Picture this: a person with psoriasis, standing practically naked in a cylindrical light box lined with vertical eight-foot-long ultraviolet light bulbs that form a complete enclosure. Her eyes are shielded by dark goggles to protect the corneas from UV damage, she is wearing a pillowcase over her head to protect her face. Her nipples are also shielded, as are the genitals in men. Fans whir, circulating stale basement-office air through the bowels of the medical center. When the lights come on, bathing not just the light box and the patient inside it, but also, because the top is open, the entire room with an eerie, violet glow, their intensity is ferocious, irradiating every surface of the body that is exposed to specifically chosen and particularly potent wavelengths of ultraviolet light.
The treatment is known as phototherapy. In order to prevent the skin from burning, the person comes for treatment three times a week for many weeks, and the length of exposure is gradually increased, from about thirty seconds at the beginning to maybe ten to fifteen minutes after a few weeks, depending on the patient’s skin type. Over time, the raised, red, inflamed patches of skin, which in severe cases cover large parts of the body, begin to flatten and change color, looking more and more like the person’s normal skin. When the treatment is complete, the skin looks entirely normal and clear. There are no more scaly patches.
The treatment is not a cure, however. The unsightly patches can return. Recurrent episodes are often triggered by psychological stress. Little is known about the genetic predisposition, the primary causes, or the molecular biology of the disease. It is an uncontrolled cell proliferation in the epidermal layer of the skin, but it is not cancer. The rapidly growing cells do not invade other tissues, nor does the disease result in ill health or death. It is, however, disfiguring in some cases, and psychologically debilitating. It can feel like having a plague.
I learned about psoriasis and phototherapy one day at a University of Massachusetts Department of Medicine retreat in the early 1980s. I happened to sit down for lunch with a young, cheerful-looking man who, as it turned out, was the chief of dermatology, Jeff Bernhard. We got to talking, and when he found out I ran the department’s Stress Reduction Clinic, where we taught Buddhist meditation practices to the patients (albeit without the “Buddhism”), he asked me if I knew the book Zen Mind, Beginner’s Mind, by Shunryu Suzuki.
I was amazed just to hear that he had read it and further amazed that he loved it. So we fell to talking about meditation and Zen, and about how we were offering the rudiments—and what we hoped was the essence—of just such training and practices to our patients. I saw the lightbulb go off in his head as he asked me if I thought we could train his psoriasis patients undergoing treatment in the phototherapy clinic to relax while they were in the light box.
He then described the disease and its treatment pretty much the way I have just done. He also explained that undergoing phototherapy was a very stressful experience for his patients for a number of reasons. First, the patients had to come to the hospital three times a week for very short treatments—so short that finding a parking space could take longer than the treatments themselves. Then the patient had to undress and cover his or her body with oil, a messy proposition in its own right, put on the goggles and the pillowcase, and stand naked in the confining space and stale air of the light box, the oppressive intensity of the lights roasting the skin, and motor noises filling the air.
Treatments took place only during the day, so having to do this three times a week for up to three months was a major disruption of one’s daily routine, especially if the patient had a job. Worse, they were unable to read magazines or distract themselves in the usual ways patients do when they are undergoing treatment. The whole thing had a kind of undignified and burdensome quality to it. Was there any way, Jeff asked, that what we were doing with our patients in the stress reduction clinic might help his phototherapy patients to be more relaxed and deal with the stress of their treatments in a better way? He was concerned because many of his patients stopped coming regularly even before their skin cleared. Others just dropped out entirely because the treatments were so disruptive. Perhaps, because the disease was not life-threatening, the incentive to undergo the extensive course of the treatment wasn’t so great, especially since it was usually for cosmetic reasons. Moreover, the effect of the treatment was only temporary.
Could meditation, Jeff wanted to know, make the whole experience of phototherapy more pleasant for his patients and increase their motivation for staying with the treatment protocol?
As he was saying this, and I was picturing what he was describing in my mind, light bulbs (no pun intended) were starting to go off in my own head. Yes, I replied. We could certainly teach his patients effective methods to relax while they were in the light box, and for dealing with the unpleasant aspects of the treatment. It seemed to be a perfect situation for guiding them in the practice of standing meditation, since they had to be standing in the light box anyway. That could include breathing meditation, hearing meditation, feeling-the-light-on-the-skin meditation, and watching-the-mind-get-stressed-out meditation, in short, a full spectrum of mindfulness practices tailored to the patient’s moment-to-moment experience in the light box. And I had no doubt that at least some would be more relaxed as a result and might actually enjoy their treatments more because they were engaging their own powers of attention, perhaps neutralizing some of the more onerous features causing the high dropout rates.
But we could do something even more adventurous. It struck me that the phototherapy paradigm was perfect for studying the important question of whether and how the mind might influence healing; in this case, a healing process that we could see and photograph and track over time. Why not train his psoriasis patients in these mindfulness-based methods as part of a controlled study to see whether we could detect effects of the mind itself on the rate of skin clearing? We could randomize potential subjects into two groups. In one, the patients would meditate while they were standing in the light box, guided by an audiotape designed specifically for the situation. In the other group, the patients would get the light treatments in the usual way, without meditation instructions. And, just to maximize the chance of finding something, I proposed that we include a visualization about the skin healing in response to the light as part of the meditation in the later stages of treatment, when the sessions run longer, and there would be more time to hear such instructions.
We went ahead and set up a pilot study along these lines, just to see what would happen. What we found was that the meditators’ skin cleared on average much more rapidly than in the case of the non-meditators. With this encouraging result under our belt, we set out to repeat the study to convince ourselves that it was not a fluke, and to do it with more patients and with a more rigorous study protocol. We used several different methods to rate the patients’ skin status over time, including regularly photographing their most prominent lesions and having two dermatologists rate the photographs independently, without knowing which group the patients were in, or who they were.
Again, we found that the meditators healed faster than the nonmeditators, and this time we were able to say something about how much faster. The statistics were showing that the meditators were clearing almost four times as rapidly as the non-meditators.
While only preliminary, this study points to a potential for intentional healing that could be important. We hope that other dermatologists will attempt to replicate our study and extend it beyond what we were able to do.
I like to think of the result as reflecting a potential that is inherent in all of us, one we have seen expressed over and over again in different ways in the Stress Reduction Clinic when our patients are encouraged to become active participants in their own medical treatment and health care.
The psoriasis study is an example of what is now being called “integrative medicine,” because it integrates mind-body
interventions such as meditations right into the delivery of more conventional medical treatments. In this case, the mind-body treatment (the meditation and visualization) is completely co-extensive in time and space with the allopathic treatment (the UV light). You could say that they are orthogonal to each other, occupying the same space at the same time.
It is revealing to note that the subjects in the psoriasis study did not get to take home the guided meditation tapes, nor did they practice in any formal way on their own, unlike at the stress reduction clinic, where daily practice at home using mindfulness meditation practice tapes or CDs is a required and integral part of the program. This means that even short periods of time practicing under the right conditions might have major effects on the body, and, presumably, the mind as well.
Our study on healing and the mind has a number of implications. The most obvious is that the mind can positively influence healing under at least some circumstances. Something that the psoriasis patients in the meditation group were doing or thinking or hoping or practicing was in all likelihood responsible for the faster pace of their skins’ clearing. It might have been the meditation practice itself, or the visualization, or their expectations or beliefs or intentions, or a combination of all of the above; we won’t know for certain until further studies are conducted. But whatever was underlying the accelerated skin clearing we observed, we can say it was in some way or other related to the activity of the mind.
Another implication is that participatory medicine might be a big money-saver in some instances. Our study had the built-in feature of being a de facto cost-effectiveness study. Faster healing means fewer treatments necessary to reach skin clearing, and thus fewer medical charges for the meditators.
What is more, since ultraviolet light is itself a risk factor for skin cancer, fewer treatments would mean less UV exposure, which would mean lowered risk of skin cancer as a side effect of the phototherapy treatments. And since psoriasis is an example of an uncontrolled cell proliferation, akin in some ways to cancer—in fact, certain genes that are implicated in psoriasis also seem to play a role in basal cell carcinoma—the demonstration that the mind can positively influence skin clearing raises the possibility that the much more dangerous uncontrolled cell proliferation in skin cancer might respond favorably, at least to some degree, to similar meditation practices and motivation.
Adapted from Coming to Our Senses, 2005, by Jon Kabat-Zinn, Ph.D. Reprinted with permission of Hyperion.
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