Heal Thyself

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I confess, I was prepared to dislike Dr. David Servan-Schreiber’s new book, The Instinct to Heal. Curing Stress, Anxiety, and Depression without Drugs and Without Talk Therapy. Especially after reading the desciption of him on the cover as “co-founder of the Center for Complementary Medicine at the University of Pittsburgh.” And especially after a glance at the table of contents listing chapters such as “The Power of Qi,” “The Energy of Light,” and “Eye Movement Desensitization and Reprocessing (EMDR): The Mind’s Own Healing Mechanism.” My knee-jerk reaction was to dismiss it as yet another paen to alternative medicine at the expense of traditional, proven, medical therapies.

But Dr. Servan-Schreiber is not your typical alternative medicine guru. He has no product to sell, no “newly discovered” technique (with video tie-in) to hype. He’s just a psychiatrist who has seen way too many people placed on Prozac simply because they wept in a doctor’s office. And he wants to do something about it.

Too often, traditional medicine assumes we can counsel away any trauma, medicate away any pain. It’s this sort of thinking that gave rise to one of the most ridiculous sites in the aftermath of September 11 – the flight of mental health professionals to lower Manhattan to provide “emergency counseling” for the victims, as if their training had given them some god-like inner wisdom that would allay the suffering of mere mortal laypeople. But pills, and even talk therapy, can’t obliterate the horror of facing your mortality, the pain of a lover’s rejection, or the loneliness of old age, let alone erase the emotional scars inflicted by man’s general inhumanity to man.

Dr. Servan-Schreiber knows this all too well. He has spent a lot of his time doing psychiatric liaison work. That is, he helps other doctors deal with the repercussions of their illnesses. It’s these sorts of patients who modern psychopharmacology fails the most. And it’s these sorts of patients Dr. Servan-Schreiber has in mind when he talks about the instinct to heal.

Take the example of the lonely old person. Many’s the time Dr. Servan-Schreiber was consulted by other doctors to recommend therapy for them. He knew from experience that no amount of psychotherapy, no potent anti-depressant, was going to cure their loneliness. So, he often made sensible recommendations instead. Recommendations like “get a pet.” The response of his colleagues was not kind. “We asked you to recommend an anti-depressant, not a zoo,” they would tell him, as they ignored his recommendation and made their own choice of anti-depressant. And one could easily imagine them scoffing at most of the ideas in this book.

The central premise of Servan-Schreiber’s approach is that our emotional brain is much more closely related to the parts of our brain that control our bodies than it is to our rational brain. (That’s why we get “sinking feelings” when we’re apprehensive, and “heartaches” when we’re sad.) We have a hard time reasoning ourselves out of our emotions. In fact, too often, we let our emotional brains overrun our rational brains. But, as hard as it may be to reason ourselves out of emotional turmoil, we can gain some control over them by controlling the parts of our bodies that are closely tied to our emotional brains. That’s what we do when we take a few deep, calming, breaths before stepping up to make that big speech, or when we count slowly to ten to avoid an angry confrontation. Those are the simple, instinctive, steps we take. According to Servan-Schreiber, we could do more. Much more, or at least seven more things of varying complexity to help control our depressions, rages, and anxieties.

The first is a method he calls “heart coherence.” By consciously controlling the variability of our heart rates, we can induce a sort of negative feedback loop to fool our emotional brain into becalming itself. It’s the same theory that has been promulgated by the dubious HeartMath Institute, but it’s also the same principle that lies behind yoga and meditation. And although there’s never been a large clinical trial to prove its efficacy, it probably works for some people – at least for those who are able to learn the technique (usually done with the assistance of computer software that monitors and displays the heart rate in real time).

The second is the awkardly labeled, and much more controversial, Eye Movement Desensitization and Reprocessing, or EMDR for short, a technique that’s often promoted for the treatment of post-traumatic stress disorder. The theory is that by invoking the sorts of eye movements we have when dreaming, or watching a movie, while thinking of a particularly traumatic event, we are able to establish new connections in the brain that override the old ones associated with the bad memory. Some studies have found the technique wanting, although there have been some that suggest it might be effective. And the case studies that Servan-Schreiber details in his book certainly seem compelling, especially those involving Kosovar children traumatized by the brutality of war.

Methods three through five are even less compelling. One is the use of light to treat depression, specifically a dawn simulator, which is a light switch that gradually brightens the room lights to mimic the rising of the sun. Instead of a jarring alarm, you wake up slowly and peacefully to the rising light. Another is the use of acupuncture, not just to treat physical pain, but to treat depression. And perhaps his weakest claim is that omega-3 fatty acids, the kind you get from taking fish oil supplements can effectively treat depression, and even in one case, schizophrenia.

The best one can say about any of these methods is that although they haven’t been proven, they’re also not likely to be harmful, at least not for the run of the mill depressions and anxieties that most of us suffer at some time or another. I wouldn’t recommend them for the suicidal or the severely schizophrenic, but for the chronically sad or anxious, they could be worth a try. Especially when conventional medicine has failed. And to Dr. Servan-Schreiber’s credit, he provides ample reference to back up his support of each method. And he never claims miracles for them or touts them to the exclusion of other treatment modalities.

The best recommendations, however, are at the end of the book. Not just the chapter that covers the importance of regular exercise to mental well-being, but the final five chapters devoted to the importance of emotional communication. That doesn’t mean communicating raw emotions with bald frankness, but developing the emotional maturity to speak honestly without giving offense, and to respond to the emotional rants of others without taking offense. (The “can’t-we-all-just-get-along?” method of inner healing.) In stark contrast to the beginning of the book, which emphasizes the disconnect between the rational and emotional brains, this emphasizes the supremacy of the rational mind over the emotional mind. (The author recommends carrying around index cards with acronyms that stand for each step in the process of effective emotional communication -both in the giving and the receiving – to help you get through it at first.) And as dorky as it may seem to take out a cheat sheet in the middle of a tempest, I find myself tempted to make up a set of cards to keep in my pocket. Lord knows there are plenty of times thoughout the day I could use them. (And so could some others around here.)

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  • Chris Kent

    This is a great blog Sydney and fascinating. You probably didn’t need the final sentence as what you were insinuating was clear.

    I have seen some people on anti-depressants and I could see how it changed them in odd, zombie-like ways. From that experience, I don’t believe I would ever take such drugs to cure anxiety or depression. I do believe talking to a therapist is productive in the short term for most people.

    Just about all of the suggestions from Instinct to Heal sound productive….

  • Shark

    Nice work, Sydney. Sounds interesting. Will check it out.

    One shouldn’t discount ‘complementary/alternative medicine’ too quickly, especially when it’s practiced by an MD (ie. under scientific auspices).

    My wife is an RN, and a lot of MDs are getting into ‘alternative’ medicine these days. The science lags behind, but because some are using clinical applications, more studies should arrive sooner than later.

    re. Omega-3 — Believe it: From what the RN says, Omega-3 appears to be somewhat of a miracle ‘drug’ for many illnesses.

    The big complaint with most Americans is stress/depression, and doctors are finding these anti-depressants often cause physiological imbalances that end up making the situation worse. But as your review / author acknowledges, a lot of this is ‘lifestyle’ depression, meaning you’re bummed out because your life sucks. Hard to treat that w/traditional drugs. And it’s the rare family physician who’ll say, “Dump your jerk spouse and get a pet.”