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Articles    H3'ed 3/13/11

Imaging and doing are not as different as they sound

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In a similar vein, neuroscientist Pascual-Leone taught two groups of people who had never studied the piano a sequence of notes, showing them which fingers to move and letting them hear the notes as they were played.   Then, the "mental practice group" imagined both playing the sequence and hearing it for 2 hours per day for 5 days.   A physical practice group played the music 2 hours per day for 5 days.   Both groups learned to play the sequence with remarkable similar brain changes.   The level of improvement in the mental practice group was not as great as those in the physical practice group, but one two hour physical practice session erased these differences, and, then, both groups performed equally well.  

What's important for us clinically, in medicine and psychology, is the realization that imagination of illness can be a powerful force to make people sick.   Last night I arrived to Hawaii for a conference, and, of course, this morning I was awake at 4 am thanks to the five hour time difference between Vermont and Hawaii.   I turned on the television and saw an old Dr. Kildare movie on Turner Classic Movies channel.   To my surprise, in the 1930s when these movies were made, people were aware that our minds could make us sick.   Dr. Kildare was trying to convince a young debutante that she was making herself sick with her thoughts.   As Jeffery Schwartz (my apologies to him for sometimes renaming him Jeremy) points out, if mind can change brain, mind is a powerful force.   This is the essence of how rehearsing a story over and over changes our physiology.   If we tell ourselves a downtrodden, sad story about how useless we are, and how we matter to nobody, our bodies will eventually respond to that story physiologically and will conform to that expectation.   If we tell ourselves happy stories about how many people love us and care about us and about how useful we are and helpful we are to others in the world, our bodies will eventually mold to embrace that reality.

In psychiatry and in mental health in general, we generally train our patients to tell themselves stories that keep them feeling defective and continue to isolate themselves.   We convince them that they will never change and will have to take medication for the rest of their lives.   We encourage them to be content living on disability and welfare.   We don't challenge them to do more.   So they tell these stories to themselves and that's what they become.   It seems too hard for many of my patients to imagine doing anything but watching television and playing videogames.   My challenge has been to encourage them to get out of their houses and apartments, to actually go into the public arena and mingle with other people, to attend events and groups, to rejoin the mass of humanity who is searching for meaning and purpose and for connection to each other, to imagine themselves well and happy.   I have found that when I ask my patients what they mean by "feeling normal" or "feeling happy" or "feeling myself again", which is what they say they want to feel, most cannot describe this.   They can't imagine what it would feel like.   If they can't imagine, they can't get there.

Similarly, if people with pain can't imagine being free from pain, how can they get there?   If people who have asthma can't imagine breathing freely and easily, how can they get there?   If people with mobility problems can't imagine walking, how can they get there?   There's no end to what we can imagine.   The typical biomedical response is to say that people will feel worse about themselves if they imagine walking and then don't.   However, I feel the opposite.   At least they had the joy of imaging movement again.   I think we need to be more playful about our imagination, and playfulness is an area of difficulty for conventional medicine and psychology.

Consider my friend, Elly, who had a dream about her mother.   In her dream, she was landing a plane in a field of golden flowers through a beautiful sunrise.   Here mother was standing at the end of the field.   The flowers made the perfect runway for the plane.   Elly exited the plane and told her mother everything she'd wanted to say to her mother before he mother died, but didn't.    Her mother received her communication very warmly and lovingly.   Elly felt embraced and supported by her mother.   Her mood was different upon awakening.   She had transformed through the imagination in a dream as if she had resolved matters with her mother.   In some indigenous beliefs, perhaps she had.   Nevertheless, we see the power of imagination, the power of "as if".

It's this power that makes placebos so incredibly effective and that underlies much of what is healing, and, it's this power that we need to more intentionally address and mobilize in our health care efforts.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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