Category Archives: Wayne B Jonas, MD

What Creates Human Flourishing?

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Fifty years ago Abraham Maslow talked about the core processes and elements of human flourishing. He put them in a hierarchy, and at the bottom he said there are basic needs for food, water, shelter, rest, and security. After you have those, then you can pay attention to things like belongingness, love, and social needs. Ultimately, the hierarchy peaks at meaningful activity, which he called self-actualization. 

There’s no question that if you don’t have the basic needs of food and water and shelter, it’s very difficult to think about self-actualization. But we now know that it’s not really quite a hierarchy, because the very things that drive wellness can be done almost anywhere and anytime and don’t necessarily need to go through a hierarchy.

It’s really more of a network.

At the center of that network is the answer to the questions: Why? Why are you here? What is your purpose? What is meaningful in your life?

Here’s how most people answer that question:

  • Altruistically— “I’m here to help others. I’m here to take care of my family”
  • In religious terms—“I’m here to give back to God or to praise God.”
  • In social terms— “I’m here to help myself at the expense others”
  • Or personally—“I’m here to make money or gain fame or get power.”

Usually those latter items don’t last very long in the hierarchy of happiness. Once the questions about meaning and purpose are answered, one can then look at other components of the hierarchy that enhance human flourishing.

These are things like psychological resilience, social bonding and cohesion, intimacy, sleep and exercise, optimum nutrition, and substance use. Without knowing the “why,” it is hard to get to the “how.” Or if you’re just told to do the “how,” the data shows that very few people do that for very long.

Surrounding these behaviors is the environment that either allows us to flourish or interferes with our ability to do engage in healthy behaviors.

These “environments” include the physical environment; the social environment, where many of the social determinants of health are; the health care environment, which contributes only about 15% to human flourishing; and the leadership environment of those who hold the power and resources of stewardship in their hands.

What are we passing on to our children?

A recent report published in Nature Medicine showed that fear induced in male rats could be genetically transmitted through two generations. This means that the experience of fear actually showed up in the genes of the grandchildren. These “molecules of emotion” are somehow grafted into our genes beyond our lifespans.

If we can pass on fear, we can also pass on happiness.

The French biologist Jean-Baptiste Lamarck (1744–1829) was right. What is embedded in our genes can be formulated through experiences. Evolution isn’t just passive selection; the environment actively shapes it. Think of the profound impact that we could have if every parent and child got a positive experience deeply embedded in their genes before they had children.

Fortunately, children are extremely good at recovering from negative experiences – if they’re given the opportunity. There was a study of children aged seven to nine with chronic abdominal pain, which is a frequent manifestation of stress. Abdominal pain accounts for about 25 percent of the pediatric visits during that particular age. A relaxation technique that the child learned through imagery markedly improved those symptoms. Once learned, the effects of the technique are permanent.

The children can relearn how to control their own stress – managing their own “molecules of emotion.”  

The mind has an extremely powerful and ubiquitous influence on our health, and yet its use is often ignored because it’s invisible. Mind-body practices can not only alter our genes, they can influence our decision making, and they can enhance our wellbeing and productivity. They’re the foundation for behavioral change. They can be used to treat many conditions: depression, anxiety, pain, insomnia, high blood pressure, etc., at very low cost.

How can you use mind-body practices in your life?

If you’re interested in learning to optimize your self-healing, download Your Healing Journey.

Controversial Treatments, Myths Debunked and Lessons Learned

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With the push to find a “cure” for the signature injuries of the Iraq and Afghanistan wars, hyperbaric oxygen (HBO) treatments have been highlighted as a potential solution to address post-traumatic stress disorder (PTSD) and concussion from traumatic brain injury (TBI).

Today’s issue of JAMA Internal Medicine includes a commentary [i] that Dr. Charles W. Hoge [ii] and I were invited to submit on a new study of HBO for TBI.


The commentary responds to the results of a clinical trial [iii] that reports significant improvements from HBO in post-concussion symptoms and also other, secondary outcomes from stress and trauma (which I call the trauma spectrum response, TSR).

However, a major disappointment for proponents of the treatment is that there were no differences between HBO and a sham procedure in which patients underwent the same ritual of HBO but without the oxygen added. In fact, symptoms for the secondary TSR outcomes were better in those who received the sham treatment than the actual HBO treatment.


So what’s the takeaway of this study, which produced significant symptom improvements in both the sham (placebo) and HBO intervention groups? If the added oxygen is not what is producing the benefit, what is?

For me, the most important lesson from this study is that good intensive medical care and the process embedded in the ritual of that care is the most important thing we can do for healing our veterans from TBI. It is the intention, inter-personal interaction and meaning that good medical care imparts that gets people better. 

These are the components of an optimal healing environment.  

That’s what is working.

I argue that this study can be a positive one for the field of post-traumatic stress and traumatic brain injury if understood from the right perspective—that of a healing environment. By shifting our focus from seeking a “magic bullet cure” to a holistic clinical approach we can optimize healing factors and provide the most help for patients and our veterans.

It’s not the placebo that makes you better; it’s the meaning and context behind the care interaction that makes you better.

The following are the underlying mechanisms of the placebo engine that make it run:

  • enhanced expectancyjudgments our brains make subconsciously when receiving care
  • conditioning – an unconscious response to a ritual or signal paired with a healing event
  • an authoritative context of care – sometimes called the “white coat effect,this refers to the tendency of patients to respond better to treatment based in the settings and rituals associated with healing
  • social reinforcement – the individual reaction to social behaviors that reinforce the above

All of these factors are part of the delivery process for HBO, with or without the oxygen. What is powerful is that these factors can lead to healing.

If we focus on the goal of increasing quality of life and decreasing the pain and stress that our warfighters are facing, their journey to recovery will become less about an intervention and more about optimizing their internal healing processes.

Our view of holistic care is one that keeps in mind all aspects of the Optimal Healing Environment framework; from tending to the internal needs of a person to their interpersonal relationships to behavioral components and finally the external environments in which the patient lives, works and receives care.

So while it’s essential to continue to search for the “magic-bullets” and “cures,” it’s equally important to explore the factors that we know lead to healing and optimize them as much as possible.

Unfortunately, we don’t know enough about these factors to fully apply them. If we want to help our veterans now and optimize any new cures that come along in the future, we need to spend more time and resources understanding healing and applying it in all aspects of health care.


 

[i] “The Ritual of Hyperbaric Oxygen and Lessons for the Treatment of Persistent Postconcussion Symptoms in Military Personnel.” JAMA Intern Med, Nov. 17.2014 epub ahead of print

[ii] Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland

[iii] “Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial.” JAMA Intern Med

Reflecting on this Veterans Day

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On this Veterans Day, I’d like to share the story of my father, a chaplain in the military for 30 years, serving in three wars. It is because of my dad that I was exposed to the idea of healing as wholeness very early in my life.

black and white photoHere is a picture of him in the Korean War in 1953, comforting a soldier. As a minister, he spent a lot of time comforting people who had been through very traumatic experiences, helping to lead them to deeper sources of strength. They didn’t call it PTSD back then, but that’s what he was treating. When his war service was over, the last being Vietnam, he became a hospital chaplain and worked with the acutely ill in the hospital.

Once I asked him why he decided to be a hospital chaplain after the wars, he said, “Because that’s where the most suffering is.” I said, “Well, what do you do in a hospital as a chaplain?” And he said, “I help people heal. I listen to them, be with them, pray with them, and pray for them, and I help them become more whole by connecting them to their spiritual selves.”

And so very early on I got the idea that healing had something to do with the spirit, with the inner environment of the person. Read more

Challenges to Our Current Health Care System

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First of all, we pay almost double of any other country for medical and health care, and yet we’re 30th or lower in our health indices. At the current rate we will spend 25 percent of our gross national product by 2025 and almost half of it by 2082 if we don’t change what we are doing. The baby boomers have started to turn 65, which means there’s a tsunami of chronic needs and illnesses coming down the pike.

We are standing on the train tracks with the train coming straight at us; yet we don’t seem to be able to move; even to save our lives. Read more

Two Approaches to Pain and Illness

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In the West we are divided about healing pain. We take two approaches and rarely integrate them. One approach to pain and illness is a technological approach. This the “we’re going to go in and we’re going to fix you” approach. It’s often done later in the disease process, is often high-cost, and it usually is quite manipulative. It over values the physical things you can see and do. For example, people in pain often get drugs, but also surgery or implantable devices.

The other approach is less visible. Read more

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