The ghost in the machine: From fiction to facts

Rene Descartes, the French Philosopher and scientist, of the seventeenth century, considered any link of the body with the mind as outlandish. He viewed the body as tangible and the mind as elusive, ruling out any connection between body and mind.[1] Gilbert Ryle seemed to have the last word when he labeled the nontangible mind as the “Ghost in the Machine.”[2] Western medicine readily identified with the views of Descartes and Ryle. By default, medicine tended toward the mechanical model of disease.[3] Medical practitioners found this simplistic approach easier than chasing the “Ghost in the Machine.” Treatments and therapies were directed at the soma rather than the psyche. In spite of the leanings toward the mechanical and reductionist model of disease driven by the Newtonian worldview and hard science, physicians down the ages intuitively knew of the placebo effect contributing to the healing process and by analogy, the nocebo effect, negativity adversely affecting health. In practice, physicians accepted the power of the psyche over soma.

Fiction writers, often astute observers of human emotions and without the constraints of consensus, often got it right. One may call it serendipity, or perhaps, emotional intelligence breaking the speed limit. Two centuries after Descartes rejected the mind–body link; O Henry dealt with the nocebo and placebo effects in his story, “The Last Leaf.”[4] The story describes the mental state of a young lady afflicted during an epidemic of pneumonia, and its impact on her physical health. Initially, negative emotions dominate and the lady is full of passivity awaiting the inevitable. Adding to the negativity is the surrounding landscape which is dull and depressing. From where she lay she saw an old ivy vine climb up a brick house shedding its leaves in the autumn. She starts counting the falling leaves. Each falling leaf acts as a nocebo signaling the life ebbing out of her. She waits for the last leaf to fall with a foreboding. The physician treating her gives up all hope. The day arrives when there is only one leaf left. This is the last leaf. Her life seems to hang on its slender stem swaying with the wind and rain in the raging storm throughout the night. Her neighbor comes to know about her predicament. He is an aging and a failed artist. During the stormy night, he paints his only masterpiece in a failed career—a leaf on the wall opposite. The morning after, the sick lady sees out of the window not expecting to see a single leaf. To her surprise, she sees the “last leaf” in full glory having withstood the trials and tribulations of the stormy night. This painted leaf acts as a placebo. The lady recovers from her illness. The old painter exposed to the rain and wind catches pneumonia and dies. O Henry in his short story used creative liberty to convey the message of the power of the mind over the body. Slowly tentatively science is catching up with this leap of imagination. Accumulating evidences point to the mind–body connection in health and illness. Fiction and fact, the twain seems to meet.

Antonovsky put forth the concept of salutogenesis in the twentieth century.[5] He proposed that one’s attitude and response to life experiences affect coherence and resilience in stressful situations. Martin Seligman[6] has coined the terms flourishing and languishing persons. Flourishing people experience more positive feelings and enjoy better overall health. These dynamics besides affecting mental health also impact physical health. In the short term, anxiety and stress may reduce immunity to infections.[7] In the long run, they may be risk factors for a number of chronic and autoimmune diseases.[7,8]

Psycho-neuro-immunology[9] is an emerging field. This studies the association between the mind, the nervous system, and the immune systems. Neurotransmitters, hormones, and neuropeptides regulate the immune system. The gut microbiome also acts as a mediator in the process.[10] This in turn can transmit messages to the nervous system by secretions of cytokines. Chronic stressors have been found to affect the immune system and psychosocial interventions ameliorate symptoms in some chronic conditions. Indirect effects of stressors and anxiety or serious mental disorders on physical health are easier to understand. Persons with disturbed mental states may be more prone to overindulgence in food,[11] tobacco,[12] alcohol,[13] drugs,[14] and unsafe sexual activity[15] endangering their physical health. As facts and fiction merge, we have to accept the “ghost in the machine” as an important part of the machine. This has implications for the management of patients, particularly in chronic psychosomatic conditions.