From the Book

Chapter 8

Mind-Body and Integrative Strategies

Interpreting Mind-Body Examples

These examples demonstrate the enormous complexity of mind–body work. Since the age of Descartes, who championed the notion of the superiority of the rational mind, our Western culture has equated rational thinking with the mind, yet neuroscience and other clinical work tell us otherwise. We know, for example, from eloquent experiments in patients who have undergone surgery to remove the connection between the left hemisphere and right hemisphere of the brain, that the left hemisphere will fabricate an explanation for behavior generated from the right hemisphere. Normally, the left hemisphere of the brain is responsible for our rational way of interpreting life or for rationalizing why we behave as we do. The right hemisphere is more dedicated to our creative and emotional intelligence. In some patients with severe epilepsy, the connection between the two hemispheres is surgically removed, thus preventing a spread of epilepsy from one side of the brain to another. These patients are known as split-brain patients.

In the eloquent experiments conducted on split-brain patients, a command can be given, through sophisticated visual cues, to either the right or left hemisphere. If the right hemisphere is given a command to follow, such as waving the left hand, the split-brain patient will wave the hand but the left side of the brain does not know why. Then, the left brain can be asked why “he” is waving, and the left brain will fabricate (rationalize) an explanation, completely believing the validity of the false rationalization.

In addition to the split-brain experiments, we know from the writings of William James (an American psychologist who described the unconscious mind before Freud) and from functional brain imaging studies, that the physiologic and physical expressions of emotions such as fear precede conscious awareness of fear. Thus, the startle response—pupil dilation, muscle contraction, piloerection, and hypervigilance—occurs almost instantaneously following a sudden threatening environmental cue, all before the individual becomes aware that he is even afraid. In other words, the body generates an emotional response before the individual is consciously aware of the emotion. The rational mind does not determine the emotion; rather, the rational mind may choose to clarify, modify, or compartmentalize the emotion. The rational mind may even choose to ignore the emotion.

These clinical examples must be considered within a conceptual framework of two key scientific discoveries: (a) emotional circuits in the brain often are dysfunctional in chronic pain patients, and these circuits maintain the perception of pain; and (b) the rational brain will provide an explanation for events that may have nothing to do with reality and that may serve to protect the individual from a reality from which the person is more comfortable ignoring or compartmentalizing. In the second example, it was only after the patient came to truly “walk through” and accept her deepest emotional truth that she was able to begin to transform her chronic pain.

Our true understanding of the implications of the emotional brain is in its infancy, especially as it pertains to chronic pain. Any understanding, with clinical implications, must be rooted in science and must be free of judgment. In this second example, the patient came to understand that she could express herself and explore her perceptions without fear of judgment. Ultimately, her clinical improvement occurred not simply because of her realizations, but because she felt she could safely explore her life— her interpretation of life—in a clinical setting that was free of judgment and full of clinical support and human compassion.

Summary Points

• Mind–body refers to the interplay between thought and emotions with the body.
• Emotional pathways often are interlinked with chronic pain pathways.
• Emotions often are expressed physiologically and physically before there is a conscious awareness of the emotion.
• The left hemisphere of the brain is primarily responsible for rational thought, but may also be responsible for rationalizing an interpretation of reality, even if that interpretation is not grounded in truth.
• We must be cautious in mind–body medicine not to form premature judgments about a possible emotional cause of pain.