Wellness: Better healer than drugs or surgery?

Doctor says self-care can cure 60% of illness

While wellness programming has clearly demonstrated that it has value as a preventive health strategy, a well-known Harvard Medical School physician says it’s much more than that: Wellness, he insists, should also be viewed as a treatment protocol.

"I’d love to get rid of the overriding concept of wellness — that it is mainly preventive," says Herbert Benson, MD. "Wellness does not a have therapeutic perception to it; we must shout that it is also critical to the treatment of illness. It can be an important complement to the appropriate care of a physician."

Benson is the Mind/Body Medical Institute associate professor of medicine at the Harvard Medical School, chief of the division of behavioral medicine at Beth Israel Deaconess Medical Center, and president of the Mind/Body Medical Institute, all of which are located in the Boston area.

The Mind/Body Medical Institute performs research and conducts teaching and training of health care professionals in mind/body and behavioral medicine approaches. Benson is also author of The Relaxation Response, and Timeless Healing: The Power and Biology of Belief.

Benson recently made his case on Capitol Hill, testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies. "The full integration of mind/body, self-care medicine is completely compatible with existing healthcare approaches," he told the subcommittee. "The integration is important not only for better health and well-being, but also for a more economically-feasible healthcare system."

The three-legged stool

The significance of wellness can best be seen when we describe health and well-being as a three-legged stool, says Benson. "The first leg is pharmaceuticals, the second surgery and procedures, and the third leg — what you call wellness — I call the self-care leg."

Benson cites research showing that 60%-90% of all visits to doctors fall into the mind-body/stress realm.1,2 "For these complaints, the first two legs of the stool do not work," he notes.

They don’t work, he further explains, because of the very nature of the self-care leg. "Self-care consists of health habits and behaviors for which patients themselves can be responsible," he testified. "Specifically, self-care includes the relaxation response, beliefs that promote health, stress management, nutrition and exercise."

Without the proper integration of all three legs, Benson explains, optimal health & well-being is not possible. "It’s a balance you’ve got to achieve," he asserts. "There is no self-care substitute."

Expanding mind/body wellness

In his enumeration of mind/body self-care approaches, Benson includes nutrition, exercise, and stress management, with which wellness professionals have long been familiar. But he also includes two other approaches — the relaxation response, and the placebo effect and the importance of belief in healing — that "have been demonstrated to successfully treat stress-related disorders."

The relaxation response was described by Benson and his colleagues about 25 years ago. It is the opposite of the well-known "fight or flight" response to stress, and results in decreased metabolism, decreased heart rate, decreased blood pressure, and a decreased rate of breathing, as well as slower brain waves.3,4

The fight or flight response occurs automatically when we experience stress, Benson explains, but the relaxation response requires the use of a technique. That technique includes two key steps:

• the repetition of a word, sound, prayer, phrase or muscular activity;

• when other, everyday thoughts intrude, a passive return to the repetition.5,6

The term "placebo effect" is one Benson says should be discarded and changed to "remembered wellness," which has a more positive connotation. What it basically comes down to is the belief of the individual, the health care professional treating him, and the individual’s ability to be healed.

The role of spirituality

Benson notes that such beliefs include spirituality. "Belief in placebos and other procedures have been shown effective in 50% to 90% of researched cases that included angina pectoris, asthma, skin rashes, all forms of pain, congestive heart failure, and so forth," he says. "And for many, the most powerful belief they have is belief in God."

Benson recognizes that discussions of God in the workplace can be controversial. "But spirituality itself may or may not be religious. By spirituality, we mean the experience of a power or an energy force — something close to you. It’s belief that’s healing, not necessarily what you believe in."

Benson asserts that there is sufficient research to convince managed care organizations of the economic importance of the self-care leg.

"We have shown that the third leg reduces visits to HMOs; to prepaid capitated systems, that is money in the bank," he says.7,8

Numbers for the HMOs

"Wellness has been turned down by HMOs in the past because it was only valued for its long-term [preventive] aspects. With people leaving their jobs so often, that is not particularly attractive. What we’re talking about is short-term effectiveness [therapeutics], coupled with long-term prospects.

"We have to rid ourselves of the perception that self-care only helps us stay well so we don’t get a disease," Benson continues. "We can also use it to get rid of disease."

[For more information, contact: Herbert Benson, MD, The Mind/Body Medical Institute, 110 Francis St., Suite 1A, Boston, MA 02215. Telephone: (617) 632-9530.]

References

1. Cummings NA, VandenBos GR. The twenty years Kaiser-Permanente experience with psychotherapy and medical utilization; implications for national health policy and national insurance. Health Policy Quarterly 1981;1:59-75.

2. Kroenke K, Manglesdorff AD. Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. American Journal of Medicine 1989;86:262-266.

3. Wallace RK, Benson H, Wilson AF. A wakeful hypometabolic physiologic state. American Journal of Physiology 1971; 221:795-799.

4. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 1974; 37:37-45.

5. Benson H. The Relaxation Response. New York; William Morrow, 1975.

6. Hoffman JW, Benson H, Arns PA, Stainbrook GL, Landsberg GL, Young JB, Gill A. Reduced sympathetic nervous system responsivity associated with the relaxation response. Science 1982; 215:190-192.

7. Hellman CJC, Budd M, Borysenko J, McClelland DC, Benson H. A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behavioral Medicine 1990. Winter: 165-173.

8. Decreased clinic use by chronic pain patients: Response to behavioral medicine intervention. The Clinical Journal of Pain 1991; vol 7. No. 4:305-310.