Two Studies on the Power of Placebo
The first two studies to be reviewed here were never followed up, to
my knowledge, in spite of their potential implications. The first was
published in 1962 by two Japanese researchers, Dr.'s Ikemi and Nakagawa
(Ikemi 1962). In Japan there is a tree whose leaves produce a rash
similar to a poison ivy rash. These researchers had noticed that some
people developed a rash if they thought they had touched the tree, even
when no such contact had occurred. They thought that maybe the power of
suggestion was at work, and decided to test this hypothesis with a
controlled study. They took 57 school boys, selected only the ones who
reported being allergic to the trees in question. They then performed a
simple experiment. On each boy, they brushed one arm with harmless
chestnut leaves, and the other with poisonous leaves. They told the
boys that they had done just the opposite, however, so that the boys
thought the benign leaves were poisonous and vice-a-versa. Within
minutes the "placebo" arm reacted in many cases with a bright red rash
with raised boils, while in the majority of cases the arm brushed with
the poisonous leaves did not react at all. Thus it was shown that a
perfectly harmless substance could produce a specific physical reaction
through the power of suggestion, and that the physical symptoms
produced could match perfectly with the symptoms that were suggested.
It was also shown that the reaction to a toxic substance could be
prevented, even in highly susceptible individuals, if they were
convinced that the toxic substance was actually a harmless one.
The second study to be reviewed was performed in the United States
in 1950, about ten years prior to the Japanese study. In this study a
bold experiment was performed, one that might not be allowed today
because it involved lying to the participants. The author of the study,
Dr Wolf, gave a group of women a toxic substance called syrup of ipecac
that causes nausea and vomiting. He lied to the women, however, telling
them it was actually a drug that would cure nausea and vomiting. The
women in the study were already suffering from chronic nausea and
vomiting of pregnancy, and so they gladly took the syrup of ipecac. In
most cases their symptoms ceased entirely. Objective evidence of their
improvement was also measured by Dr. Wolf, who had the patients swallow
small tubes to measure the amount of muscle contractions in the
stomach, contractions that occur with the heaving which occure when one
vomits. After taking the toxin, the contractions subsided. This second
study shows that, at least in the short term, a drug that is highly
toxic can actually cure the very subjective and objective symptoms that
it normally causes - if the power of belief is working in it's
favor.
This second study shows that, at least in the short term, a drug
that is highly toxic can actually cure the same subjective and
objective symptoms that it normally causes. One probable explanation is
that the power of belief is working in its favor, but there are other
explanations. Homeopathic medicines are said to work by stimulating the
body's own healing response, which is done by giving an extremely
diluted dose of a toxin. The diluted toxin is matched carefully to the
symptoms of the person who is ill, and the toxin chosen is one that
would actually cause these symptoms if it were given to a healthy
person. Even these extremely dilute homeopathic remedies can become
toxic, however, if they are given repeatedly for a long period of time.
Although many conventional medical practitioners are skeptical about
homeopathy, over 100 double-blind placebo-controlled trials of
homeopathic remedies have been performed, and a meta-analysis of these
trials was published in the Lancet, a leading medical journal (Linde et
al 1997). The meta-analysis found a significant positive effect from
the remedies.
Whatever the explanation, this study appears to demonstrate that the
short term use of a toxic substance when given with the belief that it
will cure the very illness that it causes, can actually cure the
illness.
The idea of relying exclusively on "placebo-controlled, randomized,
double-blind" studies evolved from reviewing studies like these. These
studies have become the gold standard of scientific research, but there
are some serious doubts about how well they actually eliminate the
potential for placebo-like effects. Double-blind studies are supposed
to distill out the "truly effective" drugs from those that are "only
placebos", but it has been shown repeatedly that people participating
in double-blind studies can usually tell whether they are getting the
placebo or the active substance.
Participants and researchers in placebo-controlled studies are
naturally curious as to whom is getting the real drug and who is not.
Especially for the participants, it is likely to be a question that is
repeatedly on their minds while they take their daily regimen of pills.
This has been supported by research studies designed to look at this
question which have found that patients and physicians involved in
"double blind" studies can correctly guess who is getting placebo and
who is not about 70% to 80% of the time (Greenberg and Fisher 1997).
This opens up a Pandora's box of questions regarding the effectiveness
of most drug treatments and may explain why studies like these have not
been followed up. If the placebo effect can be so powerful it becomes a
serious threat to people who have invested their time and energy into
drug treatments.
II. Can AIDS Be Caused By Stress, Social Isolation, and Negative
Beliefs?
HIV is claimed to cause a wide variety of symptoms in people who
test positive on the HIV antibody test, but even for the most common
symptoms, like immunosuppression and low CD4 T-cells, there is
continued difficulty and disagreement in understanding the mechanism
involved (Balter 1997), a fact that has led the original discoverer of
HIV, Luc Montagnier, to state that he does not think HIV can cause AIDS
without other unidentified cofactors (Balter, 1991).
Studies of both animals and humans have shown that severe, chronic
stress results in a syndrome remarkably similar to AIDS, and some of
the proposed mechanisms are easily reproduced in animal and test tube
models (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957, Cecchi
1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador 1992,
Milton 1973, Uno 1994). The effects of stress are mediated at least in
part by the hormones cortisol and epinephrine, which cause a state of
immunodeficiency characterized by a reduction of the number of T-cells.
The CD4, helper T-cells are selectively depleted, exactly as is seen in
people diagnosed HIV+ (Antoni 1990, Castle 1995, Herbert 1993, Kennedy
1988, Kiecolt-Glaser 1991, Laudenslager 1983, Kiecolt-Glaser 1988,
Pariante 1997, Stefanski 1998).
Severe stress has also been linked to increased incidences of
specific illnesses and symptoms that are officially considered "AIDS
defining conditions", including pneumonia, tuberculosis, dementia,
wasting, and death. Stress has been demonstrated in both animals and
humans to cause brain damage and neuronal atrophy, resulting in a
dementia that mirrors "HIV dementia", with the same changes in the
brain that are often observed in people who die of AIDS (Axelson 1993,
Berent 1992, Brooke 1994, Frol'kis 1994, Gold 1984, Jensen 1982, Lopez
1998, Magarinos 1997, Momose 1971, Sasuga 1997, Sapolsky 1990, 1996,
Starkman 1992, Uno 1989,1994). Severe, chronic psychological and social
stress has also been linked to increased death rates due to illnesses
like pneumonia and tuberculosis (Kennedy 1988, Luecken 1997, Russek
1997), and has been found, in animals, humans, and non-human primates,
to cause a fatal wasting syndrome that is remarkably similar to AIDS.
These studies will be reviewed in detail later in this paper, but here
is a brief quote from one study of captured wild monkeys:
"Wild-caught vervet monkeys... occasionally showed a
syndrome of cachexia associated with persistent diarrhea, anorexia, and
dehydration that usually proved fatal. Those animals appeared to be
socially subordinate and to have suffered an atypically high rate of
social harrassment and attack from their peers. Two animals died as
early as one month under such conditions, and others died after six
months to 4 years in captivity... The fatal outcome, caused by severe
prolonged social stress, induced classic pathology associated with
stress, including gastric ulcers and adrenal hyperplasia. In these
animals we also found unique insidious degeneration and resultant
depletion of neurons in the hippocampus (the area of the brain that
controls learning and memory)... Similar degeneration was also found in
cortical neurons." (Uno 1994, page 339)
Most people have heard of Voodoo hexing, where a hexed individual
succumbs to a chronic illness that often results in death, exactly as
predicted. Most people are not aware, however, that some of medicine's
leading researchers and physicians have studied this phenomenon. In
addition, most people have not considered how this might relate to
AIDS.
A number of reports, mostly by Western physicians working in
traditional societies, have appeared in medical journals over the
years. The phenomenon has been called "Voodoo death", "root work" and
"bone pointing" (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957,
Cecchi 1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador
1992, Milton 1973). A similar phenomenon occurring in modern,
"developed" societies has also been described, where people have died
after receiving terminal diagnoses from their physicians, but before
the pathology has spread enough to cause death. This has been called
"unexplained death", "self-willed death", "the given-up-giving-up
complex", and "the nocebo effect" (Benson 1997, Engel 1968, Milton
1973). As one small example of what will be presented in that section
of this paper, Meador (1992) reported on two men given voodoo hexes by
very different medicine men, one modern, and one traditional.
"The first patient, a poorly educated man near death after
a hex pronounced by a local voodoo priest, rapidly recovered after
ingenious words and actions by his family physician. The second, who
had a diagnosis of metastatic carcinoma of the esophagus, died
believing he was dying of widespread cancer, as did his family and his
physicians. At autopsy, only a 2 cm nodule of cancer in his liver was
found." (page 244)
Another comparison between these two phenomena had been provided
twenty years before by the Australian physician G.W. Milton (1973) in a
special article to the Lancet, a top medical journal. The following is
a quote which also suggests that such deaths can occur in Western
societies as well.
"There is a small group of patients in whom the realisation
of impending death is a blow so terrible that they are quite unable to
adjust to it, and they die rapidly before the malignancy seems to have
developed enough to cause death. This problem of self-willed death is
in some ways analogous to the death produced in primitive peoples by
witchcraft ('pointing the bone')." (page 1435)
Because of the controversy surrounding this topic, as well as its
possible significance in AIDS, this subject will be reviewed with
extensive quotes in the final portion of this paper.
In addition to the severe stress of living with such a devastating
prognosis, people diagnosed HIV+ also often face severe social
rejection and isolation. The groups of people primarily affected by
AIDS, male homosexuals and IV drug users, already experience this kind
of rejection, often by members of their own families. This isolation is
made much worse by being diagnosed HIV positive, in spite of efforts by
caring family, friends and health care workers. Tragically, these same
friends and loved ones may unintentionally perpetuate the social
isolation because of fear of infection. Social isolation has been shown
to be an independent risk factor for immunosuppression and to lead to
low levels of CD4 T-lymphocytes. Socially isolated people, when
compared to people with high levels of social support, have been found
in over eight studies to have between double and triple the death rates
(Berkman 1979, House 1988, Ornish 1997). A recent study found that
people diagnosed HIV positive were two to three times more likely to
"progress to AIDS" if they were socially isolated and under high levels
of stress (Leserman 1999). Here are some quotes from the abstract of
their paper:
"Faster progression to AIDS was associated with more
cumulative stressful life events (p<0.002), more cumulative
depressive symptoms (p<0.008), and less cumulative social support
(p<0.0002). ...At 5.5 years, the probability of getting AIDS was
about two to three times as high on those above the median on stress or
below the median on social support..." (page 397)
Other studies have looked at this question, but every one, including
the one quoted above, suffers from a fundamental oversight which is
critical to the argument of this paper. None of them take into account
the severe stress and feelings of isolation associated with being
diagnosed "HIV positive", but instead only examine other major
stressors. A study focusing on the stress of an HIV-positive diagnosis
would be challenging to design, or perhaps even impossible, without
breaking people's right to be fully informed about their own medical
diagnoses, but this does not solve the quandary. Similar problems exist
with a number of other studies of HIV that would shed light on this
issue.
III. Severe, Chronic, Psychological Stress: A Painful and often
Terminal Disease
Severe, chronic psychological stress and social isolation can have
health effects that are nearly identical to AIDS, especially when
combined with physical stress or illness. Stress causes a state of
immunodeficiency characterized by a reduction of the number of
T-lymphocytes, with special targeting of CD4, helper T cells. There is
also a reduced CD4:CD8 ratio, with a relative increase in CD8,
suppressor/cytotoxic T cells (Antoni 1990, Bonneau 1993, Castle 1995,
Herbert 1993, Kennedy 1988, Kiecolt-Glaser 1988, 1991, Laudenslager
1983, Pariante 1997, Stefanski 1998). Both of these immunological
changes are considered characteristics specific to AIDS. Since being
diagnosed with AIDS carries with it a high level of psychological
stress and social isolation, low CD4 counts are likely caused, at least
in part, by stress.
A marked increase of the hormone cortisol, which is released during
times of stress, appears to be one of the primary causes of these
immune changes. Catecholamines like epinephrine, which are also
released, have also been implicated but to a lesser degree. Multiple
studies have found that people diagnosed HIV positive have chronically
elevated cortisol levels (Azar 1993, Christeff 1988, 1992, Coodley
1994, Lewi 1995, Lortholary 1996, Membreno 1987, Norbiato 1996,
Norbiato 1997, Nunez 1996, Verges 1989). It is important to note,
however, that chronic stress can induce immune suppression even when
cortisol and epinephrine are not elevated (Bonneau 1993, Keller 1983),
so that the mechanisms by which stress affects health and immunity are
not at all completely understood.
Severe stress has also been shown to cause brain damage and neuronal
atrophy, especially in the hippocampus, the area of the brain that
controls learning and memory (Axelson 1993, Bremner 1995, Brooke 1994,
Frol'kis 1994, Gold 1984, Gurvits 1996, Jensen 1982, Lopez 1998,
Magarinos 1997, Sapolsky 1990, 1996, Sasuga 1997, Sheline 1996,
Starkman 1992, Uno 1989,1994). This results in decreased mental
function similar to what is often called "HIV dementia". The most
chilling research, however, is research that has demonstrated that
severe social and psychological stress can cause a fatal wasting
syndrome in animals, humans, and non-human primates that is very
similar to AIDS (Benson 1997, Binik 1985, Campinha 1992, Cannon 1957,
Cecchi 1984, Cohen 1988, Eastwell 1987, Golden 1977, Kaada 1989, Meador
1992, Milton 1973, Uno 1994), a topic that will be covered in detail
later in this paper.
Being diagnosed HIV-positive is perhaps one of the greatest
stressors one can imagine. Not only does it raise the constant and
extreme fear of a relentless deterioration and death, but it also
creates a social isolation that pervades all aspects of people's lives.
To make matters worse, many of the people diagnosed with AIDS already
suffer from social isolation and rejection. Social isolation, alone,
has been associated with a 100% to 200% increase in mortality in
several large prospective studies, and the increase in mortality is
equal to the increase associated with smoking (Berkman & Syme 1979,
House 1988). The amount of psychological stress in people diagnosed HIV
positive is likely to be much greater than the stress in the people in
these studies.
III A. The Effects of Stress and Social Isolation on
T-lymphocytes
The reduction of CD4 cells in people diagnosed HIV+ has been called
the "hallmark of the disease" (Balter 1997), and it has been claimed
since the initial discovery of HIV that it selectively targets these
cells, creating a CD4/CD8 ratio with a value less than one, referred to
as an "inverted" ratio. The mechanisms by which it might do this have
not yet been uncovered, in spite of vast sums of money spent on HIV
research. Other research has shown that CD4 cells become depleted in a
wide variety of ways and that low CD4 counts is an incredibly
non-specific finding which is common in many people suffering from all
types of physical and psychological stress (Bird 1996, Carney 1981,
Feeney 1995, Junker 1986, Kennedy 1988, Lotzova 1984, Pariante 1997,
Zachar 1998). Low CD4 counts are even relatively common in people with
no illness (Bird 1996). All of these findings raise the possibility
that low CD4 counts in people diagnosed HIV-positive may not be caused
by HIV at all, but rather by one of the many other factors present in
these people. For a complete review of this topic see the author's
comprehensive review of the literature, which shows that low CD4 counts
and other immune system changes claimed to be specific to HIV commonly
occur when a person's system is under nearly any kind of physical or
psychological stress (Irwin 2001).
Low CD4 Counts in Chronic Illness
In 1981 a group of researchers looked at CD4 and CD8 counts in ten
consecutive patients with acute mononucleosis, and compared their
counts with those of ten healthy volunteers (Carney 1981). At this time
CD4 counting was a newly discovered technique, as was the idea of
looking at CD4/CD8 ratios. The CD4 counts in the healthy volunteers
were 73% higher than those found in people with mononucleosis. The CD8
cells in people with mono were increased, resulting in an inverted
CD4/CD8 ratio in every single patient. The average ratio was only 0.2,
compared to the normal average of 1.7 found in controls. Of the nine
patients whose CD4 counts were measured, the three with the lowest CD4
counts had 194, 202 , and 255 cells/mm3. People who are HIV positive
with less than 200 CD4 cells are immediately diagnosed with AIDS, and
the assumption is made that HIV is attacking their T-cells. This
assumption that seems ill-advised in light of findings like this
one.
More recently another group of researchers looked at CD4 counts in
HIV negative people, this time in 102 consecutive Intensive Care Unit
(ICU) patients who were admitted for a variety of reasons (Feeney
1995). Fully 30% of these patients had CD4 counts less than 300. They
do not discuss how many were below 200, the level diagnosed as "AIDS"
in people with a positive HIV antibody test. They also did not find
that low CD4 counts were linked with poor health, nor were they linked
with a poor prognosis. Here are the author's comments on their
findings.
"Our results demonstrate that acute illness alone, in the
absence of HIV infection, can be associated with profoundly depressed
lymphocyte concentrations. Although we hypothesized that this
depression would be directly related to the severity of illness, this
was not seen in our results. The T-cell depression we observed was
unpredictable and did not correlate with severity of illness, predicted
mortality rate, or survival rate. This study was consistent with prior
studies that have shown similar decreases in T-cell counts in specific
subsets of acutely ill patients. These subsets included patients with
bacterial infections, sepsis, septic shock, multiple organ system
failure, tuberculosis, coccidioidomycosis, viral infections, burns, and
trauma patients. Most of these studies reported decreases in lymphocyte
populations, some of which were severe and included CD4/CD8 ratio
inversions...
"In the largest study to date of hospitalized patients, Williams et
al (1983) evaluated T-cell subsets in 146 febrile patients with serious
acute infections... with 19 of 45 patients having a CD4 count of less
than 300 per microliter." (page 1682-3)
"We also found that CD4 counts were linearly related to total
lymphocyte concentrations, as Blatt et al. (1991) reported in
HIV-positive patients." (page 1683)
Curiously, although these researchers did find the low CD4 cell
counts as seen in AIDS, they did not find that such counts were very
good measures of immune function. One major double-blind study of AZT
use in over 2000 HIV positive people found the same result. AZT
increased the number of CD4 T-cells, but in spite of this people who
received AZT earlier died at a faster rate (Seligman 1994). This study
was the major reason AZT fell out of favor as the sole drug used on HIV
positive people, but it also seriously questioned the value of CD4
T-cells as a marker for immune health.
Stress, Cortisol and CD4+ T-lymphocytes
In contrast to the confusion over how HIV affects the immune system,
the mechanism for the immunosuppression during states of chronic
physical and psychological stress is comparatively well understood. One
of the major changes during times of stress is an outpouring of the
hormones epinephrine and cortisol, which lead to a dramatic reduction
in the number of T-lymphocytes. The strength of the correlation between
decrease in T-cells, also called "lymphocytopenia", and excess cortisol
is so strong that low T-cells is one of the diagnostic criteria for
identifying excess cortisol.
Here are some quotes on this topic, from a basic textbook on
physiology used in most medical schools (Guyton 1996).
"Almost any type of physical or mental stress can lead
within minutes to greatly enhanced secretion of ACTH and consequently
cortisol as well, often increasing cortisol secretion as much as
20-fold" (p.966).
"Cortisol suppresses the immune system, causing lymphocyte
production to decrease markedly. The T lymphocytes are especially
suppressed." (p.964)
"Cortisol decreases the number of eosinophils and lymphocytes in the
blood; this effect begins within a few minutes of injection of cortisol
and becomes marked within a few hours. Indeed, a finding of
lymphocytopenia or eosinopenia is an important diagnostic criterion for
overproduction of cortisol by the adrenal gland. Likewise, the
administration of large doses of cortisol causes significant atrophy of
all the lymphoid tissue throughout the body... This occasionally can
lead to fulminating infection and death from diseases that would
otherwise not be lethal, such as fulminating tuberculosis in a person
whose disease had previously been arrested" (p.965).
This description of death from infections that "would otherwise not
be lethal" sounds identical to a description of the symptoms usually
blamed on HIV.
Many studies have linked cortisol levels with CD4 depletion, and
some have linked epinephrine, as well. These are the two major hormones
released during times of stress, and when injected into humans and
laboratory animals, immune suppression results (Crary 1983a, 1983b,
Tornatore 1998). Tornatore (1998), for example, found reductions of 70%
in the number of CD4 cells in both young and elderly people after a
single injection of a synthetic analogue of cortisol called
methylprednisone. After the single injection, it took 8-12 hours for
the numbers of lymphocytes to return to normal.
It is important to note that studies have found that these are not
the only mechanisms. The adrenal glands are the source of both cortisol
and epinephrine, but when rats have their adrenal glands removed they
still have reduced T-cell number and function when subjected to stress
(Bonneau 1993, Esterling 1987, Keller 1983).
People diagnosed HIV+ have been found in a number of studies to have
elevated levels of cortisol, and some have reduced cortisol responses
when artificially stimulated, which indicates the presence of chronic
stress as well as chronically overactive cortisol production (Membreno
1987, Christeff 1988, 1992, Verges 1989, Azar 1993, Coodley, 1994, Lewi
1995, Lortholary 1996, Nunez 1996, Norbiato 1996, Norbiato 1997).
Norbiato et al. (1997), for example, compared patients with AIDS with
healthy, HIV negative controls. They placed the AIDS patients into two
groups, those with normal cortisol receptor affinity (AIDS-C) and those
with low cortisol receptor affinity (AIDS-GR), and compared both these
groups to HIV-negative controls. When comparing urinary free 24 hour
cortisol levels, they found that patients with AIDS-GR had 451
micrograms/24hr, while control subjects had only 79 micrograms/24hr.
People with AIDS excreted nearly six times as much cortisol as normal
controls. AIDS-C patients had levels of 293 micrograms/24hr, 3.7 times
higher than normal. Plasma cortisol levels were also increased, with
levels nearly three times as high in AIDS-GR patients as in normal
controls. Their comments on their findings are revealing:
"In HIV disease, the normal interaction between
hypothalamic/pituitary axis is altered, thus producing an oversecretion
of cortisol, resulting in immune suppression. In most patients, this
trend continues throughout the course of the disease." (page
3262)
These levels are compatible with levels of cortisol commonly found
in patients with Cushing's Disease, a disease of cortisol
overproduction that results in severe immunosuppression, opportunistic
infections, neuropsychiatric abnormalities, muscle wasting, weakness,
and fat deposits in the upper back, face, and belly (Britton 1975,
Momose 1971, Robbins 1995, Starkman 1992).
Several studies have linked high stress with a selective depletion
of CD4 helper T-cells, often with increased CD8 cells. One of the
problems in comparing the immunsuppression due to stress with that in
people with AIDS, however, is that most researchers do not consider CD4
counts to be a good measure of immune function, and therefore most
studies do not measure CD4 counts. Instead, lymphocyte responsiveness
is preferred, which is nearly always reduced in states of chronic
psychological stress (Antoni 1990, Kiecolt-Glaser 1988). There are
studies that look at T-cells in times of stress, however, and these
will be focused upon here. The results to be reviewed first will be
from a study of non-human primates, followed by several human
studies.
Social Isolation and Cortisol Levels in Non-Human
Primates
A study by Sapolsky et al. (1997) looked at the effects of social
isolation and social subordination on cortisol levels in twelve wild
baboons. They found basal cortisol levels four times as high in the six
more isolated baboons, when compared with the six more socially
connected baboons, an astounding and statistically significant
difference. Here are some excerpts from their report:
"Hypersecretion of glucocordicoids (excess cortisol
production) can have deleterious effects on immune defenses,
metabolism, reproductive physiology, tissue repair, and neurological
status...
"Detailed data about adult male social behavior were collected by
one of us (S.C.A.) during the two months prior to darting for
anesthetization. These data were collected as part of a larger
multi-year study of adult male baboon social behavior and presented an
opportunity to examine social correlates of hypercortisolism (excess
cortisol production)." (pages 1137-8).
"Socially isolated males had significantly higher basal cortisol
concentrations than males that were well-connected socially (the six
more isolated baboons averaged 850 mmol/L compared to only 213 mmol/L
in the six more socially connected baboons)." (page 1141, figure 1)
"In a previous study with a wild population of baboons, we observed
that among dominant males, those with the lowest rates of grooming with
females and social interactions with infants had markedly elevated
cortisol levels... These studies cannot reveal whether there is any
causality to this link. However, studies with rodents and captive
primates demonstrate the power of social proximity or affiliation to
blunt the cortisol response to various stressors, suggesting that these
baboons are hypercortisolemic because they lack the stress-reducing
advantages of social affiliation... This association echoes the classic
finding in behavioral medicine that social isolation represents a
highly notable mortality risk factor across a wide range of maladies in
humans (House 1988). A key finding in those studies was that no
particular form of social affiliation (spouse, friend, or community
group) was more protective than the others, but that the association
instead emerged from the aggregate of social connections. Simlarly, we
did not observe any 1 of the 8 measurements of social connectedness to
predict adrenocortical status; instead, it was their aggregate that was
highly predictive." (pages 1141-1142)
Some of the studies mentioned by Sapolsky et al above were analyzed
by Coe (1993). He reviewed the research that examined the effect of
psychosocial factors on the immune systems of non-human primates. Many
studies showed that when young, captive monkeys were separated from
friends or from their mothers, their T-cells showed markedly impaired
function. Researchers also tried to assess why some monkeys were more
affected than others, and found that many subtle variables such as the
timing of the separation, the age of the monkeys, and the way the
separation was created, could all have a significant effect. Thus
measuring the effects of social support is a complex task, as is
measuring psychological stress. The influence of subtle factors related
to the social environment and to the person's internal coping
mechanisms may have significant mediating effects.
A review by Levine et al. (1996) looked at research showing that
social relationships significantly buffered the effects of stress in a
variety of animal studies. Here are some of the authors' comments.
"Our initial studies of squirrel monkey adrenocortical
activity showed that social separations of mother and infants produce
striking increases in cortisol in both mothers and infants... We also
showed that the magnitude of this physiological effect is at least
partly dependent on the degree of social support available to the
infants. In the company of mothers and/or familiar peers, social
buffering of stress-induced increases in cortisol is apparent. Dramatic
increases in cortisol occur during maternal separations when infants
are placed in novel environments... Long-lasting increases in cortisol
also occur in subadults and adults..." (page 211)
"Social separations can induce long-lasting increases in cortisol,
whereas companionship can result in social buffering... From 1 to 21
days post separation, however, cortisol remains elevated above
pre-separation controls." (page 216)
One section of this review applies particularly to people diagnosed
HIV positive. The authors discuss the effects of creation of newly
formed social groups on stress and cortisol levels, along with the
effects of major changes.
"Novelty, uncertainty, and lack of predictability are all
psychogenic factors known to activate the HPA-axis in a variety of
animals, and increased cortisol levels have previously been reported in
newly formed squirrel monkey groups. Recent evidence suggests, however,
that group formation-induced changes probably depend on a monkey's
prior social-psychological state." (Page 218)
This applies to the members of the gay community, where AIDS still
concentrates, who had recently created a new community in San Francisco
as well as a few other cities. It also applies to people for whom many
social contacts are disrupted or eliminated as a result of their HIV
positive antibody test.
Stress and Lymphocytes in Humans, Non-human Primates, and Other
Animals
A group of researchers led by Robert Sapolsky has done a great deal
of work observing the effects of psychological stress on baboons and
other primates. Most of their work has focused on neurotoxicity, which
will be reviewed in a later section of this paper. In one study,
however, they measured total lymphocyte counts and cortisol levels in a
group of baboons that were invaded by a highly aggressive young male
baboon, whom they named Hobbs (Alberts 1992). Hobbs was particularly
threatening to females in the group, and was apparently attempting to
use fear, physical intimidation, and abuse to increase his chances of
successful mating. Cortisol levels in the group nearly doubled after
Hobbs joined the group, with a slightly greater increase among females.
T-lymphocytes plummeted in the group, from a pre-Hobbs level of 67 per
10,000 red blood cells (field conditions prevented them from
determining the number of lymphocytes per microliter of blood, or from
measuring CD4 cells) to a level of about 39, a drop of 42%. When
looking at only the levels in baboons who were victims of Hobbs'
aggression, the levels fell even more steeply, to only 29 per 10,000
RBC's, a drop of 55%. Interestingly, Hobbs, himself, had the lowest
number of lymphocytes in the group, and the highest cortisol level,
suggesting that his behavior may have been taking an even greater toll
on his system than it did on the victims of his aggression. The authors
comment on their use of lymphocyte counts instead of more sophisticated
methods:
"Whereas most studies of the effects of stress upon
immunity examine functional indices of immune competence (e.g. mitogen
stimulation tests, antibody generation, cytokine responsiveness), our
field conditions limited us to this rather crude quantitative measure
of numbers of cells." (Alberts 1992 page 174)
It is notable that these researchers also agree that T-cell function
tests are the best way to measure immune competency, something
supported by earlier reports that question the value of CD4-cell
counting (Feeney 1995, Seligman 1994).
Pariante et al. (1997) measured the CD4 helper T-cells and CD4/CD8
ratio of people who were under chronic stress due to being caregivers
of severely handicapped family members. They found that the caregivers
had "significantly lower percentages of T cells, a significantly higher
percentage of T suppressor/cytotoxic cells, and a significantly lower
helper:suppressor (CD4/CD8) ratio." Another study of caregivers, this
time of people caring for people with late-stage Alzheimers, also found
decreased CD4/CD8 ratios, in addition to impaired T-cell function
(Castle 1995).
A study in rats compared the effect of three weeks of chronic stress
in rats who either had normal pre-natal experiences, or who were
exposed to ethanol in utero. Males were especially affected, and
ethanol exposed rats had significantly more lowering of CD4 counts when
placed in a stressful environment than non-exposed rats (Giberson
1995). This suggests that chemical insults can increase the
susceptibility to stress-induced immunodeficiency, especially if the
exposures occur in utero, a finding that is especially significant to
childhood AIDS cases as many of them are born to women who are IV drug
users.
It is important to note that short-term stress can have very
different effects from long-term stress. For instance, one study
compared the effects of two hours of social stress in rats with the
effects of 48 hours of stress. After two hours, there were decreases in
the number of T-cells, but an increase in the CD4/CD8 ratio. After 48
hours of the same social stress, however, the CD4/CD8 ratio had lowered
to the normal range, while T-cell numbers remained reduced (Stefanski
1998).
The effects of stress also show a lot of individual variance, which
may be due to factors like coping strategies and social support.
Several studies have found that isolated people have more immune
dysfunction than people with high levels of social support (Kennedy
1988, Kiecolt-Glaser, 1984, 1991). These studies will be reviewed in
the next section of this paper. Another mediating factor appears to be
the amount of control that one has over the source of stress. Rats who
were given some measure of control over the source of stress showed
normal lymphocyte responses, while rats who had no control showed
impaired responses, even though the amount of external stress producing
events (electric shocks) were equal (Laudenslager 1983). A review of
relevant studies from 1988 examined some of these variables, with the
following comments:
"Data are given which document immunosuppressive effects of
commonplace, short-term stressors, as well as more prolonged stressors,
such as marital disruption and caregiving for a relative with
Alzheimer's disease. Immune changes included both quantitative and
qualitative changes in immune cells, including changes in herpes virus
latency, decreases in the percentages of T-helper lymphocytes and
decreases in the numbers and function of natural killer cells. These
effects occurred independently of changes in nutrition. Psychological
variables, including loneliness, attachment and depression were related
to the immune changes. The data are discussed in a framework in which
quality interpersonal relationships may serve to attenuate the adverse
immunological changes associated with psychological distress, and may
have consequences for disease susceptibility and health."
(Kiecolt-Glaser 1988).
Another review article (Antoni 1990) has several discussions of this
topic, including some discussion of the effects of stress in people
with AIDS. Following are some of the author's statements regarding
effects on T-cells:
"Animals subjected to uncontrollable stressors, for
instance, have been noted to display... immune system decrements such
as thymic involution, decreased NK cell cytotoxicity, suppressed
lymphocyte proliferation, and decreased helper/suppressor cell ratios."
(page 41)
"In research using naturally occuring uncontrollable stressors in
human subjects... (there were) decreases in total T-lymphocyte number,
total macrophage number, and total number of CD4 cells." (page
41-42)
"Other recent work has noted that a high stress level, increased
depressive symptoms, dissatisfaction with social support, and limited
use of coping strategies predicted decreased CD4 cell number and
increased CD8 cell number." (page 42).
Several different types of stressors led to these immune system
changes, including loneliness, lack of social support, and bereavement,
all three of which have a high prevalence in people diagnosed with
AIDS. A final quote from this article (Antoni 1990) discusses the
impact of HIV diagnosis on immune function.
"Indeed, we have observed discrete and significant psychological and
immunological changes among asymptomatic gay men across the
anticipatory period preceeding HIV-1 antibody testing and during the
impact period following news of diagnosis. Furthermore, we have noted
significant benefits of behavioral interventions on psychological and
immunological functioning among asymptomatic, HIV-1 seropositive and
seronegative gay men." (page 46)
It is notable that these two reviews (Antoni 1990, Kiecolt-Glaser
1988), and also a meta-analysis (Herbert 1993) of studies looking at
the effects of stress on immune function consistently find CD4 helper T
cells selectively reduced in people subjected to chronic stress
together with a decrease in CD4/CD8 ratio. If found in someone who is
HIV positive, these effects would unquestionably be blamed on HIV, and
the effects on immunity of the extreme stress of living with an HIV
positive diagnosis would be ignored.
III B. Stress-Induced Dementia
Multiple studies have found that chronic psychological stress, and
the resultant hypercortisolism, induces brain damage characterized by
atrophy of cortical neurons, especially in the hippocampus, the region
of the brain that controls learning and memory. Another reported
finding is enlargement of the ventricles in the brain (Axelson 1993,
Brooke 1994, Frol'kis 1994, Gold 1984, Jensen 1982, Lopez 1998,
Magarinos 1997, Mimose 1971, Ohl 1999, Sapolsky 1990, Sasuga 1997,
Starkman 1992, Uno 1989,1994). Dementia is a classic finding in people
diagnosed with AIDS, and similar changes in the brain have been
reported.
A commonly recognized example of how severe stress impairs mental
function is the gaps in memory that people often have in relation to
periods of prolonged trauma, as occurs in many cases of childhood
sexual abuse, for example. Most people are not aware, however, that
chronic stress actually causes atrophy of the brain tissue.
A quote from Uno et al (1994), in the introduction to this paper,
discussed the cases of stress-induced fatal wasting syndrome in
monkeys. The authors also indicated that they found atrophy of cortical
neurons in the hippocampus, as well as in other areas of cortex. This
phenomenon was observed both in wild-caught animals subjected to severe
social stress by their peers, as well as in animals injected with
synthetic analogues of cortisol.
This phenomenon has also been observed in humans. Jensen et al
reported in 1982 that torture victims showed long-term signs of
dementia, as well as other problems, and described their findings in
five such victims:
"Examination of torture victims throughout the world has
revealed a high incidence of late physical and neuropsychiatric
sequelae. The most prominent mental and neurologic symptoms are
impaired memory and ability to concentrate, headache, anxiety,
depression, asthenia (loss of strength), sleep disturbances, cerebral
asthenopia (aching and burning of the eyes), and sexual dysfunction.
These conditions are present in other conditions in which brain atrophy
or intellectual impairment or both are frequent findings.
"We recently examined five young men subjected to to various forms
of torture years earlier. These previously healthy young men (mean age
31 years) had all been tortured severely for from two to six years.
Similar mental and neurologic symptoms developed in all of them
immediately or shortly after torture; these symptoms persisted
unaltered until examination (an average of four years later)...
Computerized axial tomography (CT scans) showed definite cerebral
atrophy that was cortical in four men and central in one...
"The symptoms and signs in the present cases were in many ways
comparable to those seen in survivors of World War Two concentration
camps. Although the social and mental complications in concentration
camp survivors were initially considered to be transient, later
follow-up studies showed that signs of dementia occured in a high
proportion of cases 10 to 20 years after detention (Thygesen 1970). The
same long-term effects with signs of irreversible brain damage may
occur in today's torture victims..." (Rasmussen 1980, page 1341).
Alzheimer's patients have also been found to have hippocampal
atrophy whose severity correlated with high cortisol levels (DeLeon
1988), and people with depression have been found to have enlarged
ventricles and greater cognitive impairment if their cortisol levels
were elevated.
Starkman et al (1992) studied the effects of chronic excess cortisol
on brain function and hippocampal atrophy. They found hippocampal
atrophy that was correlated with the amount of cortisol in the
patient's blood, just as was found in Alzheimer's patients (Starkman
1992). In their conclusions they briefly discuss these effects as
observed in various studies:
"Significant correlations between elevated cortisol levels
and severity of hippocampal atrophy have been reported in patients with
Alzheimer's disease, as well (De Leon 1988). In a broader context, it
should be noted that the role of cortisol in cognitive dysfunction
likely extends beyond its specific effects on the hippocampus. For
example, CT scans revealed ventricular enlargement and cortical atrophy
in patients with yhypercortisolism due to Cushing's disease (Momose
1971). In primary depressive disorder, patients with abnormally high
cortisol were more likely to have larger ventricles, as measured by
ventricle to brain ratios (VBRs), and those patients with large VBRs
demonstrated greater global cognitive impairment." (page
764)
Cortical atrophy and ventricular enlargement are two characteristics
commonly found in what is called "AIDS Dementia Complex" (Robbins
1996). Patients with Cushing's Disease have also been found to develop
meningitis, due to cortisol-mediated immunosuppression, which is
another common neurological complication in people diagnosed HIV
positive (Britton 1975).
While cortisol has been studied the most, epinephrine, the other
major hormone released in times of stress, also causes brain atrophy
and impaired brain function, as has been indicated by controlled animal
experiments. Gold (1984) performed such an experiment using epinephrine
injections:
"a single injection of epinephrine results in long lasting
change in brain function... The findings suggest that some hormonal
responses may not only regulate neuronal changes responsible for memory
storage but may also themselves initiate long-lasting alterations in
neuronal function." (p. 379)
There are also likely other mechanisms by which this brain damage
occurs that are not yet understood, but no matter what the mechanism,
the effects appear to be swift and often irreversible.
Robert Sapolsky authored an article published in Science that
reviewed the literature on the effects of stress in the brain (Sapolsky
1996). A number of direct quotes from this review follow:
"Glucocordicoids (GCs) like cortisol, along with
epinephrine and norepinephrine, are essential for surviving acute
physical stress (evading a predator, for example) but they may cause
adverse effects when secretion is sustained.
"Excessive exposure to GCs has adverse effects in the rodent brain,
particularly in the hippocampus, a structure vital to learning and
memory (McEwen 1992, Sapolsky 1994)... Over the course of weeks, excess
GC reversibly causes atrophy of hippocampal dendrites, whereas as GC
overexposure for months can cause permanent loss of hippocampal
neurons. Although studies suggest that similar effects can occur in the
brains of primates (Magarinos 1996, Sapolsky 1990, Uno 1989), until
recently there has been no evidence (except perhaps Jensen et al, 1982)
for GC induced damage in the human. Some new exciting studies present
such evidence.
"A first example by Sheline and colleagues concerns major depression
(Sheline 1996). Approximately half of depressed patients studied
secrete abnormally high amounts of GCs... The authors of the new study
report MRIs with far more resolution than in previous studies and have
excluded individuals with neurologic, metabolic, or endocrine diseases.
They have found significant reductions in the volume of both
hippocampi... The authors ruled out alcohol or substance abuse,
electrocunvulsive therapy, and current use of antidepressants.
Remarkably, there was a significant correlation between the duration of
the depression and the extent of atrophy.
"A similar relation was seen in patients with Cushing's syndrome
(where) there is bilateral hippocampal atrophy (Starkman 1992)... The
extent of GC hypersecretion correlated with the extent of hippocampal
atrophy, which also correlated with the extent of impairment in
hippocampal dependent cognition...
"In Vietnam combat veterans with post traumatic stress disorder
(PTSD), Bremner et al (1995) found a significant 8% atrophy of the
right hippocampus, and near significant atrophy in the left. In
(another study) Gurvits et al. (1996) also examined Vietnam veterans
with PTSD and found significant 22 and 26% reductions in volumes of the
right and left hippocampi. Finally, in another study... Bremner et al
(1996) found a 12% atrophy in adults with PTSD due to childhood
abuse... These studies controlled for age, gender, education, and
alcohol abuse... In the studies by Bremner.. there were nearly as large
(but non-significant) reductions in volumes of the amygdala, caudate
nucleus, and temporal lobe...
"How persistent are these changes? Although the Cushingoid atrophy
reverses with correction of the endocrine abnormality (excess
cortisol/GC production), in the PTSD and depression studies, the
atrophy occurred months to years after the trauma or last depressive
episode... Thus, these changes could represent irreversible neuron
loss." (Sapolsky 1996, pages 749-750)
III C. Stress and Social Isolation's Effects on Mortality
Large, prospective clinical trials of the general population have
found that people with low levels of social support have between double
and triple the death rates of people with the highest levels of social
support (House 1988, Berkman & Syme 1979). In addition, socially
isolated people have reduced numbers of T-lymphocytes (Kennedy 1988,
Kiecolt-Glaser 1984, 1991), as do socially isolated non-human primates
(Sapolsky 1997). These types of results are extremely consistent and go
back for decades in the medical literature. In 1956, for instance,
socially isolated people were found to have much higher rates of
tuberculosis, even when they lived in wealthy neighborhoods (Holmes
1956). It is worth noting that tuberculosis is an "AIDS defining
illness", so these people would have been diagnosed with AIDS if they
tested positive on the HIV antibody tests.
The effects of social support on survival of cancer has been
examined by many researchers, as well. In all eight prospective studies
found by this author in which levels of social support were compared
among cancer patients, increased survival was observed in people with
higher levels of social support. These increases were statistically
significant in seven of the eight studies (Cassileth 1988, Colon 1991,
Eli 1992, Goodwin 1987, Maunsell 1995, Reynolds 1990, 1994,
Waxler-Morrison 1991). Similar results for heart disease have also been
found in a large number of studies (Ornish 1998).
Perhaps the most tragic findings regarding social support and human
contact involve childhood development. Infants raised in severely
understaffed Romanian orphanages have been found to have extremely high
rates of developmental disorders and very high death rates (Carlson &
Earls 1997, Rosenberg 1992).
Social Support and Survival of Cancer
Cancer patients with high levels of social support have as much as
double the survival rates as those with low levels of social support
(Berkman & Syme 1979, Colon 1991, Reynolds 1994), Every prospective
study looking at this issue found higher survival rates for cancer
patients with higher levels of social support (Cassileth 1988, Colon
1991, Eli 1992, Goodwin 1987, Maunsell 1995, Reynolds 1990, 1994,
Waxler-Morrison 1991). Social support interventions were also found to
increase survival in two of three studies where a group of cancer
patients receiving a social support intervention was compared to a
control group (Fawzy 1993, Gallert 1993, Spiegel 1989). Further weight
was added to these results by the fact that the two studies with
statistically significant results (Fawzy 1993, Spiegel 1989) were also
those that used randomized group selection, giving them much more
external validity than the other, nonrandomized study by Gallert et al.
(1993). Siegel et al. (1989) found that women with late stage breast
cancer randomized to receive social support group interventions lived
nearly twice as long, and Fawzy et al (1993) found that only three of
34 melanoma patients randomized to receive group education and support
intereventions died after seven years compared to ten of 34 who did
not. there was also a trend for decreased recurrence, with seven
recurrences in the group receiving group interevention compared to
thirteen in the control group.
III D. Social Support, Human Contact, and Childhood
Development
One of the great tragedies of the 20th century has been the
suffering of children in Romanian orphanges that occurred under the
rule of Nicolae Ceausescu. Two different teams of researchers have
studied these children and come to heart rending conclusions. The
children have suffered extremely high rates of developmental delay,
mental retardation, delirium, and death. Because these children
received adequate food, clothing, shelter, and medical care when sick,
the researchers concluded that these children suffered and died because
of lack of physical and emotional contacts during their infancy. The
first quotes are from a letter published in JAMA in 1992 (Rosenberg
1992).
"Since the downfall of Nicolae Ceausescu's communist regime
in Romania in December 1989, several almost barbaric institutions for
children have been discovered throughout the country. Because of
draconian probirth policies implemented by Ceausescu coupled with
Romania's status as one of the poorest countries in Europe, children
were frequently abandoned by their parents and placed in state-run
orphanages. As a result, approximately 40,000 abused and neglected
children languish in these orphanages...
"Prior to 1989, it was estimated that 35% of these children died
every year. During September of 1991 we conducted a neuropsychiatric
assessment of the entire population of one of these orphanages. One
hundred and seventy patients resided in this institution, and all had
been declared 'irrecuperable'.
"The orphanage was severely understaffed... This understaffing
resulted in such minimal child-staff interaction that 75% of the
children did not know their own name or age... It should be noted,
however, that the director and many of the attendants had a true desire
to help these children but did not have the means, or the training, to
do so... 85% of the children had no family contact whatsoever." (page
3489)
The researchers report the results of their neurospychiatric
assessment in table 1 on page 3489. They found that fully 94% of the
children had developmental language and speech disorders, 40% were
mentally retarded, 26% had muscular atrophy, 22% were "completely
immobile", 14% suffered from delirium, 12% had epilepsy, 10% had
autism, and 4% had psychosis.
Another description of these children is given by a husband and wife
team from Harvard Medical School and School of Public Health, Mary
Carlson and Felton Earls (Carlson & Earls 1997). Their analysis is both
moving and comprehensive, and extended quotes from their work
follow.
"The situation of infants and children living in
state-operated residential institutions in Romania provides a setting
in which the consequences of severe social deprivation can be examined.
These children experience a form of social care in which their medical
and nutritional needs are met, but but their social and psychological
needs are not. We believe it is scientifically and ethically imperative
to analyze the developmental deficits of such children within the
context of the social and material resources available to them... Study
of the defecits or capacities of the decontextualized child can lead to
invalid attributions of intrinsic causation within the child (eg. genes
for temperament or IQ)...
"Studying children in a situation of extreme deprivation provokes
such a strong reaction that pursuing an ethical voice to govern one's
work would seem crucial. We intend to... become advocates for these
children at the same time that we assess the consequences of their
living conditions...
"The demonstration of direct relation between tactile modality and
social deprivation was established in the laboratory of Henry Harlow
where it was shown that... tactile (but not visual or auditory)
deprivation was a critical determinant of the autistic-like behavioral
syndrome that resulted from early social deprivation. These studies
were continued by Mason and many others, including one of the authors
of this article." (pp. 419-420)
The authors go on to give a detailed account of the mechanisms by
which touch induces healthy responses in brain neurotransmitters,
receptors, and neuronal development, and go on to describe how
increased cortisol (glucocorticoids) can inhibit this process. They
then describe the condition of these children, and outline a small
program that successfully reversed much the damage that had been
done.
"The muteness, blank facial expressions, social withdrawal,
and bizarre stereotypic movements of these infants bore a strong
resemblance to the behavior of socially deprived macaques and
chimpanzees. Most of the children... had experienced severe
tactile/social deprivation due to the high child:caretaker ratios and
custodial rearing practices... we discovered an early enrichment
program..., organized by an American psychologist, Joseph Sparling. In
this program, two groups of 2-9 month old infants were randomly
assigned to either a social/educational enrichment program with
child:caretaker ratio of 4:1 or left in standard depriving conditions
with a child:caretaker ratio of 20:1...
"In the 9 month period necessary to obtain funding, this
intervention program lost its support. Thus, after 13 months of
enrichment, children in the intervention group were once again living
in the depriving conditions. The children in the intervention group had
shown significantly accelerated physical growth and mental/motor
development compared to the control group during the enrichment period,
but 6 months after the program ended they were no longer superior to
the control children (as measured on the Denver Development Screening
Test). Measures of weight and height, head, triceps and chest
circumference, and mental and motor performance (using the Bayley
Scales of Infant Development) revealed that the intervention group had
lost the advantage gained from the enrichment experience. At this same
time, we measured cortisol levels using the non-invasive method of
saliva sampling to determine its level, diurnal variation (cyclic daily
variation), and its reactivity to a stressful event... The control
group levels can be seen (Fig 2) to rise significantly at noon,
compared to intervention group levels. Significant correlations were
found between levels of cortisol and physical growth (Denver
Developmental Scale) as well as mental and motor performance (Bayley
Scale)." (pp. 422-424)
The authors later provide a brief description of other studies
showing memory loss and brain damage (neuronal death and shrinkage of
the hippocampus) in adults who were victims of prolongued stress, and
discuss chronically elevated cortisol as a possible cause.
"This study of psychologically deprived and stressed young
children not only carries implications for deficient learning and
memory, but also may convey a life-long vulnerability to certain
psychiatric disorders. The results of this research will be compared to
clinical studies of psychiatric conditions in adults that reveal
similar factors of HPA (hypothalamus-pituitary axis) dysregulation,
hippocampal neuron degeneration, and declarative memory loss...
"The most profound similarity with the work in rodents is the
finding of significant hippocampal shrinkage in patients with
post-traumatic stress disorder. The presence of shrinkage is strongly
associated with declarative memory deficits... Both changes in
hippocampal volume and verbal memory loss have been associated with the
degree of cortisol elevation in adults with Cushing's disease. Elevated
levels of cortisol associated with memory impairment are seen in
depressed adults and adolescents, and elevated levels of exogenous
glucocordicoids administered for control of asthma have been shown to
produce memory deficits and other cognitive changes in children." (p
426)
Finally, Carlson and Earls provide the following comparison to
conditions in the United States, where child neglect is also
present.
"Although this research undoubtedly has implications for
the nature of affiliative relations in Romanian society, we are
increasingly concerned about the consequences of the growing numbers of
children under age 5 who live in poverty in this country (a rate that
has increased from 15% to 26% over the past 20 years). When this
reality is coupled with the increasing rates of maternal unemployment,
which is the objective of "workfare", and the insufficient supply of
satisfactory child care services, the enduring negative effects on
child well-being for a large segment of American society should be
appreciated." (page 426)
IV. Voodoo Hexing, Root Work, Bone Pointing, and AIDS
We have seen how stress and social isolation can cause immune
deficiency that resembles AIDS, and also how they can cause dementia
and increased rates of chronic and often fatal illnesses. The most
dramatic syndrome caused by stress, however, is a fatal wasting
syndrome that results when a "voodoo hex", is cast in certain
traditional societies. Physicians observing this phenomenon postulate
that the power of such a hex is derived from the group beliefs of the
person, their family and their society. Such syndromes are not limited
to humans, however.
Stress-Induced AIDS in Wild-Caught Baboons
A study that looked at the effects of severe stress on the health of
monkeys found that some monkeys who had been subjected to severe social
harrassment and attack from their peers showed a relentless wasting
syndrome that usually proved fatal. The authors comments were quoted at
the beginning of this paper, but bear repeating:
"Wild-caught vervet monkeys... occasionally showed a
syndrome of cachexia associated with persistent diarrhea, anorexia, and
dehydration that usually proved fatal. Those animals appeared to be
socially subordinate and to have suffered an atypically high rate of
social harrassment and attack from their peers. Two animals died as
early as one month under such conditions, and others died after six
months to 4 years in captivity...
"The fatal outcome, caused by severe prolonged social stress,
induced classic pathology associated with stress, namely gastric ulcers
and adrenal hyperplasia (adrenal hyperplasia is caused by chronic
excess cortisol secretion). In these animals we also found unique
insidious degeneration and resultant depletion of neurons in the
hippocampus... Similar degeneration was also found in cortical
neurons." (Uno 1994, page 339)
This description resembles the syndrome that is called "AIDS", as do
some of the descriptions in the articles on voodoo hexing which follow.
It is the author's hope that by seeing how much damage negative beliefs
can cause, our readers of this article will help people reintroduce
healthy beliefs, such as people diagnosed HIV-positive.
The Voodoo Hex in the Medical Literature
Walter Cannon, the renowned professor of physiology at Harvard
School of Medicine who first described the hormonal effects of the
"fight or flight" response, was also the first to publish a review of
the phenomenon that he called "Voodoo death". He compiled reports from
a number of Western-trained physicians who lived in areas of the world
where native inhabitants believed in, and practiced, this phenomenon
(Cannon 1957). These physicians attempted to rule out other
explanations for the deaths, such as poisoning. Here are a number of
excerpts from this classic article:
"Dr. S.M. Lambert of the Western Pacific Health Service
wrote to me that on several occasions he had seen evidence of death
from fear. In only one case was there a startling recovery... When Dr.
Lambert arrived at the mission (in Mona Mona in North Queensland,
Australia) he learned that Rob (the chief helper at the mission) was in
distress and that the missionary wanted him examined... He was
impressed by the obvious indications that Rob was seriously ill and
extremely weak. From the missionary he learned that he had had a bone
pointed at him by Nebo (a local medicine man) and was convinced that he
must die. Thereupon Dr. Lambert and the missionary went for Nebo,
threatened him sharply that his supply of food would be shut off if
anything should happen to Rob. At once Nebo agreed to go with them. He
leaned over Rob's bed and told the sick man that it was all a mistake,
a mere joke-indeed, that the bone had not been pointed at him at all...
That evening Rob was back at work, quite happy again, and in full
possession of his physical strength. (page 183)
"Dr. Lambert (also) wrote to me concerning the experience of Dr.
P.S. Clarke. One day a Kanaka (a local native resident) came to his
hospital and told him he would die in a few days because a spell had
been put upon him and nothing could be done to counteract it. The man
had been known by Dr. Clarke for some time. He was given a very
thorough examination, including an examination of the stool and of the
urine. All was found normal, but as he lay in bed he gradually grew
weaker. Dr. Clarke called upon the foreman to come to the hospital to
give the man assurance, but on reaching the foot of the bed, the
foreman leaned over, saying, "Yes, doctor, he will soon die". The next
day at 11 o'clock in the morning he ceased to live. A postmortem
examination revealed nothing that could in any way account for the
fatal outcome." (pages 183-184)
"Dr. J.B. Cleland, professor of Pathology at the University of
Adelaide, has written to me that he has no doubt that from time to time
the natives of the Australian bush do die as a result of a bone being
pointed at them, and that such death may not be associated with any of
the ordinary lethal injuries... In his letter to me he wrote,
'Poisoning is, I think, entirely ruled out in such cases.' " (page
184).
Cannon also provides the following eloquent description of how the
reaction of the hexed person's community and family combine to multiply
the force of the words of the medicine man. These words emanate from
the early part of this century into ours with prophetic power. The
description is chilling in its similarity to what often happens in
people diagnosed HIV positive.
"Now to return to the observations of W.L. Warner regarding
the aborigines of northern Australia. There are two definite movements
of the social group, he declares, in the process by which black magic
becomes effective on the victim of sorcery. In the first movement, the
community contracts; all people who stand in kinship relation with him
withdraw their sustaining support. This means everyone he knows -all
his fellows- completely change their attitudes towards him and place
him in a new category... The organization of his social group has
collapsed, and, no longer a member of a group, he is alone and
isolated. During the death illness which ensues, the group acts with
all the outreachings and complexities of its organization and with
countless stimuli to suggest death positively to the victim, who is in
a highly suggestible state. In addition to the social pressure upon
him, the victim, himself... through the multiple suggestions which he
receives, cooperates in the withdrawal from life. He becomes what the
attitude of his fellow tribesmen wills him to be. Thus he assists in
committing a kind of suicide.
"Before the death takes place, the second movement of the community
occurs which is to return to the victim in order to subject him to the
fateful ritual of mourning... The effect of the double movement in the
society, first away from the victim and then back, with all the
compulsive force of one of its most powerful rituals, is obviously
drastic. Warner (1941) writes:
"'An analogous situation in our society is hard to imagine. If all a
man's near kin, his father, mother, brothers, sisters, children,
business associates, friends, and all other members of the society
should suddenly withdraw..., refusing to take any other attitude but
one of taboo and looking at the man as already dead, and then after
some little time perform over him (death rituals), the enormous
suggestive power of this two-fold movement of the community can be
somewhat understood by ourselves.'" (page 185)
Perhaps an analogous situation is not so hard to imagine occurring
in our society, after all, given the similarities between what is
described above and what is experienced by someone diagnosed "HIV
positive". A study of the effects of curses and hexes on family
dynamics was published in the American Journal of Psychiatry in
November, 1970 (Raybin 1970). The author provided detailed case
histories of four families in which a member of the family had been
"cursed" or "hexed", focussing on the emotional and psychological
affects of these curses on the individuals. These hexes often resulted
in severe emotional despair and repeated suicide attempts, as well as
disruption of social ties. He states in his conclusion that:
"The four clinical vignettes have illustrated family
mythology in general, and curses and prophecies in particular, whether
they be direct or implied. These communications can effectively disrupt
or devastate a family, or they can serve to maintain a precariously
balanced equilibrium... The dynamic issues involved in myths and curses
vary with the individual family." (p. 620)
A more recent article by Meador appeared in the Sothern Medical
Journal in 1992. Dr. Meador gave case histories of two people who
received death-hexes from medicine men. The two men had very different
outcomes, apparently due to the ability of one of their physicians to
alter the belief structure of the patient. One of the most astounding
elements of his case histories is that one of the men was a Haitian
given a death hex by a medicine man, while the other was an American
given a death hex unintentionally because of a false positive liver
scan which appeared to indicate widespread metastatic cancer, when in
actuality there was none. The "medicine man" who placed this second hex
was Dr. Meador, himself, the author of the article.
"The first patient, a poorly educated man near death after
a hex pronounced by a local voodoo priest, rapidly recovered after
ingenious words and actions by his family physician. The second, who
had a diagnosis of metastatic carcinoma of the esophagus, died
believing he was dying of widespread cancer, as did his family and his
physicians. At autopsy, only a 2 cm nodule of cancer in his liver was
found." (page 244)
The actions of the physician whose patient made a dramatic recovery
were truly remarkable, and involved something more akin to theatre,
rather than medical treatment:
"The patient had been ill for many weeks and had lost a
large amount of weight. He looked wasted and near death. Tuberculosis
or widespread cancer was considered the likely diagnosis. The patient
refused to eat and continued a downward course despite a feeding
tube.
"He soon reached a stage of near stupor, coming in and out of
consciosness, and was barely able to talk. Only then did his wife ask
to speak with Dr. Daugherty privately... The wife told him that about 4
months before hospitalization, the patient had an argument with a local
voodoo priest. The priest summoned him to a local cemetery late one
night, and... annonced that he had "voodooed" him, that he would die in
the very near future.
"Dr. Daugherty spent many hours that evening pondering... what he
could do to save this moribund man. The next morning he gathered 10 or
more of the patient's kin at the bedside; they were trembling and
frightened to even be associated with this doomed man. Dr. Daugherty
announced in his most authoritative voice that he now knew exactly what
was wrong. He told them of a harrowing encounter at midnight the night
before in the local cemetery where he had lured the voodoo priest. Dr.
Daugherty reported that he had... choked the priest against a tree
nearly to death until the priest described exactly what he had done.
Dr. Daugherty announced to the astonished patient and family "That
voodoo priest made some lizard eggs climb down into your stomach and
they hatched out some small lizards. All but one of them died leaving a
large one which is eating up all of your food and the lining of your
body. I will now get that lizard out of your sustem and cure you of
this horrible curse." With that he summoned the nurse, who had, on
prearrangement, filled a large syringe with apomorphine (a powerful
emetic for inducing vomiting). With great ceremony, Dr. Daugherty
squirted the smallest amount of clear liquid into the air and lunged
towards the patient, who by now had gathered enough strength to be
sitting up wide-eyed in the bed. Although he pressed himself against
the headboard trying to withdraw from the injection, Dr. Daugherty
delivered the entire dose of apomorphine. With that he wheeled about,
said nothing, and dramatically left the ward.
"Within a few moments the patient began to vomit. When Dr. Daugherty
arrived at the bedside the patient was retching, one wave of spasms
after another. His head was buried in a metal basin. After several
minutes of continued vomiting and at a point judged to be near its end,
Dr. Daugherty pulled from his black bag, carefully and secretively, a
live green lizard. At the height of the next wave of retching, he slid
the lizard into the basin. He called out in a loud voice, "Look what
has come out of you. You are now cured. the voodoo curse is
lifted."...
"The patient's eyes widened and his mouth fell open. He looked
dazed. he then drifted into a deep sleep within a minute or two, saying
nothing. The sleep lasted until the next morning. When he awoke, he was
ravenous for food. Within a week the patient was discharged home, and
soon regained his weight and strength. he lived another 10, or more,
years, and died of an apparent heart attack. No one else in the family
was affected...
"I reflected on this case for many years. I could make no sense of
it until I read Walter Cannon's classic paper, "Voodoo Death"." (pages
244-245)
Dr. Meador goes on to describe Cannon's paper, and summarizes the
aspects necessary to cause a voodoo hex to succeed, including deep
belief in the hex by the victim, the family, and the community, as well
as initial social isolation followed by expectant preparations for
death. Before describing the American man who died after a false liver
scan, he asks the following question:
"Even if such a strongly held belief could cause death,
most Westerners think of hexing as a bizarre superstitious practice
limited to ignorant people. It has no pertinence to modern Western
society... does it?" (page 245).
This patient died with only a small patch of pneumonia and a small
nodule of cancer in his liver. His wasting syndrome was unresponsive to
antibiotics, and he died "thinking that he was dying of cancer, a
belief shared by his wife, her family, his surgeons, and me, his
internist" (page 246).
Meador asks yet another question of the reader:
"If the first patient was cured of a hex, did the second die of a
hex?".
Some of the descriptions of the first patient's illness bear
remarkable resemblance to AIDS. The patient "had lost a large amount of
weight". He looked "wasted and near death". Tuberculosis or widespread
cancer was considered the likely diagnosis, and tuberculosis is one of
the most common "AIDS-defining illnesses". Several types of cancer are
also considered AIDS-defining. The patient "continued a downward course
depsite a feeding tube", showing that malnutrition alone did not
explain his demise. He also suffered from severe dementia.
Kaada (1989) presents a review of research into the opposite of the
placebo effect, dubbed the "nocebo" effect. This is the negative effect
on health associated with harmful beliefs and psychological stressors.
He comments on voodoo hexing and the ability to resist its power as
follows:
"In its most extreme, nocebo-stimuli may cause death, as in
voodoo-death in primitive societies, an example of the fear-paralysis
reflex. Whether the outcome is positive or negative is determined,
inter alia, by the subject's possibility of coping with the
situation."
This could explain why some people live for years after an HIV
diagnosis with no ill health, while others succomb in much shorter
time.
Also quoted in the introduction of this paper was a brief quote from
a special article to the Lancet (Milton 1973). Dr. Milton was an
Australian physician who commented as follows:
"There is a small group of patients in whom the realisation
of impending death is a blow so terrible that they are quite unable to
adjust to it, and they die rapidly before the malignancy seems to have
developed enough to cause death. This problem of self-willed death is
in some ways analogous to the death produced in primitive peoples by
witchcraft ("pointing the bone")...
"Throughout questioning his answers are minimal, and as soon as the
questions stop he is silent... He does not have the obvious signs of
extreme anxiety or fear. Blood pressure, pulse, and respiration remain
normal... Within a month of the onset of this syndrome the patient will
almost certainly be dead. If a necroscopy is carried out, ... there
will often appear to be no adequate explanation for the cause of
death.
"A similar syndrome is associated with the custom of "pointing the
bone" in primitive societies... Pointing the bone is essentially a
magic spell cast by a witch-doctor into the spirit of the victim. The
Australian aborigines believe that all disease is the result of
disharmony of the spirit. If the spirit can be disturbed by such
spells, illness should follow... Any hope of escape becomes
unthinkable, and, provided the victim holds the necessary beliefs,
death follows the witch-doctor's spell. Obviously, the method is
ineffective against those who do not hold the necessary beliefs...
"The Melanoma Clinic at Sydney hospital (where Dr. Milton worked)
often admits patients with incurable melanoma who are beginning to show
all the features of self-willed death. As soon as the patient feels
that something can be done to help him, ... his mental attitude
improves. This improvement may be so dramatic that there is danger of
the medical staff believing that various treatments offered ... have
prolonged the patient's life by an organic effect." (pages
1435-1436)
This last description could explain the widely propogated belief
that new protease inhibitor "cocktails" are prolonging people's lives,
especially since controlled clinical trials do not show reduction in
death rates. This topic will be addressed in a later section.
Another paper on hexing appeared in the Journal of the American
Medical Association in 1975 (Cappannari 1975). This case was different
from other in that it occurred in the United States, and did not
involve a professional "witch doctor" but rather a woman considered to
have magical powers. The person hexed was the woman's duaghter-in-law,
which adds a new dimension to the classic tension between mothers and
women who marry their sons. It all began when the woman in question
found she was pregnant and her mother in law, who "did not like her"
told her that her baby would be born dead.
"The patient maintained that she did not worry about this
threat, in spite of her mother-in-law's reputation in the community as
being a "bad lady" who "cast spells".
"In September the baby was born dead at full term. that evening the
patient experienced abdominal pain, nausea, vomiting and diarrhea. In
November (with persistence of her symptoms) she went to a local
hospital and a diagnosis of sickle cell trait was made (which
ordinarily produces no symptoms). Continued symptoms precipitated the
first admission to Vanderbilt University Hospital in January 1972, when
regional enteritis was diagnosed on the basis of findings on x-ray and
biopsy. In addition to treatment with corticosteroids and sulfonamides,
therapy with isoniazid was begun.
"In June, the patient and her husband separated. She noted that "he
was tired of me being sick all the time"... He said that "he didn't
want to leave, but something had power over him and was making him do
it". In September (one year after the still-birth) the patient was
readmitted because of weight loss. Dosages of corticosteroids were
increased, and she was tube-fed. When she left the hospital her weight
was 47kg (105 lb) compared to her normal range of 63 to 68kg (140 to
150 lb) before pregnancy. (p. 938)
"The patient learned formally that a hex had been placed on her by
her mother-in-law, and went to an "herb doctor" who told her to "throw
away all she owned of her husband and his mother's possessions in order
to free her of the hex" (p. 938) Unfortunately this did not work and
she "began to doubt that the hex was gone". Soon she learned of a new
hex placed on her.
"In July, (nearly two years after the still-birth) her husband
served her with divorce papers and said "I must do this... I'm under
another power, and besides, you will die in January anyway." He
repeated this prophecy to her before remarrying in December, when he
disappeared from her life. (According to the patient's mother his
present wife is said to be losing weight). This dire prophecy was given
additional weight by a physician who told the patient she would always
have her disease and that it would eventually "kill" her.
"Since her weight had fallen to 33 kg (72 lb - about half of her
normal weight) and she had begun to look as if she might die, she was
readmitted to the hospital. At that time a psychiatric opinion was
requested. She was laconic (spoke little), appeared depressed, but was
not anxious or psychotic. Concerning the hex, she said "I don't know if
I am going to die or not, but I believe my stomach trouble was caused
by her spell."... She would not participate in the interview, but let
her mother answer questions. It was clear her mother believed in the
hex and in the validity of the gypsies as much or more than her
daughter... But then she added with emotion, "She will not die until
the Lord is ready for her. His power is the greatest of all."...
"The psychiatric consultant suggested that a fundamentalist black
Baptist minister (who was also involved in voodoo) talk with the
patient. He briefly interviewed the patient and informed her that the
hex was "all in her head". Then he read biblical passages concerning
the casting out of devils, whereupon she entered a hypnoid-like state
from which she later emerged, saying that she felt better. The next day
she said that she had "forgotten" about the hex and did not wish to be
reminded of it... Her mother said she was angry about people bringing
up "things which were upsetting her"...
"She gained weight. Her spirits improved greatly after February 1
(she was predicted to die in "January"), although she continued to have
abdominal cramping... She observed that her hex was never real, that
she only had "regional enteritis," and concluded "anybody can be
fooled". (pp. 938-939)
The authors provide some brief comments:
"It seems clear that this patient and her omnipresent
mother were torn between two distinct systems of belief: one, the
supernatural, including especially a belief in hexing.., and the other,
involving contemporary allopathic medicine...
"It is pertinent that the mother-in-law had a reputation for casting
spells and was viewed in the community as a "bad-lady"... This case is
complicated by the patient's having regional enteritis. Although there
is some controversy about the psychosomatic aspects of this disease,
there is evidence that it is related to psychosocial stress and that
psychodynamic factors are of etiological importance. Several
independent reports emphasize the role of emotional stress in the
precipitation of symptoms." (p. 940)
There was evidence of psychosocial stress with the chaotic and
disruptive marital situation, as well as severe object loss with the
birth of the dead infant... Thus, the clinical picture is also
consistent from a psychosomatic viewpoint even out oif context of the
hex, which in itself may be looked on as a form of psychic stress.
One evidently adverse suggestion by a physician to the patient to
the effect that she would not recover was all too similar to her
husband's prophecy that she would die in January. It constituted a
blatane example of the inadvertent hexing sometimes performed by
physicians...
If this case were classic of hexing, with total belief by the
patient (and mother) in magical powers of the mother-in-law, the
patient should have died as scheduled... A person may, of course,
subscribe to more than one belief system at a time, even when such
systems are logically or empirically contradictory. Most of the medical
literature on voodoo deals with voodoo death. The mechanisms that cause
death are still under discussion, but the full acceptance of witchcraft
by the victims is characteristic in these reports. In this case, the
persons involved subscribed in part to two differing systems of disease
causation and cure. Indeed, this vacillation may have prevented this
patient's death.
While it is certainly possible that "hexing" had nothing to do with
this patient's illness. The fact that her symptoms began improving
immediately after a spiritual intervention induced a "hypnoid-like
state" and then again after she outlived her predicted date of death,
however, suggests otherwise. The physicians involved in her care
evidently agree, as their comments make clear.
In this case the hex was more vague, and death did not result.
Instead, a period of severe chronic illness was created, that lasted
over two years.
Campinha-Bacote provided an excellent overview of "voodoo illness"
in an article in the journal, Perspectives in Psychiatric Care in the
winter of 1992 (Campinha-Bacote 1992). He also describes, in much more
detail than the other authors cited so far, what the voodoo religion is
like and who practices it.
"Voodoo illness involves a belief that illness or death may
come to an individual via a supernatural force. Other terms for this
illness include "root work", a "hex", "conjuring", a "trick", "black
magic", "conjure illness", "hoodoo", "voodoo", "witchcraft", or a
"spell". Voodoo illness is classified as a culture-bound syndrome, that
is, as an illness that varies from culture to culture...
"Voodoo is derives from the word vodun, which means "spirit". In the
African Haitian belief system, God or "Gran-Mat" is acknowledged as
creator of heaven and earth. this Gran Met delegates certain spirits
... to serve as intermediaries between God and man. The voodoo priests
or priestesses practice sorcery and conjuring, as well as the voodoo
religion, in an attempt to maintain harmony with these spirits. the
priests are expected to be knowledgable about black magic in order to
counteract malignant forces."
The author then goes on to describe how the voodoo religion affected
and interacted with the culture of African slaves in America, and how
this has affected current day beliefs in some members of African
American communities. After this, she describes common symptoms of
"voodoo illness".
"Conjure doctors and folk healers report that symptoms
typically fall into two broad categories: gastrointestinal and
behavioral. Gastrointestinal symptoms include diarrhea, nausea,
vomiting, food not tasting right, and "falling off" (unexplainable
weight loss). Behavioral symptoms include bizarre behavior, delusions
and hallucinations...
"Generally, the victim believes in the power of the person who
administered the hex, and realizes he/she has been hexed or at least
suspects it.
"Left untreated, voodoo illness can progress to voodoo death. While
voodoo death is not surprising to the folk healers who understand the
belief system that victims hold, to Western health workers such death
is a shocking and mystical phenomenon... (In the United States) hexing
practices are no longer restricted to rural isolated communities ...
Nor is a belief in voodoo illness restricted to the poor, uneducated,
or lower socioeconomic classes. Indeed, the Western health worker is
more likley to encounter (this phenomenon) than ever before.
"Generally speaking, Western medicine treats these individuals as
having either psychological or physiological problems. The spiritual
and cultural dimensions of the client's presenting problem are often
overlooked, except by the folk medicine practicioner, who sees no
distinction between the mind, body and spirit... Western medicine
classifies voodoo illness under the heading of psychiatric disorders,
listing diagnostic criteria in the Diagnostic and Statistical Manual of
Mental Disorders, 3d ed., Revised (DSM-III)."
Campinha-Bacote also provides a brief description of several
proposed mechanisms.
"Western medicine has posed several different etiological
explanations for voodoo death. As early as 1942, Cannon (1957)
explained magical death in terms of the response of the autonomic
nervous system to extreme emotion; in such cases death was thought to
be caused by the exhaustion of the sympathetic nervous system. In
contrast, Richter (1957) believe death was due to the excessive
response in the parasympathetic nervous system, which was a result of
extreme feelings of helplessness. Lex (1974) proposed that voodoo death
involves stimulation of both the parasympathetic and sympathetic
nervous systems. Other explanations of voodoo death have included the
power of suggestion and pharmacological poisoning."
The next study to be reviewed documents similar types of severe,
chronic illnesses, which the author feels were caused by a voodoo hex
and the powerful beliefs that were generated.
Golden (1977) provided a description of voodoo hexing that he
observed while serving as a peace corps volunteer. His article was
published in the American Journal of Psychiatry. Although the author is
not a physician, he provides perhaps the best research summary of all,
as well as an excellent discussion comparing the "hexing" that occurs
in a traditional society with similar phenomena that occur in Western
society. He describes both the practice of hexing as he observed it, as
well as the effects of such a curse on someone he knew quite well, his
landlady.
"As a Peace Corps volunteer teacher I spent two years in
West Africa. There I lived in an area where the voodoo cult originated,
and where cursing and hexing were actively practiced. Vodu in the Ewe
dialect of the West african village where I lived means "one to be
feared"...
"Disobedience of tribal custom is punished by fines, disgrace,
banishment, or, when the infraction is particularly serious, by curse
death, which means certain death to the victim. My landlady was fatally
affected by such a curse... For a year or so she had been suffering
from severe and acute attacks of abdominal pains. She had had
exploratory surgery performed by European doctors ... Towards the end
of my Peace Corps tour I noticed that she was losing weight and saw her
less and less often. When she died, she was buried at the outskirts of
the cemetery. When I asked a friend of mine why, I was told that she
had been cursed by one of the yehwe, one of the major cults of the
village, because she had been an adulteress.
"For the curse to be successful, the victim has to be made aware
that he or she has been cursed... Death comes slowly but surely over a
period of months. When the curse becomes known, the victim's family and
friends as well as the entire community withdraw their support. The
victim becomes an outsider to the few cohesive and organized activities
of the village ...
"Feeling Hopeless and helpless, the victim withdraws, thus
furthuring his or her isolation ... Although the threat to life is not
acute, the emotional strain of feeling hopeless is evident over an
extended period of time. The victim fatigues easily in order to
conserve the energy needed to protect threatened resources from the
emotionally overstressful situation. The victim remains in a state of
chronic fatigue and melancholia, and ... he or she simply dies.
"Unlike the curse death in this village, curse deaths in other parts
of Africa have been reported to occur immediately after the curse has
been placed... When cursed with all the drama of the ceremony, the
victim dies suddenly. Many physicians have speculated on the
physiological basis of such curse death as well as other types of death
caused by emotionally stressful situations...
"In the village I lived in, belief in the power of such hexes is
wholehearted. In areas where the belief is weaker, the victim seems
more amenable to treatment... when curses and hexes are effective,
overdependency and a feeling of powerlessness also occur...
"Furthur, psycho-physiological forms of giving up are often seen in
(Western) hospitals. Patients ... told of their imminent death have
been known to react by withdrawing, eating and drinking poorly, and
socially isolating themselves; at times these reactions result in
premature death." (pp. 1425-1426)
A Likely Explanation for the "Course" of AIDS
Based partly on this evidence, a compelling argument can be made
that much of what we call AIDS is a self-fulfilling prophecy which
might happen as follows:
a) The severe, acute psychological stress of being diagnosed "HIV
Positive" is quickly transformed into a severe, chronic psychological
stress of living with a prediction of a horrifying decline that could
start at any time. This causes a suppression of the immune system, with
selective depletion of CD4 T-cells. In addition, people are more likely
to be tested for HIV when there is already some health problem present,
so that the psychological stress adds to significant stress due to the
illness already present. These illnesses are often severe and chronic
in nature. It is not necessary, however, for prior illness to be
present. These factors have been studied in healthy people where they
create the very same immunosuppression and immune dysregulation that
may later be called "AIDS".
b) After testing positive, people are often put on a variety of
powerful medications as a preventative measure and/or for treatment of
actual infections. These include long-term regimens of the most potent
broad-spectrum antibiotics, as well as "antiretroviral" agents like
AZT, ddI, ddC, and protease inhibitors. Although the toxicities of the
"antiretrovirals" have been outlined elsewere, antibiotics also often
have debilitating side effects which are easily blamed on HIV,
including immune suppression. Perhaps more significantly, they lead to
a complete disruption of the normal microbial flora present in the
gastrointestinal system. The healthy balance of flora in the
gastrointestinal tract and elsewhere in the body is one of the most
important protectors against infection (8). If this is not enough,
these antibiotics also often lead to the development of
multidrug-resistant strains of bacteria, fungi, and viruses, which can
later ravage a person's system, especially if their immune system is
not functioning very well.
c) Once the immune system starts to crack under the strain of the
emotional stress, previous health problems (if there were any), and
disrupted natural defenses, the diagnosis of AIDS is made. If not
already on "antiretrovirals", then the person will now definitely be
started on them, with all of the toxic effects.
d) The new "cocktails" are to be given until the patient dies, with
no exceptions, if possible. This is because of the theory that mutant,
drug resistant, HIV will flourish if they go off of their treatment.
Patients who abandon "antiretroviral" treatment would then,
theoretically, be a public health threat because they might infect
others with their superpowerful, mutated "HIV". Thus, aside from
considering their own health, the patient has a larger social
responsibility to stay on the "cocktail", no matter how debilitating
the "side effects" are. It is heavily stressed that the patient must
not miss a single dose, if at all possible. When the patient's health
begins to fail, the failure is blamed on the effects of this "mutated
HIV", possibly due to the patients poor compliance. Rarely are the drug
toxicities and complications caused by the treatment held
responsible.
Some people seem to respond well (at least temporarily) to these
"antiretroviral" regimens. The reasons for this are unclear, but may be
related to:
1) Direct actions of the drugs on many possible pathogens including,
possibly, HIV.
2) Toxic substances have been observed to stimulate the release of T
cells from the bone marrow, before eventually exhausting the supply and
causing immune cell depletion and anemia. The initial rise in CD4
counts seen in this case would be interpreted as improved immune
function when it is actually the beginning of immune exhaustion.
3) Relief of the severe psychological stress due to the powerful
belief that these drugs are "life-saving". This is often reinforced by
rising CD4 counts and falling "viral load", which are doubtful and
non-specific markers of actual health.
Matt Irwin MD is a family practice resident who wrote several literature
reviews on HIV and AIDS while attending medical school at George Washington
University. He also holds a Master's degree in social work from the Catholic
University of America. In addition to his interest in alternative views of HIV
and AIDS, he specializes in health promotion with nutritional, psychological,
social, and spiritual interventions, as well as classical homeopathy. He has
a practice near Washington, D.C. The above article was extracted from a
draft of his book on AIDS, and updated by the author in Feb. 2002.
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