"The Power of the Whole - Exploring New Ways to Heal"

HEALTHWISE, Sutter-CHS Newsletter - September 1996

Step into Room 106 at San Francisco's California Pacific Medical Center (CPMC) and you may find a circle of women swaying to the eerie but beautiful tones of ancient folk music. The lights may be dimmed and a candle lit.

As the women dance, eyes closed, graceful and relaxed, one might never guess they are in the midst of battle. Yet this group of women has breast cancer, and they are fighting for their lives in a 12-week Arts Medicine support group hosted by CPMC's Institute of Healing. This is therapy. But unlike the traditional regimens these women are also undergoing, this treatment doesn't use needles, drugs or machines. Here, the mind is the medicine, and dance the vehicle for healing.

CPMC's Arts Medicine program, directed by Ilene Serlin, Ph.D., A.D.T.R., is one example of numerous holistic therapies, integrating right and left-brain knowledge within the mainstream health care environment. Such approaches have long been featured at places like Sutter Center for Psychiatry; yet now, these intuitive, often artistic, therapies are on a journey from the world of mental health into the realm of physiology.

Given the increasing evidence that the mind can help heal the body, advocates believe that right brain exercises-- ranging from storytelling to dance-- can stimulate the healing process. These activities offer a bridge between the mind and body, giving the human spirit a chance to join forces with traditional medicine in the quest for healing.

Already researchers have seen positive outcomes of these therapies, some scientific, some anecdotal. Such results have prompted deep philosophical questions about the nature of health, healing and disease.

"Is our responsibility simply to the cellular structure of a patient or is it to the entire person?" asks Rari Coss, director of the Sutter Wellness and Healing Network (SWAHN), a group of Sacramento physicians, nurses, and other health care professionals working to promote wellness and alternative therapies within mainstream care.

Consider the following: A study at the Medical Illness Counseling Center in Maryland found that guided imagery stimulated the production of white blood cells, our bodies' defense against cancer cells.

At the Cancer Counseling and Research Center in Dallas, Texas, O. Carl Simonton, M.D., concluded that terminally ill cancer patients who practiced guided imagery while undergoing radiation treatment lived twice as long after diagnosis as those who did not use imagery.

In their initial research, Ilene Serlin, Ph.D., and Barbara Frances, Ph.D., found that women with breast cancer, participating in movement and art therapy, reported improved mood, quality of life and spirituality, as well as reduced depression, anxiety and tension.

Motivated by such results, clinicians, psychologists, artists and social workers have joined forces to mix the best of clinical and intuitive knowledge. For example, a cancer patient might spend the morning in chemotherapy and the afternoon in music therapy, or someone with lupus might try art therapy as an addition to a regimen of drugs. For those involved, these new approaches to health care represent efforts to treat the "whole" person-- mind, body and spirit. And many believe this can make the difference in fighting and living with disease.

"In a neck-and-neck race, a 10 percent lead can be the winning margin," says Leslie Davenport, director of Marin General Hospital's Humanities Program. Marin General is one of the only hospitals in the nation to offer free-guided imagery to all of its patients. In addition, Marin General offers courses in art therapy, Mandala drawings, dance and music. Such programs help patients maximize their healing resources, says Davenport.

How Do Artistic and Intuitive Therapies Promote Healing?

"Creative therapies are a way of recapturing those things that will nurture us in harder times," says SWAHN's Coss.

These therapies are vehicles that help people to reach deeper layers of consciousness where many believe haling can occur.

Through the ritual of dance, people are able to connect with each other and themselves, says Serlin. "It helps people tap into healing images from within and listen more closely to the body."

Barbara Frances, Ph.D., an Arts Medicine instructor and certified storyteller at CPMC, says creative art therapies help us bypass our linear brain, which is "stuck" in logic. Frances works with patients through storytelling and mythology in an attempt to better understand themselves and their disease. "What is your personal mythology and what role might your disease play in your myth?" Frances asks. "If your disease were telling your story, what would it have to say about you?" These answers, says Frances, offer patients a fresh perspective into their circumstances, perhaps opening channels of healing.

"Art helps us to make sense of what has happened," says Peggy Gulshen, A.T.R., director of Children's Bereavement Art Group at Sutter General Hospital in Sacramento. "The grief process can be very physical. If people don't express or externalize grief, they can be susceptible to physical illness."

Gulshen believes programs like the bereavement art therapy group are preventative medicine. Having worked in psychiatric facilities, where many patients had suffered the loss of loved ones as children, Gulshen committed herself to helping people externalize their grief before their sadness translated to physical and mental illness.

"Why not spend a little on these children now, so that they can deal with grief in a healthy way, so that when they go out in the world, they aren't at risk of ending up in a psychiatric inpatient unit because they're depressed or on drugs. To me, it seems a bargain."

For some, intuitive and artistic therapies help by enabling people to live with their "dis-ease," finding peace with their circumstances.

"I use music to keep me in the moment and in tune with the world," one SWAHN music therapy patient said. "The music is an aesthetic experience that affirms life, even if that means coping with cancer."

Sometimes, the benefits of creative therapies are indirect. Celeste Behnke, a board certified music therapist (R.M.T.) involved in the SWAHN program, says she has seen music therapy help health care staff, as well as patients. Behnke has seen music bring a lightness to the darkest of circumstances, prompting even the most serious of physicians to sing.

"Music fills space and creates an environment that nurtures everyone present," says Behnke.

What About Resources? - Can health care providers and patients afford these therapies that go beyond the bare basics of traditional medicine? Private and public sector health care resources are slim. Yet Americans spend $14 billion a year out of their pockets on alternative medicines. Some say the pressing dilemma is not whether complementary therapies ought to be included in mainstream medicine, but how.

"There is a huge demand for these services, an we need to find ways to integrate them into the traditional medical model," says Mark Rieger, assistant administrator for heart and transplant services in Sutter/CHS' Central Area. The challenge, says Rieger, is getting hospitals, primary care physicians and health plans together to make this expanded model a reality. "The problem is that we're dealing with a fixed or declining revenue stream. More money is going to have to come in or get redirected from other services.

Yet doors are opening. Sixteen major HMOs now fund five "complementary therapy" classes at CPMC's Institute of Healing for its members. Meanwhile, more than 20 major U.S. medical schools offer classes in "alternative medicine."

As the health care industry changes, so too must today's patients. With mind/body approaches like artistic therapies entering mainstream medicine, patients will need to become actively engaged in their own care.

"Everything we do is either health creating or health negating," says Bill Stewart, M.D., medical director at CPMC's Institute of Healing. "We are all responsible."

To many, these new approaches to health care can be threatening, but according to Maxine Barish, M.D., a Sacramento internist, their emergence serves as an indicator that times are changing for the better. "Current challenges in health care may turn out to be a blessing. We're going to be pushed in the direction of searching for what is really essential, and we may find, in the end, that we can achieve well-being and even healing without so much technology after all."

Tune Into Your Feelings - You might meditate, breathe deeply, sing, walk, dance-- whatever gives you an emotional breather. Try to sort out what you're feeling and why. "Many people have diffuse feelings of anxiety or depression without realizing what's bothering them," says James Gordon, M.D., author of Manifesto for a New Medicine: Your Guide to Healing Partnerships and the Wise Use of Alternative Therapies. "If you focus and put your finger on what's triggering it, you can do something about it."

Find an Outlet for Your Emotions - James Pennebaker, Ph.D., professor of psychology at Southern Methodist University, has found that volunteers who relive a traumatic event by writing about it in a journal require fewer visits to physicians and have stronger immune functions. Holding back emotions, he theorizes, may put a chronic strain on the body.

Focus on the Moment - Living fully, in the here-and-now even if just for a little while each day-- is one of the most effective ways to counter stress and relax the mind.

Reason With Yourself - Hostility expert Redford Williams, M.D., advises asking three questions when you fell your temper flare: Is it important? Is my anger justified? Is there any way I can change the situation? "When my wife isn't ready to go to church on time," he says, "I tell myself that the worst that can happen is that we'll have to sit in the back. Then I read a book until she's ready."

Join With Others - If you have a chronic health condition or a serious illness, look for a support group in your area. "In a group, you're able to talk about what's most frightening without feeling that you're burdening or scaring anyone," says breast cancer survivor Anne Ure. "And sharing so openly helps to defuse your fears and anxiety."

Do Good - In her work with breast cancer patients, Ilene Serlin, Ph.D., has found that women begin to give more and more to others as they heal. In fact, studies have shown that altruism-- selfless giving to others-- can enhance immune function and promote well-being.

Rely on Humor - Laughter can indeed be the best medicine, particularly in coping with pain. Norman Cousins, one of the earliest advocates of mind-body medicine, found that "ten minutes of solid belly laughter would give me two hours of pain-free sleep"-- a much-needed break during his recovery from a debilitating musculoskeletal illness.

Pray - Long dismissed by many scientists, prayer has been show to help terminal patients live longer and to improve the health of individuals with high blood pressure and heart disease.

Practice Optimism - It is possible to learn to see a glass as half-full rather than half-empty. The key is to block negative thoughts by saying "STOP" of "CANCEL" and to substitute a positive statement. "You don't have to be positive in a happy-face sort of way," says Dr. Serlin. "What's important is to acknowledge what you're going through while still hoping for and expecting the best."

Don't Blame Yourself - When Anne Ure developed breast cancer at 42, she blamed herself for thinking, feeling or doing something wrong. "It wasn't until I joined a support group and met women with very different lifestyles, habits and outlooks that I realized that all of us couldn't have brought this on ourselves."

According to clinical psychologist Catherine Classen, Ph.D., "Fear sadness and guilt are scary, but they're a natural response to illness. You have to let yourself feel fear and sadness before those feelings will go away. It's better to let everything out than to try to put negative thoughts out of your mind."

Whenever you find yourself playing the blame game, Elana Rosenbaum, a stress therapist, suggests asking one question: What good will it do? "Blaming yourself just makes things worse," she points out. "It's far better to concentrate on being as alive and as well as possible."

Patients undergoing treatment for serious illness also have to be realistic. "A cure may or may not be possible," says Larry Burk, M.D., of Duke University Medical Center. "But there's a difference between curing and healing. Healing occurs at an emotional and spiritual level and involves fitting disease into your life story. Rather than asking 'What did I do to cause this?' it's more important to ask, 'What can I learn from this experience?' Disease can be part of a transformation process."

In her work with a support group for breast cancer patients, Ilene Serlin, Ph.D., of the Institute for Health and Healing in San Francisco stresses the meaning of illness. "There's no reason to feel guilty for being sick or for not getting well," she says. "But illness can be a turning point, an opportunity to become more self-aware and to learn to respect your emotions."

In the two years since her breast cancer diagnosis, Ann Ure, a participant in one of Dr. Serlin's groups, feels she's learned the most important lesson of all: "Not to waste time trying to figure out why I got cancer, but to make the most of all the wonderful things I have in my life."