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Book Review   |    
John J. Miller
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.11.1353
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by Anne Harrington; New York, W.W. Norton & Company, 2008, 354 pages, $25.95

Dr. Miller is medical director of the Center for Health and Well-Being, Exeter, New Hampshire.

The book The Cure Within is a masterfully written overview of the history of mind-body medicine, which makes it a must-read for any health care professional. Author Anne Harrington, professor and chair of the History of Science Department at Harvard University, brings together her background as a historian, her professional experience in researching the placebo effect, her longtime participation in research groups studying mind-body interactions (including involvement with the Mind and Life Institute), and impeccable objectivity in writing this fact-filled book.

Harrington skillfully defines six general templates of mind-body medicine, which she calls "narratives." These narratives encompass general themes that manifest through specific cultural beliefs that are in a constant state of evolution and that have percolated through mainstream and alternative medicine over the past 2000 years. These six narratives, which are the backbone of this important book, are the power of suggestion, the body that speaks, the power of positive thinking, broken by modern life, healing ties, and Eastward journeys.

The power of suggestion narrative reviews the diverse phenomena that have used an authoritarian healer to facilitate a change in a person afflicted with some state of disease. Starting in the Judaic Second Temple period of approximately 200 B.C. and culminating in 16th century Catholicism, the author reviews cultural beliefs in demonic possession, the role of rituals and incantations, and ultimately the authority of the Catholic Church to exorcise these demons from the possessed individual. In 1774 the medical profession stepped in, and in large part due to the work of Mesmer, physicians replaced the priests. Sequentially, animal magnetism, trance states, and finally medical hypnotism became paradigms that had as their foundation in an authoritative individual whose skillfully spoken suggestions facilitated a genuine change in an afflicted person. An additional player in this narrative is the placebo effect, which has proven to be so powerful that all medical research incorporates a placebo treatment arm to factor in the health benefits of the treatment protocol minus the actual treatment being investigated.

The narrative labeled the body that speaks explores hysteria, conversion disorder, shell-shock, and the birth of psychosomatic medicine in the 1920s. The most recent addition to this narrative is posttraumatic stress disorder, created as a new diagnostic category by the American Psychiatric Association in 1980, when it was published in the DSM-III. The third narrative, the power of positive thinking, reaches back to 1858 when Bernadette Soubirous, a simple peasant girl from the village of Lourdes, France, saw an apparition, allegedly of the Virgin Mary. Reports of healings when people contacted a nearby spring of fresh water ultimately led the Pope in 1876 to officially declare Lourdes a holy site of healing. Lourdes remains a famous site for Catholic pilgrims today. In 1952 Norman Vincent Peale published his classic book The Power of Positive Thinking, which enjoyed great popularity. Peale's message set the stage for Norman Cousins to rock the Western medical establishment in 1976 with the publication of "Anatomy of an Illness" in the New England Journal of Medicine. Cousins' shared his own story of self-prescribed laughter and positive emotions as remedies for his degenerative ankylosing spondylitis. Understandably, the placebo effect makes its way into this narrative as well.

The narrative labeled broken by modern life is all about stress and the effect of stress on our health. This narrative has its roots in the 1880s when George Beard, a New York neurologist, coined the term "neurasthenia" to describe the symptoms of chronic exhaustion that were attributed to the fast-paced modern lifestyle, such as newspapers, steam-powered locomotion, and advances in science and communication through the telegraph. Then, in 1936, Harvard physiologist Walter B. Cannon gave a lecture presenting his hypothesis that when the fight-or-flight response is chronically activated in a stressful modern world, with no physical threat to fight or run from, the hyperaroused physiology can have negative effects on our health. In the 1950s, Hans Selye, professor at the University of Montreal, presented the concept of stress and a stress response. By the 1960s the Social Readjustment Rating Scale had been published. From there the author guides us through an evolving understanding of how a stressful lifestyle contributes to the onset of disease, reviewing the research on executives, type A personality, hostility and cynicism, and stress and the immune system.

The healing ties narrative explores the role of social support, community membership, and intimacy as factors that promote good health. In this narrative the author reviews the research demonstrating the benefits of social support for decreasing the incidence of coronary heart disease and all-cause mortality, the impact of caregiver styles on child development, and the well-publicized research of Stanford psychiatrist David Spiegel, who studied the effect on life expectancy of a weekly support group for women with metastatic breast cancer.

The final narrative, Eastward journeys, reviews the complex theme of individuals searching for a healing practice or philosophical belief system outside of their own cultural experiences to complement, or in some cases replace, the conventional models that they perceive as limiting and incomplete. In this narrative the individual seeks to draw upon some source of ancient wisdom or nonconventional treatment modality to attain a degree of physical, psychological, and spiritual health beyond what he or she believes to be possible from the established health system. This section explores the invasion of Western medicine by yoga, meditation, Eastern mysticism, chi, and qigong. This narrative ends with a review of the pioneering work by Richard Davidson at the University of Wisconsin, who has studied the EEG activity of the brains of persons advanced in meditation. His results have created a great deal of excitement in the neurological arena.

What I enjoyed most was Harrington's concluding chapter, where after presenting all of the facts and mapping out her six narratives, she shares her own perspectives on mind-body medicine and the cure within.

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