacerbated by stress. Stress has wide-ranging direct effects on physiology, including the heart, gut and immune system. This can have dramatic immediate effects, such as diarrhea, panic attack or even heart failure. It increases the risk of adverse events during surgery. And over time, it puts pressure on the cardiovascular system, which can lead to heart disease, and triggers chronic inflammation, which disrupts wound healing, increases our susceptibility to infection and autoimmune disease, and contributes to chronic diseases from diabetes to dementia.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Stress can also exacerbate medical conditions in less direct ways, for example by increasing our sensitivity to symptoms such as pain, nausea and fatigue. And of course it feeds into our behavior, making us more likely to indulge in unhealthy habits (such as smoking and eating fatty food) and less likely to stick to our medication, all of which in turn influence our physical condition.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">You write that the drug companies are averse (obviously) to psychological cures over medicinal ones, but what can the average person do to put pressure on them or to encourage their doctors to be more open minded?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Buy them a copy of my book!</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What’s obsessing you now and why?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I’m very interested in the effect of the body on the mind. Just as psychological cues can alter physical health, physical factors – such as diet, exercise, immune responses and sleep – influence our mental state. A simple example is when you’re ill with flu. You experience physical symptoms such as fever, sore throat and aching joints. But you also feel exhausted and miserable. These psychological symptoms are triggered directly by your immune response to the virus, probably as a protective mechanism to ensure that you rest and stay isolated. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The subtitle of CURE refers to the science of<span style="mso-spacerun: yes;"> </span>“mind over body”, because this is the idea that I set out to investigate. But I soon realized that this concept isn’t really accurate. Rather than the mind ruling the body, each one inevitably reflects and influences the state of the other. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What question didn’t I ask that I should have?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">One of the questions that most intrigued me when I started researching this book is why placebos work. Why should simply believing we’ve been treated trigger the appropriate physical response?</div><div class="MsoNormal"><br /></div><div class="MsoNormal">There is not just one placebo effect but many, and they work through different mechanisms. But in general, it turns out that these responses reflect a much deeper evolutionary principle.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Sensations such as pain, fatigue and nausea evolved as warning signs: they tell us something is wrong and encourage us to change our behavior – to move away from a threat, to rest, or to seek help. Pain makes us remove our hand from a burning stove; nausea stops us from eating food that might make us sick.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These symptoms help to keep us safe, but they have a cost. If we’re feeling ill, we’re less able to escape from predators, for example, or to seek food. Researchers are discovering that the brain constantly engages in a kind of cost-benefit analysis, calculating what level of threat a situation poses, and therefore how severe the warning signals need to be. To do this, the brain takes into account physical signals from both our body – such as injury or the presence of pathogens – and our environment. We feel more fatigued than normal if the temperature is high, or if oxygen levels are low.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">But a key insight – and I think this is one of the central messages of my book – is that our <i style="mso-bidi-font-style: normal;">psychological perception</i> of a situation influences these decisions too. If we break an ankle, the pain tells us to stop and seek help. If we feel alone or in danger, that pain is amplified. On the other hand, once we know we’re safe and being cared for, there’s less need for the warning signal and our pain eases. (Or in a life-and-death situation such as being chased by a predator, it might be suppressed altogether – now it is more important to flee than to rest.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">How ill or well we feel therefore depends not just on our physical body but on our mental state. How threatened or safe do we feel? Believing we have no hope for recovery, hearing on the radio that there has been a poison gas leak nearby, feeling alone or stressed: all of these can amplify or even create symptoms. On the other hand, taking what we believe to be an effective medical treatment or receiving supportive, empathic care tells the brain that the crisis is over. The warning signals are switched off, and we feel better.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">For me, this means that although we should always listen to our symptoms, we don’t have to be ruled by them. And placebos, instead of being a mysterious, almost magical-sounding phenomenon, suddenly make perfect scientific sense. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>
Can the mind help heal the body? Award-winning science writer and journalist Jo Marchant talks about Cure: A Journey into the Science of Mind Over Body, how placebos can actually create biological change, training our immune system to respond to scents and
<!-- /* Font Definitions */ @font-face {font-family:"ＭＳ 明朝"; mso-font-charset:78; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1791491579 18 0 131231 0;} @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-alt:Cambria; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1073743103 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page WordSection1 {size:595.0pt 842.0pt; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.WordSection1 {page:WordSection1;} </style><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I'm fascinated with the mind-body connection, and award winning science writer and journalist Jo Marchant has written a revolutionary and fascinating book about her research on the subject. From the placebo effect (yes, it's real) to how our psychological state influences our illnesses, CURE could change the way you think about modern medicine. I'm honored to host Jo Marchant here. Thank you, Jo</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="mso-bidi-font-weight: normal;">Why haven’t more doctors embraced the neuroscience of mind-body therapies? Is it a fear that people will fall prey to charlatans and not get the medical care that they need? Or is the simply the way alternative healers present their cures?</span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think there are several intertwined reasons for this. Much of the skepticism does seem to come from a fear that if we acknowledge a role for the mind in health, this will encourage people to believe in the vastly overblown claims of some alternative therapists. The mind cannot shrink a tumor, banish a life-threatening infection, or mend a broken spine. To pretend otherwise raises false hope and put patients at risk if they don’t get the conventional treatment they need. (I agree that we need to be clear about the limitations of the mind in health, but underestimating it is dangerous too. When scientists and doctors ignore or deny evidence that alternative therapies do help some people, this damages trust in science among the millions of people who feel they benefit from these therapies, and pushes them towards pseudoscientific explanations.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Another reason for the reluctance to accept research in this field is that science in general is based on a reductionist, materialist worldview that goes all the way back to Descartes, in which subjective elements – thoughts, feelings, experiences etc – as seen as less “real”, and less worthy of scientific exploration, than measurable physical matter. For many fields of research this is a useful distinction, it helps us to get rid of observer bias in experiments, for example. But in medicine the way we <i style="mso-bidi-font-style: normal;">feel</i> is of crucial importance, and I think we have to find a way to take this more seriously. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Then there’s the fact that our medical system is based on evidence from clinical trials. We compare treatments against placebos (fake medicines) to make sure they work. That’s important, and works well for physical interventions such as drugs. But it means we underestimate the value of other components of care. This is partly because most trials are funded by drug companies. A more fundamental problem is that placebo-controlled studies are specifically designed to discount any effect of the mind – pathways such as expectation, stress reduction and social support – because these elements are all present in the placebo group too. Any approach that harnesses these mechanisms will automatically fail the trial, no matter how much it benefits patients.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">We’re left with medical systems that spend more and more on physical drugs, while cutting staff numbers and squeezing appointment times. A lot of doctors would probably acknowledge that this is counter-productive, but they’re working in a system that doesn’t give them much choice.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What was the most astonishing finding for you – and why?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">There were many findings that surprised me. Placebo responses trigger biological changes. Reducing stress slows the progression of HIV. Loneliness shows up in the activity of our genes. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But perhaps the one that astonished me most was that we can train our immune systems to respond to taste and smell. This works through a process called conditioning, in which we learn to associate a psychological cue with a particular physiological response. The most famous example is Pavlov’s dogs: the Russian physiologist Ivan Pavlov repeatedly fed his dogs at the same time as sounding a buzzer, until they salivated just in response to the sound.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Similar processes work in humans too, with many aspects of physiology including the immune system. If you take a few doses of a drug that suppresses the immune system, for example, subsequently taking a look-a-like placebo will trigger the same response. Researchers hope conditioning can reduce drug doses (and therefore side effects and costs) in situations such as organ transplants, arthritis and cancer.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I started to research CURE, I was intrigued by the ability of the mind to influence subjective symptoms such as pain and fatigue. But to discover that our perception of the environment can have immediate and dramatic effects on something as fundamental to our survival as the immune system – that blew me away.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What fascinated me was your writing about sometimes placebos actually perform as well or better than the traditional med they are replacing. How the, could an individual wean themselves off meds by trying a placebos – I know there is a company that makes placebos, but isn’t part of why they work believing that they are other than what they really are?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">In many situations we are better off taking conventional medicine. Drugs generally work better than placebos because when we take them, we benefit from both the direct effect of the medication and any associated placebo response. There are lots of things we can do to maximize the placebo responses we experience with the drugs we take, from actively engaging with our treatment to finding a doctor we respect and trust.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">However in situations where drugs aren’t very effective (and/or come with risks such as side effects and addiction) and where placebo responses are strong, then some patients might do better on placebo. Examples might include chronic pain, irritable bowel syndrome, depression, and the side effects of chemotherapy.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Scientists have generally assumed that for a placebo to work, we must be fooled into thinking it is a real treatment. But there is now evidence, in conditions including migraine, ADHD, depression and IBS, that placebos can still work even when we know we’re taking them (although perhaps not as well). </div><div class="MsoNormal"><br /></div><div class="MsoNormal">This may be because believing that a placebo will help us works even if we know it contains no active drug. Or there’s evidence that if receiving medical treatment makes us feel safe and cared for, this can ease symptoms such as pain regardless of what pill we take. A third mechanism is physiological conditioning (as described above), which works regardless of our conscious beliefs. Researchers suggest that for chronic conditions from pain to asthma to ADHD, alternating an active drug with a placebo should give the same therapeutic benefit with a lower dose of drug.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Alternative medicines offer another way to take advantage of placebo effects without active medication. For example, a German trial published in 2007 followed 1162 patients with chronic back pain. Some of them received real acupuncture, and some received placebo acupuncture (where the needles are placed at incorrect points, and don’t fully penetrate the skin). There was no difference between the two: a result that would traditionally be cited as evidence that acupuncture is worthless. But in this trial there was a third group. These patients received conventional care – a combination of drugs, physiotherapy and exercise – and they did barely half as well as those in the acupuncture groups. Acupuncture, whether real or fake, was a much more effective treatment than conventional care.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Ultimately, instead of relying on dummy pills and treatments we should be developing evidence-based interventions that harness the mind. In CURE, I describe some effective examples, from hypnotherapy for irritable bowel syndrome (IBS) to virtual reality therapy for burns victims in severe pain. But so far, few patients have access to these approaches. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">Aren’t all disorders and diseases stress-related – or at least exacerbated by stress?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s hard to think of a condition that isn’t directly or indirectly exacerbated by stress. Stress has wide-ranging direct effects on physiology, including the heart, gut and immune system. This can have dramatic immediate effects, such as diarrhea, panic attack or even heart failure. It increases the risk of adverse events during surgery. And over time, it puts pressure on the cardiovascular system, which can lead to heart disease, and triggers chronic inflammation, which disrupts wound healing, increases our susceptibility to infection and autoimmune disease, and contributes to chronic diseases from diabetes to dementia.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Stress can also exacerbate medical conditions in less direct ways, for example by increasing our sensitivity to symptoms such as pain, nausea and fatigue. And of course it feeds into our behavior, making us more likely to indulge in unhealthy habits (such as smoking and eating fatty food) and less likely to stick to our medication, all of which in turn influence our physical condition.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">You write that the drug companies are averse (obviously) to psychological cures over medicinal ones, but what can the average person do to put pressure on them or to encourage their doctors to be more open minded?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Buy them a copy of my book!</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What’s obsessing you now and why?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I’m very interested in the effect of the body on the mind. Just as psychological cues can alter physical health, physical factors – such as diet, exercise, immune responses and sleep – influence our mental state. A simple example is when you’re ill with flu. You experience physical symptoms such as fever, sore throat and aching joints. But you also feel exhausted and miserable. These psychological symptoms are triggered directly by your immune response to the virus, probably as a protective mechanism to ensure that you rest and stay isolated. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The subtitle of CURE refers to the science of<span style="mso-spacerun: yes;"> </span>“mind over body”, because this is the idea that I set out to investigate. But I soon realized that this concept isn’t really accurate. Rather than the mind ruling the body, each one inevitably reflects and influences the state of the other. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What question didn’t I ask that I should have?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">One of the questions that most intrigued me when I started researching this book is why placebos work. Why should simply believing we’ve been treated trigger the appropriate physical response?</div><div class="MsoNormal"><br /></div><div class="MsoNormal">There is not just one placebo effect but many, and they work through different mechanisms. But in general, it turns out that these responses reflect a much deeper evolutionary principle.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Sensations such as pain, fatigue and nausea evolved as warning signs: they tell us something is wrong and encourage us to change our behavior – to move away from a threat, to rest, or to seek help. Pain makes us remove our hand from a burning stove; nausea stops us from eating food that might make us sick.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These symptoms help to keep us safe, but they have a cost. If we’re feeling ill, we’re less able to escape from predators, for example, or to seek food. Researchers are discovering that the brain constantly engages in a kind of cost-benefit analysis, calculating what level of threat a situation poses, and therefore how severe the warning signals need to be. To do this, the brain takes into account physical signals from both our body – such as injury or the presence of pathogens – and our environment. We feel more fatigued than normal if the temperature is high, or if oxygen levels are low.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">But a key insight – and I think this is one of the central messages of my book – is that our <i style="mso-bidi-font-style: normal;">psychological perception</i> of a situation influences these decisions too. If we break an ankle, the pain tells us to stop and seek help. If we feel alone or in danger, that pain is amplified. On the other hand, once we know we’re safe and being cared for, there’s less need for the warning signal and our pain eases. (Or in a life-and-death situation such as being chased by a predator, it might be suppressed altogether – now it is more important to flee than to rest.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">How ill or well we feel therefore depends not just on our physical body but on our mental state. How threatened or safe do we feel? Believing we have no hope for recovery, hearing on the radio that there has been a poison gas leak nearby, feeling alone or stressed: all of these can amplify or even create symptoms. On the other hand, taking what we believe to be an effective medical treatment or receiving supportive, empathic care tells the brain that the crisis is over. The warning signals are switched off, and we feel better.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">For me, this means that although we should always listen to our symptoms, we don’t have to be ruled by them. And placebos, instead of being a mysterious, almost magical-sounding phenomenon, suddenly make perfect scientific sense. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>
Can the mind help heal the body? Award-winning science writer and journalist Jo Marchant talks about Cure: A Journey into the Science of Mind Over Body, how placebos can actually create biological change, training our immune system to respond to scents and
<!-- /* Font Definitions */ @font-face {font-family:"ＭＳ 明朝"; mso-font-charset:78; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1791491579 18 0 131231 0;} @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-alt:Cambria; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1073743103 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page WordSection1 {size:595.0pt 842.0pt; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.WordSection1 {page:WordSection1;} </style><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I'm fascinated with the mind-body connection, and award winning science writer and journalist Jo Marchant has written a revolutionary and fascinating book about her research on the subject. From the placebo effect (yes, it's real) to how our psychological state influences our illnesses, CURE could change the way you think about modern medicine. I'm honored to host Jo Marchant here. Thank you, Jo</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="mso-bidi-font-weight: normal;">Why haven’t more doctors embraced the neuroscience of mind-body therapies? Is it a fear that people will fall prey to charlatans and not get the medical care that they need? Or is the simply the way alternative healers present their cures?</span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think there are several intertwined reasons for this. Much of the skepticism does seem to come from a fear that if we acknowledge a role for the mind in health, this will encourage people to believe in the vastly overblown claims of some alternative therapists. The mind cannot shrink a tumor, banish a life-threatening infection, or mend a broken spine. To pretend otherwise raises false hope and put patients at risk if they don’t get the conventional treatment they need. (I agree that we need to be clear about the limitations of the mind in health, but underestimating it is dangerous too. When scientists and doctors ignore or deny evidence that alternative therapies do help some people, this damages trust in science among the millions of people who feel they benefit from these therapies, and pushes them towards pseudoscientific explanations.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Another reason for the reluctance to accept research in this field is that science in general is based on a reductionist, materialist worldview that goes all the way back to Descartes, in which subjective elements – thoughts, feelings, experiences etc – as seen as less “real”, and less worthy of scientific exploration, than measurable physical matter. For many fields of research this is a useful distinction, it helps us to get rid of observer bias in experiments, for example. But in medicine the way we <i style="mso-bidi-font-style: normal;">feel</i> is of crucial importance, and I think we have to find a way to take this more seriously. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Then there’s the fact that our medical system is based on evidence from clinical trials. We compare treatments against placebos (fake medicines) to make sure they work. That’s important, and works well for physical interventions such as drugs. But it means we underestimate the value of other components of care. This is partly because most trials are funded by drug companies. A more fundamental problem is that placebo-controlled studies are specifically designed to discount any effect of the mind – pathways such as expectation, stress reduction and social support – because these elements are all present in the placebo group too. Any approach that harnesses these mechanisms will automatically fail the trial, no matter how much it benefits patients.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">We’re left with medical systems that spend more and more on physical drugs, while cutting staff numbers and squeezing appointment times. A lot of doctors would probably acknowledge that this is counter-productive, but they’re working in a system that doesn’t give them much choice.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What was the most astonishing finding for you – and why?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">There were many findings that surprised me. Placebo responses trigger biological changes. Reducing stress slows the progression of HIV. Loneliness shows up in the activity of our genes. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But perhaps the one that astonished me most was that we can train our immune systems to respond to taste and smell. This works through a process called conditioning, in which we learn to associate a psychological cue with a particular physiological response. The most famous example is Pavlov’s dogs: the Russian physiologist Ivan Pavlov repeatedly fed his dogs at the same time as sounding a buzzer, until they salivated just in response to the sound.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Similar processes work in humans too, with many aspects of physiology including the immune system. If you take a few doses of a drug that suppresses the immune system, for example, subsequently taking a look-a-like placebo will trigger the same response. Researchers hope conditioning can reduce drug doses (and therefore side effects and costs) in situations such as organ transplants, arthritis and cancer.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I started to research CURE, I was intrigued by the ability of the mind to influence subjective symptoms such as pain and fatigue. But to discover that our perception of the environment can have immediate and dramatic effects on something as fundamental to our survival as the immune system – that blew me away.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What fascinated me was your writing about sometimes placebos actually perform as well or better than the traditional med they are replacing. How the, could an individual wean themselves off meds by trying a placebos – I know there is a company that makes placebos, but isn’t part of why they work believing that they are other than what they really are?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">In many situations we are better off taking conventional medicine. Drugs generally work better than placebos because when we take them, we benefit from both the direct effect of the medication and any associated placebo response. There are lots of things we can do to maximize the placebo responses we experience with the drugs we take, from actively engaging with our treatment to finding a doctor we respect and trust.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">However in situations where drugs aren’t very effective (and/or come with risks such as side effects and addiction) and where placebo responses are strong, then some patients might do better on placebo. Examples might include chronic pain, irritable bowel syndrome, depression, and the side effects of chemotherapy.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Scientists have generally assumed that for a placebo to work, we must be fooled into thinking it is a real treatment. But there is now evidence, in conditions including migraine, ADHD, depression and IBS, that placebos can still work even when we know we’re taking them (although perhaps not as well). </div><div class="MsoNormal"><br /></div><div class="MsoNormal">This may be because believing that a placebo will help us works even if we know it contains no active drug. Or there’s evidence that if receiving medical treatment makes us feel safe and cared for, this can ease symptoms such as pain regardless of what pill we take. A third mechanism is physiological conditioning (as described above), which works regardless of our conscious beliefs. Researchers suggest that for chronic conditions from pain to asthma to ADHD, alternating an active drug with a placebo should give the same therapeutic benefit with a lower dose of drug.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Alternative medicines offer another way to take advantage of placebo effects without active medication. For example, a German trial published in 2007 followed 1162 patients with chronic back pain. Some of them received real acupuncture, and some received placebo acupuncture (where the needles are placed at incorrect points, and don’t fully penetrate the skin). There was no difference between the two: a result that would traditionally be cited as evidence that acupuncture is worthless. But in this trial there was a third group. These patients received conventional care – a combination of drugs, physiotherapy and exercise – and they did barely half as well as those in the acupuncture groups. Acupuncture, whether real or fake, was a much more effective treatment than conventional care.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Ultimately, instead of relying on dummy pills and treatments we should be developing evidence-based interventions that harness the mind. In CURE, I describe some effective examples, from hypnotherapy for irritable bowel syndrome (IBS) to virtual reality therapy for burns victims in severe pain. But so far, few patients have access to these approaches. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">Aren’t all disorders and diseases stress-related – or at least exacerbated by stress?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s hard to think of a condition that isn’t directly or indirectly exacerbated by stress. Stress has wide-ranging direct effects on physiology, including the heart, gut and immune system. This can have dramatic immediate effects, such as diarrhea, panic attack or even heart failure. It increases the risk of adverse events during surgery. And over time, it puts pressure on the cardiovascular system, which can lead to heart disease, and triggers chronic inflammation, which disrupts wound healing, increases our susceptibility to infection and autoimmune disease, and contributes to chronic diseases from diabetes to dementia.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Stress can also exacerbate medical conditions in less direct ways, for example by increasing our sensitivity to symptoms such as pain, nausea and fatigue. And of course it feeds into our behavior, making us more likely to indulge in unhealthy habits (such as smoking and eating fatty food) and less likely to stick to our medication, all of which in turn influence our physical condition.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">You write that the drug companies are averse (obviously) to psychological cures over medicinal ones, but what can the average person do to put pressure on them or to encourage their doctors to be more open minded?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Buy them a copy of my book!</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What’s obsessing you now and why?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I’m very interested in the effect of the body on the mind. Just as psychological cues can alter physical health, physical factors – such as diet, exercise, immune responses and sleep – influence our mental state. A simple example is when you’re ill with flu. You experience physical symptoms such as fever, sore throat and aching joints. But you also feel exhausted and miserable. These psychological symptoms are triggered directly by your immune response to the virus, probably as a protective mechanism to ensure that you rest and stay isolated. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The subtitle of CURE refers to the science of<span style="mso-spacerun: yes;"> </span>“mind over body”, because this is the idea that I set out to investigate. But I soon realized that this concept isn’t really accurate. Rather than the mind ruling the body, each one inevitably reflects and influences the state of the other. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What question didn’t I ask that I should have?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">One of the questions that most intrigued me when I started researching this book is why placebos work. Why should simply believing we’ve been treated trigger the appropriate physical response?</div><div class="MsoNormal"><br /></div><div class="MsoNormal">There is not just one placebo effect but many, and they work through different mechanisms. But in general, it turns out that these responses reflect a much deeper evolutionary principle.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Sensations such as pain, fatigue and nausea evolved as warning signs: they tell us something is wrong and encourage us to change our behavior – to move away from a threat, to rest, or to seek help. Pain makes us remove our hand from a burning stove; nausea stops us from eating food that might make us sick.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These symptoms help to keep us safe, but they have a cost. If we’re feeling ill, we’re less able to escape from predators, for example, or to seek food. Researchers are discovering that the brain constantly engages in a kind of cost-benefit analysis, calculating what level of threat a situation poses, and therefore how severe the warning signals need to be. To do this, the brain takes into account physical signals from both our body – such as injury or the presence of pathogens – and our environment. We feel more fatigued than normal if the temperature is high, or if oxygen levels are low.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">But a key insight – and I think this is one of the central messages of my book – is that our <i style="mso-bidi-font-style: normal;">psychological perception</i> of a situation influences these decisions too. If we break an ankle, the pain tells us to stop and seek help. If we feel alone or in danger, that pain is amplified. On the other hand, once we know we’re safe and being cared for, there’s less need for the warning signal and our pain eases. (Or in a life-and-death situation such as being chased by a predator, it might be suppressed altogether – now it is more important to flee than to rest.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">How ill or well we feel therefore depends not just on our physical body but on our mental state. How threatened or safe do we feel? Believing we have no hope for recovery, hearing on the radio that there has been a poison gas leak nearby, feeling alone or stressed: all of these can amplify or even create symptoms. On the other hand, taking what we believe to be an effective medical treatment or receiving supportive, empathic care tells the brain that the crisis is over. The warning signals are switched off, and we feel better.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">For me, this means that although we should always listen to our symptoms, we don’t have to be ruled by them. And placebos, instead of being a mysterious, almost magical-sounding phenomenon, suddenly make perfect scientific sense. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>
Can the mind help heal the body? Award-winning science writer and journalist Jo Marchant talks about Cure: A Journey into the Science of Mind Over Body, how placebos can actually create biological change, training our immune system to respond to scents and
<!-- /* Font Definitions */ @font-face {font-family:"ＭＳ 明朝"; mso-font-charset:78; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1791491579 18 0 131231 0;} @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-alt:Cambria; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1073743103 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page WordSection1 {size:595.0pt 842.0pt; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.WordSection1 {page:WordSection1;} </style><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I'm fascinated with the mind-body connection, and award winning science writer and journalist Jo Marchant has written a revolutionary and fascinating book about her research on the subject. From the placebo effect (yes, it's real) to how our psychological state influences our illnesses, CURE could change the way you think about modern medicine. I'm honored to host Jo Marchant here. Thank you, Jo</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="mso-bidi-font-weight: normal;">Why haven’t more doctors embraced the neuroscience of mind-body therapies? Is it a fear that people will fall prey to charlatans and not get the medical care that they need? Or is the simply the way alternative healers present their cures?</span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think there are several intertwined reasons for this. Much of the skepticism does seem to come from a fear that if we acknowledge a role for the mind in health, this will encourage people to believe in the vastly overblown claims of some alternative therapists. The mind cannot shrink a tumor, banish a life-threatening infection, or mend a broken spine. To pretend otherwise raises false hope and put patients at risk if they don’t get the conventional treatment they need. (I agree that we need to be clear about the limitations of the mind in health, but underestimating it is dangerous too. When scientists and doctors ignore or deny evidence that alternative therapies do help some people, this damages trust in science among the millions of people who feel they benefit from these therapies, and pushes them towards pseudoscientific explanations.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Another reason for the reluctance to accept research in this field is that science in general is based on a reductionist, materialist worldview that goes all the way back to Descartes, in which subjective elements – thoughts, feelings, experiences etc – as seen as less “real”, and less worthy of scientific exploration, than measurable physical matter. For many fields of research this is a useful distinction, it helps us to get rid of observer bias in experiments, for example. But in medicine the way we <i style="mso-bidi-font-style: normal;">feel</i> is of crucial importance, and I think we have to find a way to take this more seriously. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Then there’s the fact that our medical system is based on evidence from clinical trials. We compare treatments against placebos (fake medicines) to make sure they work. That’s important, and works well for physical interventions such as drugs. But it means we underestimate the value of other components of care. This is partly because most trials are funded by drug companies. A more fundamental problem is that placebo-controlled studies are specifically designed to discount any effect of the mind – pathways such as expectation, stress reduction and social support – because these elements are all present in the placebo group too. Any approach that harnesses these mechanisms will automatically fail the trial, no matter how much it benefits patients.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">We’re left with medical systems that spend more and more on physical drugs, while cutting staff numbers and squeezing appointment times. A lot of doctors would probably acknowledge that this is counter-productive, but they’re working in a system that doesn’t give them much choice.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What was the most astonishing finding for you – and why?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">There were many findings that surprised me. Placebo responses trigger biological changes. Reducing stress slows the progression of HIV. Loneliness shows up in the activity of our genes. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But perhaps the one that astonished me most was that we can train our immune systems to respond to taste and smell. This works through a process called conditioning, in which we learn to associate a psychological cue with a particular physiological response. The most famous example is Pavlov’s dogs: the Russian physiologist Ivan Pavlov repeatedly fed his dogs at the same time as sounding a buzzer, until they salivated just in response to the sound.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Similar processes work in humans too, with many aspects of physiology including the immune system. If you take a few doses of a drug that suppresses the immune system, for example, subsequently taking a look-a-like placebo will trigger the same response. Researchers hope conditioning can reduce drug doses (and therefore side effects and costs) in situations such as organ transplants, arthritis and cancer.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I started to research CURE, I was intrigued by the ability of the mind to influence subjective symptoms such as pain and fatigue. But to discover that our perception of the environment can have immediate and dramatic effects on something as fundamental to our survival as the immune system – that blew me away.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What fascinated me was your writing about sometimes placebos actually perform as well or better than the traditional med they are replacing. How the, could an individual wean themselves off meds by trying a placebos – I know there is a company that makes placebos, but isn’t part of why they work believing that they are other than what they really are?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">In many situations we are better off taking conventional medicine. Drugs generally work better than placebos because when we take them, we benefit from both the direct effect of the medication and any associated placebo response. There are lots of things we can do to maximize the placebo responses we experience with the drugs we take, from actively engaging with our treatment to finding a doctor we respect and trust.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">However in situations where drugs aren’t very effective (and/or come with risks such as side effects and addiction) and where placebo responses are strong, then some patients might do better on placebo. Examples might include chronic pain, irritable bowel syndrome, depression, and the side effects of chemotherapy.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Scientists have generally assumed that for a placebo to work, we must be fooled into thinking it is a real treatment. But there is now evidence, in conditions including migraine, ADHD, depression and IBS, that placebos can still work even when we know we’re taking them (although perhaps not as well). </div><div class="MsoNormal"><br /></div><div class="MsoNormal">This may be because believing that a placebo will help us works even if we know it contains no active drug. Or there’s evidence that if receiving medical treatment makes us feel safe and cared for, this can ease symptoms such as pain regardless of what pill we take. A third mechanism is physiological conditioning (as described above), which works regardless of our conscious beliefs. Researchers suggest that for chronic conditions from pain to asthma to ADHD, alternating an active drug with a placebo should give the same therapeutic benefit with a lower dose of drug.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Alternative medicines offer another way to take advantage of placebo effects without active medication. For example, a German trial published in 2007 followed 1162 patients with chronic back pain. Some of them received real acupuncture, and some received placebo acupuncture (where the needles are placed at incorrect points, and don’t fully penetrate the skin). There was no difference between the two: a result that would traditionally be cited as evidence that acupuncture is worthless. But in this trial there was a third group. These patients received conventional care – a combination of drugs, physiotherapy and exercise – and they did barely half as well as those in the acupuncture groups. Acupuncture, whether real or fake, was a much more effective treatment than conventional care.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Ultimately, instead of relying on dummy pills and treatments we should be developing evidence-based interventions that harness the mind. In CURE, I describe some effective examples, from hypnotherapy for irritable bowel syndrome (IBS) to virtual reality therapy for burns victims in severe pain. But so far, few patients have access to these approaches. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">Aren’t all disorders and diseases stress-related – or at least exacerbated by stress?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s hard to think of a condition that isn’t directly or indirectly exacerbated by stress. Stress has wide-ranging direct effects on physiology, including the heart, gut and immune system. This can have dramatic immediate effects, such as diarrhea, panic attack or even heart failure. It increases the risk of adverse events during surgery. And over time, it puts pressure on the cardiovascular system, which can lead to heart disease, and triggers chronic inflammation, which disrupts wound healing, increases our susceptibility to infection and autoimmune disease, and contributes to chronic diseases from diabetes to dementia.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Stress can also exacerbate medical conditions in less direct ways, for example by increasing our sensitivity to symptoms such as pain, nausea and fatigue. And of course it feeds into our behavior, making us more likely to indulge in unhealthy habits (such as smoking and eating fatty food) and less likely to stick to our medication, all of which in turn influence our physical condition.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">You write that the drug companies are averse (obviously) to psychological cures over medicinal ones, but what can the average person do to put pressure on them or to encourage their doctors to be more open minded?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Buy them a copy of my book!</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What’s obsessing you now and why?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I’m very interested in the effect of the body on the mind. Just as psychological cues can alter physical health, physical factors – such as diet, exercise, immune responses and sleep – influence our mental state. A simple example is when you’re ill with flu. You experience physical symptoms such as fever, sore throat and aching joints. But you also feel exhausted and miserable. These psychological symptoms are triggered directly by your immune response to the virus, probably as a protective mechanism to ensure that you rest and stay isolated. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The subtitle of CURE refers to the science of<span style="mso-spacerun: yes;"> </span>“mind over body”, because this is the idea that I set out to investigate. But I soon realized that this concept isn’t really accurate. Rather than the mind ruling the body, each one inevitably reflects and influences the state of the other. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What question didn’t I ask that I should have?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">One of the questions that most intrigued me when I started researching this book is why placebos work. Why should simply believing we’ve been treated trigger the appropriate physical response?</div><div class="MsoNormal"><br /></div><div class="MsoNormal">There is not just one placebo effect but many, and they work through different mechanisms. But in general, it turns out that these responses reflect a much deeper evolutionary principle.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Sensations such as pain, fatigue and nausea evolved as warning signs: they tell us something is wrong and encourage us to change our behavior – to move away from a threat, to rest, or to seek help. Pain makes us remove our hand from a burning stove; nausea stops us from eating food that might make us sick.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These symptoms help to keep us safe, but they have a cost. If we’re feeling ill, we’re less able to escape from predators, for example, or to seek food. Researchers are discovering that the brain constantly engages in a kind of cost-benefit analysis, calculating what level of threat a situation poses, and therefore how severe the warning signals need to be. To do this, the brain takes into account physical signals from both our body – such as injury or the presence of pathogens – and our environment. We feel more fatigued than normal if the temperature is high, or if oxygen levels are low.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">But a key insight – and I think this is one of the central messages of my book – is that our <i style="mso-bidi-font-style: normal;">psychological perception</i> of a situation influences these decisions too. If we break an ankle, the pain tells us to stop and seek help. If we feel alone or in danger, that pain is amplified. On the other hand, once we know we’re safe and being cared for, there’s less need for the warning signal and our pain eases. (Or in a life-and-death situation such as being chased by a predator, it might be suppressed altogether – now it is more important to flee than to rest.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">How ill or well we feel therefore depends not just on our physical body but on our mental state. How threatened or safe do we feel? Believing we have no hope for recovery, hearing on the radio that there has been a poison gas leak nearby, feeling alone or stressed: all of these can amplify or even create symptoms. On the other hand, taking what we believe to be an effective medical treatment or receiving supportive, empathic care tells the brain that the crisis is over. The warning signals are switched off, and we feel better.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">For me, this means that although we should always listen to our symptoms, we don’t have to be ruled by them. And placebos, instead of being a mysterious, almost magical-sounding phenomenon, suddenly make perfect scientific sense. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>
Can the mind help heal the body? Award-winning science writer and journalist Jo Marchant talks about Cure: A Journey into the Science of Mind Over Body, how placebos can actually create biological change, training our immune system to respond to scents and
<!-- /* Font Definitions */ @font-face {font-family:"ＭＳ 明朝"; mso-font-charset:78; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1791491579 18 0 131231 0;} @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-alt:Cambria; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:-536870145 1073743103 0 0 415 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"ＭＳ 明朝"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page WordSection1 {size:595.0pt 842.0pt; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:35.4pt; mso-footer-margin:35.4pt; mso-paper-source:0;} div.WordSection1 {page:WordSection1;} </style><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-SiQsOy2Dvd0..." /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Mx4TK2cUNL0..." /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I'm fascinated with the mind-body connection, and award winning science writer and journalist Jo Marchant has written a revolutionary and fascinating book about her research on the subject. From the placebo effect (yes, it's real) to how our psychological state influences our illnesses, CURE could change the way you think about modern medicine. I'm honored to host Jo Marchant here. Thank you, Jo</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="mso-bidi-font-weight: normal;">Why haven’t more doctors embraced the neuroscience of mind-body therapies? Is it a fear that people will fall prey to charlatans and not get the medical care that they need? Or is the simply the way alternative healers present their cures?</span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think there are several intertwined reasons for this. Much of the skepticism does seem to come from a fear that if we acknowledge a role for the mind in health, this will encourage people to believe in the vastly overblown claims of some alternative therapists. The mind cannot shrink a tumor, banish a life-threatening infection, or mend a broken spine. To pretend otherwise raises false hope and put patients at risk if they don’t get the conventional treatment they need. (I agree that we need to be clear about the limitations of the mind in health, but underestimating it is dangerous too. When scientists and doctors ignore or deny evidence that alternative therapies do help some people, this damages trust in science among the millions of people who feel they benefit from these therapies, and pushes them towards pseudoscientific explanations.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Another reason for the reluctance to accept research in this field is that science in general is based on a reductionist, materialist worldview that goes all the way back to Descartes, in which subjective elements – thoughts, feelings, experiences etc – as seen as less “real”, and less worthy of scientific exploration, than measurable physical matter. For many fields of research this is a useful distinction, it helps us to get rid of observer bias in experiments, for example. But in medicine the way we <i style="mso-bidi-font-style: normal;">feel</i> is of crucial importance, and I think we have to find a way to take this more seriously. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Then there’s the fact that our medical system is based on evidence from clinical trials. We compare treatments against placebos (fake medicines) to make sure they work. That’s important, and works well for physical interventions such as drugs. But it means we underestimate the value of other components of care. This is partly because most trials are funded by drug companies. A more fundamental problem is that placebo-controlled studies are specifically designed to discount any effect of the mind – pathways such as expectation, stress reduction and social support – because these elements are all present in the placebo group too. Any approach that harnesses these mechanisms will automatically fail the trial, no matter how much it benefits patients.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">We’re left with medical systems that spend more and more on physical drugs, while cutting staff numbers and squeezing appointment times. A lot of doctors would probably acknowledge that this is counter-productive, but they’re working in a system that doesn’t give them much choice.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What was the most astonishing finding for you – and why?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">There were many findings that surprised me. Placebo responses trigger biological changes. Reducing stress slows the progression of HIV. Loneliness shows up in the activity of our genes. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But perhaps the one that astonished me most was that we can train our immune systems to respond to taste and smell. This works through a process called conditioning, in which we learn to associate a psychological cue with a particular physiological response. The most famous example is Pavlov’s dogs: the Russian physiologist Ivan Pavlov repeatedly fed his dogs at the same time as sounding a buzzer, until they salivated just in response to the sound.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Similar processes work in humans too, with many aspects of physiology including the immune system. If you take a few doses of a drug that suppresses the immune system, for example, subsequently taking a look-a-like placebo will trigger the same response. Researchers hope conditioning can reduce drug doses (and therefore side effects and costs) in situations such as organ transplants, arthritis and cancer.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I started to research CURE, I was intrigued by the ability of the mind to influence subjective symptoms such as pain and fatigue. But to discover that our perception of the environment can have immediate and dramatic effects on something as fundamental to our survival as the immune system – that blew me away.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What fascinated me was your writing about sometimes placebos actually perform as well or better than the traditional med they are replacing. How the, could an individual wean themselves off meds by trying a placebos – I know there is a company that makes placebos, but isn’t part of why they work believing that they are other than what they really are?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">In many situations we are better off taking conventional medicine. Drugs generally work better than placebos because when we take them, we benefit from both the direct effect of the medication and any associated placebo response. There are lots of things we can do to maximize the placebo responses we experience with the drugs we take, from actively engaging with our treatment to finding a doctor we respect and trust.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">However in situations where drugs aren’t very effective (and/or come with risks such as side effects and addiction) and where placebo responses are strong, then some patients might do better on placebo. Examples might include chronic pain, irritable bowel syndrome, depression, and the side effects of chemotherapy.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Scientists have generally assumed that for a placebo to work, we must be fooled into thinking it is a real treatment. But there is now evidence, in conditions including migraine, ADHD, depression and IBS, that placebos can still work even when we know we’re taking them (although perhaps not as well). </div><div class="MsoNormal"><br /></div><div class="MsoNormal">This may be because believing that a placebo will help us works even if we know it contains no active drug. Or there’s evidence that if receiving medical treatment makes us feel safe and cared for, this can ease symptoms such as pain regardless of what pill we take. A third mechanism is physiological conditioning (as described above), which works regardless of our conscious beliefs. Researchers suggest that for chronic conditions from pain to asthma to ADHD, alternating an active drug with a placebo should give the same therapeutic benefit with a lower dose of drug.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Alternative medicines offer another way to take advantage of placebo effects without active medication. For example, a German trial published in 2007 followed 1162 patients with chronic back pain. Some of them received real acupuncture, and some received placebo acupuncture (where the needles are placed at incorrect points, and don’t fully penetrate the skin). There was no difference between the two: a result that would traditionally be cited as evidence that acupuncture is worthless. But in this trial there was a third group. These patients received conventional care – a combination of drugs, physiotherapy and exercise – and they did barely half as well as those in the acupuncture groups. Acupuncture, whether real or fake, was a much more effective treatment than conventional care.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Ultimately, instead of relying on dummy pills and treatments we should be developing evidence-based interventions that harness the mind. In CURE, I describe some effective examples, from hypnotherapy for irritable bowel syndrome (IBS) to virtual reality therapy for burns victims in severe pain. But so far, few patients have access to these approaches. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">Aren’t all disorders and diseases stress-related – or at least exacerbated by stress?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s hard to think of a condition that isn’t directly or indirectly exacerbated by stress. Stress has wide-ranging direct effects on physiology, including the heart, gut and immune system. This can have dramatic immediate effects, such as diarrhea, panic attack or even heart failure. It increases the risk of adverse events during surgery. And over time, it puts pressure on the cardiovascular system, which can lead to heart disease, and triggers chronic inflammation, which disrupts wound healing, increases our susceptibility to infection and autoimmune disease, and contributes to chronic diseases from diabetes to dementia.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Stress can also exacerbate medical conditions in less direct ways, for example by increasing our sensitivity to symptoms such as pain, nausea and fatigue. And of course it feeds into our behavior, making us more likely to indulge in unhealthy habits (such as smoking and eating fatty food) and less likely to stick to our medication, all of which in turn influence our physical condition.</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">You write that the drug companies are averse (obviously) to psychological cures over medicinal ones, but what can the average person do to put pressure on them or to encourage their doctors to be more open minded?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Buy them a copy of my book!</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;">What’s obsessing you now and why?</b></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I’m very interested in the effect of the body on the mind. Just as psychological cues can alter physical health, physical factors – such as diet, exercise, immune responses and sleep – influence our mental state. A simple example is when you’re ill with flu. You experience physical symptoms such as fever, sore throat and aching joints. But you also feel exhausted and miserable. These psychological symptoms are triggered directly by your immune response to the virus, probably as a protective mechanism to ensure that you rest and stay isolated. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The subtitle of CURE refers to the science of<span style="mso-spacerun: yes;"> </span>“mind over body”, because this is the idea that I set out to investigate. But I soon realized that this concept isn’t really accurate. Rather than the mind ruling the body, each one inevitably reflects and influences the state of the other. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"> <b style="mso-bidi-font-weight: normal;">What question didn’t I ask that I should have?</b> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">One of the questions that most intrigued me when I started researching this book is why placebos work. Why should simply believing we’ve been treated trigger the appropriate physical response?</div><div class="MsoNormal"><br /></div><div class="MsoNormal">There is not just one placebo effect but many, and they work through different mechanisms. But in general, it turns out that these responses reflect a much deeper evolutionary principle.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">Sensations such as pain, fatigue and nausea evolved as warning signs: they tell us something is wrong and encourage us to change our behavior – to move away from a threat, to rest, or to seek help. Pain makes us remove our hand from a burning stove; nausea stops us from eating food that might make us sick.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">These symptoms help to keep us safe, but they have a cost. If we’re feeling ill, we’re less able to escape from predators, for example, or to seek food. Researchers are discovering that the brain constantly engages in a kind of cost-benefit analysis, calculating what level of threat a situation poses, and therefore how severe the warning signals need to be. To do this, the brain takes into account physical signals from both our body – such as injury or the presence of pathogens – and our environment. We feel more fatigued than normal if the temperature is high, or if oxygen levels are low.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">But a key insight – and I think this is one of the central messages of my book – is that our <i style="mso-bidi-font-style: normal;">psychological perception</i> of a situation influences these decisions too. If we break an ankle, the pain tells us to stop and seek help. If we feel alone or in danger, that pain is amplified. On the other hand, once we know we’re safe and being cared for, there’s less need for the warning signal and our pain eases. (Or in a life-and-death situation such as being chased by a predator, it might be suppressed altogether – now it is more important to flee than to rest.)</div><div class="MsoNormal"><br /></div><div class="MsoNormal">How ill or well we feel therefore depends not just on our physical body but on our mental state. How threatened or safe do we feel? Believing we have no hope for recovery, hearing on the radio that there has been a poison gas leak nearby, feeling alone or stressed: all of these can amplify or even create symptoms. On the other hand, taking what we believe to be an effective medical treatment or receiving supportive, empathic care tells the brain that the crisis is over. The warning signals are switched off, and we feel better.</div><div class="MsoNormal"><br /></div><div class="MsoNormal">For me, this means that although we should always listen to our symptoms, we don’t have to be ruled by them. And placebos, instead of being a mysterious, almost magical-sounding phenomenon, suddenly make perfect scientific sense. </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>
Sari Wilson talks about her astonishing debut Girl Through Glass, how yoga is sometimes the go-to for recovering ballerinas, the addictive TV series Flesh and Bone, writing, and so much more
I love the ballet. When I was in my twenties, I took it up to heal a bruised heart, and became obsessed. Of course I was terrible. But debut novelist Sari Wilson wasn't. She was a scholarship student at Eliot Feld's New Ballet School and went on to perform modern dance with Stephan Kloplowitz. A Wallace Stegner Fellow at Stanford, a Fine Arts Work Center Fellow in Provincetown, Massachusetts, she's also received a residency from The Corporation of Yaddo. Girl Through Glass, which NPR called "obsession and passion en pointe" is an extraordinary read, and I'm honored to host Sari here. Thank you, Sari!
I always think writers are haunted by some idea and they write their novels to come to terms with it. So what sparked the writing of your novel?
First off, I just want to say thanks for having me on your blog as a debut novelist. I’m honored! I think you are totally right in the case of Girl Through Glass. I was haunted by this book, this material, by my own past. Ballet was my great young love. After I stopped training that whole part of my life became locked in a very private place. It was shocking, being cut off from this whole world that had sort of raised me. I tried to put it behind me and move and devote myself to other things. One day, I sat down and wrote what is now the entire first part of the novel—and then I cried. So I knew I had something. But it took me many more years to figure out what.
You trained as a dancer, which gives your novel a fascinating authenticity. Are there any skills from dance that translate to putting words on the page? And do you still dance or take classes?
I started writing during college, after I had a second surgery that just made it clear that I could never be a professional dancer. And writing following dance, yes, they were very connected. I think I tried to give expression in words to the same impulses I had had as a dancer. Also, a dancer’s familiarity with—even dependence on—repetition and routine is really good for the self-discipline of the writer’s life. On the other hand, I’ve definitely had to unlearn some of the perfectionism and rigidity that came with ballet training.
I actually haven’t danced in some years now, but I am always doing some kind of movement and/or movement therapy—right now, it’s yoga, Pilate's, and Alexander technique. I’ve talked to a lot of “recovering” dancers who have found a lot of peace in yoga, which can be, sometimes dance-like, especially if it is a deep flow class.
I deeply admire the structure of the novel, the ease in which you move from the past to the present, and how those worlds collide. Was this the original shape of the novel or did it change as you began writing? (I ask this because my novels always shape shift!)
Thank you, Caroline! That means so much to me—because I really, really worked on the structure. It was definitely hard-won, the result of many drafts. First I wrote the Mira storyline, which took a number of years. Then Kate’s voice started coming to me—really just speaking to me. So I spent another number of years writing her story. I realized how the two—Mira’s and Kate’s—stories were connected as I went along. It felt like I was reading the book in a way as I worked along. This was the most exciting part of the process—with these two voices it suddenly felt like a book. That is, a work with its own internal logic and language—and it was teaching me how to write it.
Girl Through Glass is an incredible debut because it's so assured. So what kind of writer are you? Do you have rituals? Do you plan things out?
I always have to start with a free-writing stage because for me the challenge and deep pleasure of fiction is to go into worlds that seem to exist only in some deep part of the mind. To get there, I have to let go of a logical planning mind. I feel like an explorer. When I come back from the exploration I have to figure out what everything means and how it all connects. Girl Through Glass may be my first novel but I wrote and rewrote it so many times over the years that I think I wrote several novels along the way. It was such an education and journey for me because it required different sets of skills at various stages—in the beginning, I had to really just let myself go and just get back to the place of my childhood. But at a certain point I realized I had to start engaging the planning part of my brain. So I had to very consciously study structure and make charts.
What's obsessing you now and why?
The Flesh and Bone miniseries on STARZ and Elena Ferrante’s My Brilliant Friend (I’m on book two). Both of these stories take on the emergence of a girl in to womanhood. Both depict these sub-cultures with their own logic to evoke this journey. In Flesh and Bone, it’s the crucible of the ballet world. Elena Ferrante uses a closed neighborhood of Naples in the 1950s. But I see some of the same compelling themes—a universal portrayal of the experience of girls emerging into womanhood, complex and compelling and unapologetic and human. And that’s fascinating.
What question didn't I ask that I should have?
Maybe about the character of Maurice? People seem fascinated by him. And I was too! He is totally fictional—I think this is a really important thing to know. But I tried to encompass some real pressures that young dancers face in that characters—that is, the importance of being seen—since all that you have, really, is your body as your vehicle for expression. And also the passion and obsession, especially historically, that some ballet fans—known as balletomanes—feel about ballet and, especially, ballerinas.
Melanie Benjamin talks about The Swans of Fifth Avenue, Truman Capote, Babe Paley, being a grumpy gussies (not true!), the lies people tell themselves--and the truths, and so much more
Want to know what kind of person Melanie Benjamin is? Well, then, imagine this: I'm on tour in Chicago during a blizzard. Melanie Benjamin is so kind, she braves the snow and comes out to hear me AND she insists on driving me back to the scary Bed and Breakfast (there are NO other guests but me). AND she waits outside to make sure I get in, and when I can't, she gets out of the car and trudges through the snowy walk to help me, waiting until the grumpy bed and breakfast comes out to even-more-grumpily let me in.
But Melanie is more than just a wide open heart. She's a fabulous writer who gets inside the hearts and minds of some of history's most complex and interesting people. A New York Times Bestseller, she's the author of The Aviator's Wife, The Autobiography of Mrs. Tom. Thumb, Alice I have Been, and now the extraordinary Swans of Fifth Avenue (great title, right?) The only thing better than hosting you on this blog, Melanie, would be kicking back a glass of wine with you.
I’m totally fascinated by the subjects of your novels, from Alice of Alice in Wonderland, to Mrs. Tom Thumb. And I love the whole idea of centering on the “swans” the glamorous society ladies of New York City’s Manhattan. So I want to know, what do you look for when considering who or what to write about? What particularly haunts you about your subjects, and do you see a running theme between each of them?
I think I'm drawn to people whose public stories are fairly well known, but whose private lives seem to indicate that there was a lot more going on that we didn't know about or learn about. The liars of history, in other words. So far, I think the only running theme I see (but then again, authors are the very last people in the world to understand what they've written; readers get that so much sooner than we do!) is the theme of an unconventional love story. Alice Liddell and Charles Dodgson (aka Lewis Carroll); Lavinia Warren Stratton and P.T. Barnum; Anne Morrow and Charles Lindbergh. And now, Truman Capote and Babe Paley. Not all of these are affairs of the flesh but they are all affairs of the heart, in one way or another.
This novel seems as though it was a blast to research. What was the most fun? What was the least? And what surprised you?
Yes! It was the most fun I've had writing a book; I felt as if I were invited to the most fabulous party in Manhattan, with Truman Capote as host, and I was able to eavesdrop on every conversation. The parties, the entire era (an era in which everyone dressed to the nines, even just for lunch), the clothes, particularly - they were just so much fun to explore, and then write about.
The least fun part was uncovering the tragedies, the sordidness, the heartbreak, that these beautiful people tried so hard to conceal behind the designer clothes. The tragedy of growing old when your entire self-worth, your currency, has been based on your appearance - that was interesting, yet ultimately sad, to explore.
What surprised me? Discovering Truman Capote's heart. Because that's a difficult thing to uncover, really, and to discover it, and in discovering it, find Babe Paley, and learn about her - that was totally surprising. Yet ultimately, the reason why I wrote this book. I had the end of the story right off - a literary scandal, because of the publication of a short story, the betrayal of secrets. But how did it begin? It was the anatomy of this relationship between Babe and Truman that I wanted to explore.
I love a statement you made in your endnotes about how so many of the characters were incurable liars, who made fiction out of their own facts. Do you think anyone ever really knows the truth about their own lives, let alone another person’s?
No! We lie to ourselves all the time! We decide what story to tell to everyone else, and we stick to it. We leave things out, every minute of every day. You're on Facebook - do you share everything about yourself? Everything you do? I don't; I'm constantly editing my own life.
And absolutely, I do not believe we ever know the truth about our own lives, and it sometimes takes the storyteller in our midst to find that truth, to expose it - but we don't like that. We don't want someone else to tell our story, even if we decide, ourselves, not to tell it. Truman was the ultimate storyteller; the ultimate desperate storyteller in that, after IN COLD BLOOD, he ran out of stories to tell, had told all his own (most of his work, to that point but excluding IN COLD BLOOD, was extremely autobiographical, I firmly believe) - and so he had to borrow other people's. And that's crossing a line; a line most people, even most storytellers, wouldn't cross. But Truman had no scruples in that area.
But not all of us are storytellers, of course. Most of us keep our secrets, hold them dear, and respect the secrets of others. But the Truman Capotes of the world, well, they're not so respectful.
Central to this glorious book is the relationship between Babe Paley and Truman Capote, but there are so many other famous cameos from Lauren Bacall, C. Z. Guest, Andy Warhol and more. Your novel is so vivid, so alive on the page, that I really felt transported. While you were writing The Swans of Fifth Avenue, did you feel disorientated at all? Did you find yourself yearning for this period of time more so than any of your other wonderful historical fiction?
"Disorientated" is a wonderful word! But no, it doesn't describe how I wrote this book. I am able, through some mysterious alchemy, to enter completely into a different time, a different world, a different voice, and then when I'm done with that day's work, tuck it aside and be myself, for the most part. I'm sure a little bit of what I'm writing, the era in which I'm spending most of my day, seeps in, but not much. Although I admit I did go through a period when I coveted designer clothing and shoes and handbags! I did envy, and want to emulate, the exquisite taste and fashion sense that Babe possessed, for quite a long time. I feel that desire coming out again, as I'm gearing up for my book tour. I'd love to wear Chanel or Givenchy to every one of my signings! But alas, I cannot. I content myself with the pen I bought from Tiffany's, for signing books; that's the closest I can come to Babe.
I do love this time period. I admit, I'm a grumpy gussie who wishes everyone did dress up, like in these days, the 1950s and early 1960s. I think we've lost something with our casual appearance - people walk about in yoga pants now, all the time! I appreciate the care and consideration that goes into dressing for the public, into respecting them. I recently had a conversation with some other female authors about what to wear to a book signing; I was adamant that I dress for my readers; I respect that they give of their time to see me, and so I'm going to dress in a way that honors that. I'm not going to show up in jeans and a peasant blouse. I believe in this, and maybe it's a crutch, but still, I will dress my very best when I'm out in public. I simply enjoy it, and believe in at least attempting good taste. So this time period did fit nicely in with my (probably futile) quest to change the way we dress, and try to counteract the studied casualness of this era.
(And I'm also the kind of crabby person who can't stand when someone shows up on a flight wearing pajamas! Ugh. This just happened last week. I wanted to shake my old lady cane at the girl!)
I always love and admire your writing, but this particular novel seems to soar in a very different way than your others. Do you find your writing changes with the time period you are writing about?
My writing changes, yes. I'm not sure it's about the time period, though. I feel it's more about the subject(s). I always look first for story, not time period. I try to push myself with each novel. I'm terrified of ever taking a step backward. I've decided not to publish books for that very reason; I went through this just recently.
What’s obsessing you now and why?
Hmmm. California, a long time ago, in a galaxy far, far away. That's all I can say, for now. (I also want to write a real Western, but that seems to be far in the future. It's tough to get people in publishing on board with a Western these days. But I'm stubborn; I'll keep at them!)
What question didn’t I ask that I should have?
Everyone always asks me how old I am! I don't know why. But I'm not telling. (53.) Everyone also wants to know where I write, as if I have some fantastic Aladdin's Cave of an office. Nope. It's just a small room with pumpkin-colored walls, and no view at all besides the red brick of the townhouse next door. And I sit on a futon with my laptop, and I write. Every day. It's not very inspiring, really.
January 23, 2016
The great Christopher Castellani talks about The Art of Perspective, the negotiation between editor and writer, and so much more
Christopher Castellani is the son of Italian immigrants and the artistic director of Grub Street, one of the country's leading non-profit creative writing centers. He is the author of three critically-acclaimed novels, A Kiss from Maddalena (Algonquin Books, 2003)—winner of the Massachusetts Book Award in 2004— The Saint of Lost Things (Algonquin Books, 2005), a BookSense (IndieBound) Notable Book; and All This Talk of Love (Algonquin, 2013), a New York Times Editors' Choice and finalist for the Ferro-Grumley Literary Award. Christopher is on the faculty and academic board of the Warren Wilson MFA program and the Bread Loaf Writers Conference. In April 2014, Christopher was awarded a Guggenheim fellowship for fiction. And most importantly of all, Christ is one of the coolest, kindest people around. Thank you so, so much for coming on the blog!
I love the whole Art Of series, which takes one brilliant writer who explains one thorny topic in writing, be it syntax, time, description, or in your case, perspective. What made you choose perspective?
Perspective chose me, actually, in the form of Charles Baxter, the series editor and the only brilliant writer directly involved with this book. We teach together at the Bread Loaf Writers’ Conference and the Warren Wilson MFA Program, where he sat through umpteen lectures and talks I gave on the subject of narration. The first two and a half chapters of The Art of Perspectiveare expanded versions of those talks. I chose narration and point of view as the topic of my lectures because, in workshops, our discussions of revision frequently hinged on the role of the narrator, and I was surprised by how many students hadn’t paid enough attention to the implications of that all-important decision of who told the story. The key to unlocking each story’s revision would invariably lie with that narrator, and yet students seemed almost afraid to turn the lock, daunted by what awaited them once they did.
You write that the author must be his character, and yet he or she never can fully be--so the author is occupying two states of existence at all times. I don’t think I’ve heard a better definition of what it is to be a writer. You write “we can’t help but reveal ourselves to ourselves,” which makes me wonder--when you are writing a novel, do you realize the deeper meaning of what you are writing about before you have finished? And then, if it comes as a surprise, does it still sort of feel inevitable?
I frequently think I know the deeper meaning of what I’m writing before I’m finished, but invariably I’m dead wrong. I think writers need the illusion that we’re control of the material in order to commit scenes and descriptions and dialogue to the page, but, for me, that process involves a constant bursting of those illusions. As for “we can’t help but reveal ourselves to ourselves,” I meant that quite personally: it’s a reference to the fact that I wrote three novels with mother-son relationships at their core with no deliberate intention of doing so. I’m embarrassed to say that only after the books were published did I see how strongly each of them relied on those mother-son relationships. Granted, I already knew I had mother issues, but they were never so clear as when I got some distance from the novels. While I was in the muck of drafting those novels, I was under the persistent illusion that they were “About” something else, but really they were revealing me to myself through their narrators. That’s the inevitable part, if you’re doing it right: you’re surprised by how much you didn’t know you knew.
Another important thing you brought up is the “negotiation” between author and editor. I know many people (not writers!) who think that the writer writes the book, and there you go, and any editing is changing an errant comma or two. But this negotiation is part of the magic, and it often merges two points of views--the author’s and the editor’s--and the book is always better for it. Do you think there is ever a “too many cooks spoil the broth” moment?
What you describe is the ideal, of course: a meeting of minds in service of the author’s original vision. The best editors – and I’ve been lucky, all of my editors have been this way -- can see a grown-up version of the book the author intends to write and can skillfully guide the author toward that version without compromising the project’s integrity. That relationship between a good editor and a writer can be magic in that way; the editor can certainly see things the writer can’t. It certainly gets dangerous when more voices come in, especially when those voices are beholden to, say, the marketing department or the bottom line.
As you know, my favorite novel of 2015 was Hanya Yanagihara’s A Little Life. In the case of that book, the author held fiercely to her vision and her narrative strategy despite her highly experienced and accomplished editor’s insistence that she cut it significantly and tone down the violence and suffering. She had already written the book in constant consultation with her friend, who read every page and offered his trusted take on those controversial decisions, and so by the time it got to her official editor, it was fully formed the way she wanted it. I mention this because, in an interview, the author said that she would have taken more of her editor’s advice if she’d trusted that it was not given “out of fear:” fear that the book was too long and therefore too big a financial risk to print, too violent to appeal to delicate audiences, too sad for a mainstream hit. I think it’s tough for many authors, especially new authors, to be confident that their editors aren’t editing out of fear, since so much of an editor’s success depends more on the book’s commercial success than its critical reception.
I also loved that you talked about intimacy in reading a novel. That’s why you don’t want a lot of pesky adjectives and adverbs, because it makes you see the writer rather than being lost in the world of the novel. But you also write about getting rid of words like “she saw” or “she realized” because it offers up a barrier, and I think you’re right. What other barriers to intimacy do writers make the mistake of using?
I want to be clear that filtered consciousness in narration – “she saw, she realized” – is not wrong. I tried to point out examples where it is necessary, where it creates a productive distance and functions as a useful directional signal. I think the issue about narrative distance is that many writers don’t modulate it effectively; they actually don’t realize when they are zooming in and when they’re zooming out and how that affects the reader’s experience. The author wants the reader to feel what a character is feeling on some deep emotional level in a moment of crisis, but the mode of narration he is employing contains too many distancing elements: filtered consciousness is just one of them. Another is “showing off” instead of not fully imagining the true state of mind of that character in that particular moment. I can’t tell you how many drafts I’ve read – and written – in which a character in the throes of some emotional crisis stops to describe the detail of the carpet or to deliver some “interesting” historical fact about the field across which she’s fleeing…This is Fiction 101, of course, but I’m surprised and frustrated by how often I need a remedial course…
I want to say that reading this little book was a pleasure--you’re funny, full of stories and your insights are profound. So what was it like writing this? Did you worry you’d miss something? And do you think, that after writing this, your own writing is going to change?Thank you for those very kind words. I certainly wanted the book to be accessible, and for the narrator to have a story of his own; that was part of my narrative strategy. I wanted to emulate, as best I could, the companionable narrator of Howards End, that fellow who guides you along and whispers in your ear from time to time. In early drafts, there was much more of that whispering; I pared it down because it was getting self-indulgent.
Because Charles Baxter and Graywolf designed the books in the Art Of series to be idiosyncratic, not comprehensive, takes on various topics, I felt no pressure at all to be comprehensive. It would be impossible, really, to be comprehensive with the endlessly complex topic of point of view and narration. A whole series could – and maybe should – be done on this topic alone. And though the series is also supposed to be more meditative than prescriptive, I think the fiction or non-fiction writer who reads The Art of Perspective will find a reason or two to look again, more pragmatically perhaps, at their drafts to determine how they could be improved with a reassessment of their narrative strategies.
This happened to me, in fact. Writing The Art of Perspective helped me immensely to figure out not only who would narrate my current novel-in-(slow)-progress, but why they were the best choices, and how they would fit together. I’ve never been so confident in my choice of narrator or point of view, and I owe that all to writing this book. This is no guarantee that the novel will be any good, of course, but at least I’m writing it with greater confidence, and that’s half the battle.
How did you go about choosing the books you used for examples?
It was a highly subjective process. The books and stories I chose are a small sample of what has obsessed me over the years, the common denominator among them being that the narrator seemed to play a big part in their power and effect. I’m the first to admit that it’s a fairly traditional list, the product of my fairly traditional canonical education, though, within the list, there are some non-traditional approaches to storytelling. Again, I didn’t set out to be comprehensive or even inclusive; these books are but a small subset of one writer’s reading history, the books I thought I understood best through the lens of narration. If I were industrious enough to have my own blog, I’d spend it reviewing a wide range of books and films purely through that lens.
You write that you miss the omniscient authors of the 19th century, that they are more confident in their vision. Can’t a writer have equal confidence in using several third person characters?
Yes, they can have confidence in their vision for the complexity of each character, and in their overall vision for how those characters fit together to tell the overarching story of the novel. But, often, when a novel features more than one narrator, the goal is to show different versions of the same story, or different takes on a single or collective experience, or different phases of a family’s or town’s history. The result is that prismatic effect I discussed in the chapter, “The Story(ies) of a Marriage.” And, I’m sure you’ll agree, what invariably happens is that readers prefer or align themselves with one of the narrators more than the other, or one section over another. What I’m saying I miss is a kind of unifying vision – often a moral vision, which is wonderfully problematic – on the part of the author from which the reader can’t quite escape, and with which she must negotiate in order to enter into the world of the novel.
I loved what you wrote in the “Position of Power” chapter about the comfort of the single story, and the fear of writing a perspective that’s out of our bounds, like Grace Paley’s writing in the voice of a black man. But we should do this, even if doing it leads to terror and thoughts of chucking it all and going to dental school, because that’s our job as a writer, don’t you think, to get uncomfortable, to take risks.
Yes, of course we should write from an “out of bounds” perspective, but only if we feel compelled to do so. It doesn’t make you a better or a braver writer to write from a perspective that’s not yours; you don’t get points for being more imaginative or more daring, especially if all you’re doing is reinforcing familiar perceptions. (Who’s tallying those points, anyway?) If a story is nagging at you to be told, but it’s one you feel like you aren’t permitted to tell, then I think you should absolutely grant yourself the permission to write it, or at least try to write it, from whatever perspective. If not, there is plenty of risky terrain to traverse within the realm of “what you know.” Ask Flannery O’Connor or Alice Munro. My main point in the “Position of Power” chapter was how there is often an anxious investment in the prismatic approach, the cataloguing of voices, when writers from groups outside the so-called mainstream claim perspective for themselves.
You write about how our perspective shifts as we write a novel. We might think we are writing to get over grief over a loved one, but that grief and how you feel about it changes over the years. Don’t you think that if you rewrote any one of your fine novels, it would come out different, because you now, are different?
Absolutely. Every novel is a document of the author’s state of mind – and stage of development and level of maturity – at the time. I don’t see the characters from my first novel the same way I did in 2002; I like to think that if I had to re-write that novel today, it would be richer and wiser. It probably wouldn’t be, but again I’d like to think that. At the very least, I wish I could go back and put more flesh on their bones. That’s maybe why I, and so many other writers, keep re-visiting characters, or writing versions of the same characters, in subsequent books.
What’s obsessing you now and why?
It sounds so dorky, but right now I’m obsessed with our almost fanatical emphasis on scene. Why does everything I write have to be one scene after another, interspersed with descriptions of the weather? Why do I/we reward aspiring and emerging fiction writers who follow this formula, even when they do it beautifully and powerfully? I think it’s a particularly American rut, and so I’ve vowed to myself this year to read and study novels that aren’t stuck in it.
What question didn’t I ask that I should have?
You didn’t ask me if I’d take you out to lunch the next time you’re in Boston to thank you for inviting me on your blog, reading this book, and asking these great questions. But the answer is yes.
Taylor Brown talks about Fallen Land, the Civil War's last days, and so much more
Orphans, Bounty Hunters, Lovers daring an escape, and the last days of the Civil War--that's only part of the incredible story in Taylor Brown's Fallen Land. He is the recipient of a Montana Prize in Fiction, and he’s been a finalist for the Press 53 Open Awards, Machigonne Fiction Contest, Wabash Prize in Fiction, Rick DeMarinis Short Story Contest, and Doris Betts Fiction Prize. He is also he author of In the Season of Blood and Gold, The River of Kings, and Gods of High Mountain, as well as numerous award-winning short stories. I'm thrilled to have him here.
I always believe that there is something haunting the writer that compels him or her to write a specific book. At least it’s that way for me. Is it for you? And if so, what was the question you were hoping the novel might answer for you--and is it different from what you expected?
What a wonderful question. I was absolutely haunted by this book. Fallen Land actually began as a short story, “In the Season of Blood and Gold,” which is the title story of my collection from Press 53. That story has a hanging ending—quite literally! And the unnamed boy, who later became Callum—I simply wanted to know what happened to him. At the end of the short story, it seems likely that he won’t survive—that his final words in the story are the final words in his short, cruel life. And I think, to some extent, I didn’t want his story to end that way. I felt a little like an older brother toward him, this skinny little buck with his overlarge hat and stolen horse, his big little heart and wild audacity.
So that started me writing. What happens to our boy? How does he get out of this fix? And what are the consequences? The cost? And what more will be required of him now?
Later, as the story progressed, the driving question evolved: can Callum and Ava survive this cruel world in which they find themselves? Not just physically, but mentally and emotionally. Will they be broken, or will there be light for them in the end?
To be honest, I’ve realized only recently just how truly personal that question was. The narrative arc of Fallen Land, I see now, parallels the arc of my own life over the years I wrote it. My ex and I moved to Asheville, NC, shortly before I started the book, and those ended up being very rough years for us. We had little money, few friends, and we ended up living in an “ex-whorehouse” (the landlady’s words) rife with ants and mice and mold. I had nightmares about the place before we signed the lease, and I ignored them. All the drug deals in town seemed to go down in front of that house. Meth-eyed strangers prowled the block. I saw seven people arrested in the first two weeks—one person attacked with a length of PVC pipe. And we were going through some deep personal traumas of our own. It seemed a cold world we were in, with little to rely on but each other. We lived on hope and love like they were food. Would this break us? Or would we make it to the coast, the dream we’d set before ourselves?
Now the parallels seem obvious. Funny how the subconscious works!
I absolutely love the story of your novel, the last violent and terrible years of the Civil War. What was the research like? Did anything surprise or disturb you?
The research was substantial. There were books on the Partisan Rangers of the Civil War and histories of Sherman’s March, plus diaries and first-person accounts. There were 19th century cavalry manuals and books on horses and horsemanship and firearms.
Some of the history was disturbing, for sure. The atrocity, the sheer savagery on both sides. But I find that’s usually the case when studying a war, no matter the setting or era. You find so much that’s hard to wrap your mind around, to reconcile with what you want us, as a species, to be. That’s the very nature of it, I guess.
What surprised me was how relevant, even contemporary, some of the history felt. When we think of the Civil War, we tend to think of these big, bilateral battles with gray and blue skirmish lines arrayed on the fields of Gettysburg or Chancellorsville. But here was the shadowy part of the war, with small units of irregulars operating much like modern-day commandos or special forces, engaging in ambush and sabotage, kidnapping and assassination—far from the big battlefields of the newspapers. Here were the fractured loyalties of the mountain communities, and people living under the oppression of outlaw gangs and night-riders and guerrilla bands—common people stuck fatally between one side and the other.
Another thing that surprised me was the extent to which Sherman’s March still impacts popular culture. For instance, many of us just ate black-eyed peas on New Year’s Day for good luck. Well, some theorize that’s because Sherman’s army neglected to burn stores of black-eyed peas, regarding them only as stock feed, and the people of Georgia and South Carolina were able to subsist off of the unburned peas. That’s how they became a good-luck tradition!
There was also the non-academic, physical part of my research: learning horses. At the time, my good buddy Blaine Capone (HoofandClaw.org) was living on a land trust west of Asheville, in a very primitive manner: woodstove for heat, gravity-fed water, no cellular signal, and a road that was not always safe and open. He had two horses up there, and I would go up and help him chop wood or do other chores around the property, and he would teach me about horses. Believe it or not, we are planning to ride the path of Sherman’s March on horseback from Atlanta to Savannah, hopefully in the fall of 2016, raising money for a charity that does equine therapy with veterans.
At its heart, Fallen Land is a composite of opposites, loyalty against betrayal, two lovers against brutal bounty hunters, yet it is all woven together so effortlessly, it makes me breathless. What strikes me is the story of these two young lovers fleeing the brutality of the war, and bounty hunters, even as they are desperate to craft a new way of life. It’s like one your beautiful lines, “a pinhole of light in the great dark.” Can you talk about this please?
Absolutely. I think you hit on a central element of the book. I hate to say “theme,” because I don’t really think about it like that. But I had this vision of a gray, cruel landscape, with these two orphans traveling across it, largely innocent, and the little flashes of light they reflect or spark or draw from the ash. I feel like they’re carrying this hope between them, this dream, and it’s fragile as something newborn, and they’re trying to protect it against the myriad dangers, the sharp corners and teeth at every turn. I think that’s something a lot of us can relate to, even today.
Can we talk about process? How do you write? Do you have rituals, do you map things out, or does the story slowly evolve through your writing?
I’m pretty disciplined with it. I write at the same time of day at the same cafe at the same table, if possible, pretty much every day. I love the ritual of it. The baristas know when to expect me and what I’ll order. It’s like being a regular at a neighborhood bar, only more productive! When I’m going strong, I’ll often write both before and after “work-work,” which is what I call my non-writing work. (I’m the founder and editor-in-chief of a custom motorcycle blog, BikeBound.com, and I do a variety of other content development and marketing work.)
I’m totally one of those people who lets the story evolve. I feel too limited if I map it all out. And I think I’m addicted to those moments when the story takes a turn you never expected and never could have planned, but you know it’s just right. Inevitable, even. I think it was E.L. Doctorow who said that writing is a lot like driving a night: “you can only see as far as your headlights, but you can make the whole trip that way.” That’s exactly how I feel about it.
What’s obsessing you now and why?
Right now, I’m pretty obsessed with the exotic animal trade, rhino and elephant poaching, and canned hunting. I’ve been working on a cycle of stories set on a fictional wildlife sanctuary in South Georgia. A couple of months ago, I visited Carolina Tiger Rescue in Pittsboro, North Carolina, for research, and the stories I heard there just broke my heart.
Before that, I was obsessed with the Altamaha River, a 137-mile river that empties into the Atlantic just north of where I grew up on the Georgia coast. The Nature Conservancy calls it one of the 75 “Last Great Places in the World,” and it’s the setting for my second novel, The River of Kings, which is forthcoming from St. Martin’s. It’s home to all kinds of rare and endangered species, and it even has its own “river monster.”
What question didn’t I ask that I should have?
I’m biased, of course, but one thing I think is interesting is the musical influence in the book. There’s a dedication at the beginning to the musicians who keep alive the old ballads of Ireland and Appalachia. That’s because the story was partially inspired by an old frontier ballad, “When First Unto This Country” (Library of Congress Archives of American Folk Song #65A2), which has been covered by everyone from Joan Baez to Jerry Garcia to one of my personal favorites, Aoife O’Donovan of Crooked Still. The song was first recorded in 1934, but the starting lines appear in Irish ballads nearly 200 years old! We know little of the ballad’s provenance, and nothing of its authorship, but there’s a rending, lonesome sweetness to the song that became a guiding force for me with the novel. Those old ballads migrated from England and Ireland to the mountains of Appalachia, where they were revised and re-versed to fit their new country, and there’s a parallel there with Callum, I think.
I have zero musical talent—in fact, I got in big trouble in elementary school because the music teacher thought I was mocking “Amazing Grace,” so bad was my (mandatory) audition for the school musical. But in some ways, I think of Fallen Land as a kind of ballad itself.
Sally Hepworth talks about love, memory and her astonishing new novel The Things We Keep
I'm always fascinated by anything that has to do with memory, so of course, I was mesmerized by Sally Hepworth’s incredible new novel, The Things We Keep, about memory, family, and so much more. She’s also the author of The Secrets of Midwives and I’m delighted to have her on the blog. Thank you, Sally!
So, rather than ask, “Where do your ideas come from?” (every writer I know hates that!), I want to know what was haunting you at the time that gave root to this novel?
I suppose I was haunted by the question: If you take away someone’s memory, what is left?
Five years ago, I was flicking television channels when I came across a news segment about a young woman—a newlywed—who was pregnant with her first child. She had also recently been diagnosed with Alzheimer’s disease. She was 31 years old.
A couple of years later, I was having coffee with a friend who is a nurse at a dementia facility. She told me about an elderly man and woman who held hands in the communal living area of the center every day. They came into the facility as strangers. Their memories were less than five minutes long. They were both non-verbal. Yet every day, they sat next to each other. Every day he reached for her hand, and every day she allowed him to take it. And for them, every time was the first time.
It got me thinking about why people do the things they do and feel the way they feel. I liked the idea of exploring that further in a novel.
The idea of not having my mind terrifies me--and my mother now has dementia, which terrifies me even more. While you were writing this, did you find yourself monitoring yourself and your thinking? Were there sections of the novel that were particularly difficult to read?
With each novel I write, I spend an enormous amount of time researching, so of course the topic plays on my mind. And yes, as I wrote this book, I became utterly convinced that everyone in my life (myself and my toddler children included) had early-onset dementia. Then again, I am currently writing a book about a woman diagnosed with ovarian cancer and I am convinced I have that! Such is the peril of being a novelist.
As for any sections that were difficult to read—there is a scene where Anna doesn’t recognize her favorite nephew and it always makes me cry. I think it’s because even though she doesn’t recognize him, she tells him she loves him. And that, in essence, is what the entire book is about … that love remains, even when nothing else does.
What kind of research did you do for this book--and what surprised you the most about it about it?
I always begin research with books—lots and lots of books—and this time was no different. I read everything I could find about dementia—fiction and non-fiction. Then I contacted my local Alzheimer’s group. The head of younger-onset dementia met with me on several occasions and read the manuscript and provided feedback. I also met with a nurse who spent her career working with people with dementia. Her stories and experiences fed this story.
What surprised me was the generosity of the people in this world who tirelessly advocate for people with this illness, making life better for them every day.
In the novel, Eve, a cook at the assisted living place where the two main characters live, is at a crossroads. So I want to ask you--what do you think that we should risk to help others? When does it become too much?
That’s a tough one. A person’s desire to help someone will always stem from his or her own values and experiences, and, of course, his or her relationship with the person that needs help. Obviously people are far more likely to help a loved one than a stranger. But, every now and again, someone will step up and risk something for someone else simply because it’s the right thing to do. Those are the kinds of people who deserve page space in my novels.
What’s obsessing you now and why?
I’ve been thinking a lot about the way our lives touch others around us. The barista we see every morning at the coffee shop, or the crazy guy we catch the train with. The fact that they exist outside those few minutes a day when we see them seems unthinkable sometimes. This might be the seed that starts my next novel.
What question didn’t I ask that I should have?
I suppose I’d like to make it clear that this isn’t a book about dementia—it’s a book about human nature. About how we move forward when our past has been built on sand and the tide is coming in. About what is true when everything feels like a lie. About what we are capable of when it seems we are capable of so little. About what we keep.
