Psychoneuroimmunology:
What Is It and Can It Help Me?

by Marilyn McGregor

Psychoneuroimmunology (PNI) is the scientific study of the interaction among emotions the brain, and the immune system, some of th~ body's most complex systems. It springs from healing traditions that are both ancient and modem, Eastern and Western. The emotions (the psyche), the neurological system (the brain, spinal cord, and other nervous system organs), the immensely complex immune system and the various interactions of these systems offer much that, when understood, can prove fascinating and useful to people with cancer.

The immune system is composed of the thymus, spleen, lymph nodes, lymphatic vessels, tonsils and adenoids, and—most important—the bone marrow, which manufactures all the cells that eventually develop into T cells, B cells, phagocytes, macrophages, Natural Killer (NK) cells, etc. Early immunologists thought that the immune system operated independently with little or no interaction with other organ systems. Then as PNI developed as a field of study rather than the isolated work of individual researchers, that assumption was dropped and researchers began to focus on the interrelatedness of the systems.

During the past two decades, a growing number of popular authors have written on the intimate "mind-body" connection. Recently, however, scientific researchers in PNI have begun using the classical methods of Western scientific medicine to explore a variety of phenomena that are interlinked, interdependent, and capable of bidirectional effects (effects that work both ways).

While the lay person can believe in a mindbody connection, the PNI researcher is looking for the exact mechanisms by which specific brainimmunity effects are achieved. To better understand the potential of PNI research, let's look at the results of studies reported at a conference on "Brain and Immunity" held in Naples, Italy in March 1991. Several studies showed that Natural Killer (NK) activity was reduced in those persons who had the highest levels of overall life stress. After a number of such studies, researcher's began to suspect that the NK depression resulted from the person's response to the stress, rather than an overall depression of the immune system.

One now famous study tested medical students during examination time. Their NK activity was reduced during exam time but returned to normal after exams. In another study, animals were injected with tumor cells. Those animals subjected to shocks over which they had no control developed tumors which grew more rapidly and death occurred more quickly. Those rats who were able to control the shock grew tumors at a lesser rate.

Further studies, using the UCLA Loneliness Scale showed that people with higher loneliness scores had lower NK cell activity. Researchers then began to ask: Now that we know that stress Gan affect the immune system, we need to ask how it can produce a specific disease if, indeed, central nervous system-induced immunomodulation (immune system changes) can influence the course and development or recurrence of a disease.

European researchers began to look seriously at stress, cancer, and immunity and came up with some general theories, based on their laboratory, animal, or human studies. Depleting life events (such as divorce, loss of spouse, unemployment, loneliness) were not sole predictors for disease but the particular coping style of the person seemed to be a predictor of development of disease. Other researchers began to generalize about persons who develop cancer, finding that those persons showed exaggerated niceness, pleasantness, perfectionism, social conformism, repression of feelings and emotions, and rigid defensiveness and avoidance of conflicts.

Some investigators tried to develop a schema to find a "Type C" or Cancer-prone personality. Their findings indicated that suppression of feelings, especially anger, and "pathological niceness" seemed to be predictors of cancer development. They also found that "pathological niceness" worked as a useful defense for these individuals as long as their personal world held together but not when things took a turn for the worse.

One researcher identified three predictors of worsening disease prognosis in breast cancer patients: patient's adjustment, lack of social support, and fatigue/depression. NK cell activity was increased when breast cancer patients felt they were getting social support from a spouse, close friend, or the treatment staff. Breast cancer patients who looked for social support as a way to cope with the disease also did better. The now famous study by Dr. David Spiegel of Stanford University reported that metastatic breast cancer patients who were in a support group that used self-hypnosis as well as other mind-body techniques lived some 18 months longer than the control group (who did not use these techniques). Another study showed that melanoma patients who had six weeks of group therapy had higher levels of immune enhancing cells.

In a recent Italian study, cancer patients frequently were found to have thymic atrophy (the thymus, located behind the breastbone, is where T-Cells develop). Patients also had low levels of a thymulin, a thymic hormone. Low thymulin levels are associated with reduced levels of biologically active zinc. When patients were given zinc as well as a commercial amino acid (arginine and lysine), both their thymus efficiency and their T-cell efficiency improved. These researchers concluded that "the present study provides clear-cut evidence that cancer is associated with thymic failure and that such a failure can be corrected by a nutritional-pharmacological intervention, based on an amino acid preparation."

Another amino acid, adenosine triphosphate, or ATP, is creating excitement among researchers, based on new analysis of this substance. More than 30 years ago, pioneer ATP researcher, Dr. Geoffrey Burnstock, theorized that the major cells of the immune system had receptors for ATP, receptors that can alter the effects of ATP on the brain. Long the object of ridicule by his peers, Burnstock's theory and research findings have since been validated by the work of others. Some researchers are using ATP in treatment of metastatic cancer. Very early studies showed that injected ATP appeared to increase the amount of adenosine in the blood, which appeared to act against metastatic cancer cells for several hours.

The new field of PNI is exciting and dynamic, with a variety of ongoing studies ranging from in vitro techniques, to laboratory animals, and human subjects. While it is safe to say that brain and immunity are interconnected and interrelated, it is too soon to say precisely what the research means to the individual who has survived cancer or who is having a recurrence. Given the usual rate of scientific research and the requirement for reproducible studies, it may be a long time before PNI therapy is seen as a standard of care, reimbursable by insurance.

Meanwhile, individuals with cancer can develop their own personal PNI therapy using the traditional methods of calming, meditation, and support. Visualization may work best for some people; others may find Chi Gong most effective (Chi Gong is the breathing and exercise system widely used in China to treat cancer). Some may find a loving environment and support system, plus prayer and their old time religion their best PNI. Others may choose to "rage, rage, against the dying of the light," and become involved in activism either individually or in a group.

People with cancer are familiar with The Patient's Bill of Rights that hangs on hospital walls. But there are other rights just as important to effective treatment: the right to loving, respectful compassion on the part of your treatment team or doctor for the particular way you choose to start your own PNI program; the right to hope and loving kindness. Dr. Susan Love exemplifies a physician with Western training who nevertheless shows respect and compassion for the various means that people with cancer use to help themselves.

Many activists and physicians have been concerned with the way some of the "mind-body" material has been used in a cruel, blaming way against the person with cancer or other lifethreatening disease. The most notorious of some of these mind-body gurus have been quoted as saying "What have you done to bring back your cancer?" The fact that the brain influences immunity does not mean that you "caused" your cancer; before you start blaming yourself, remember the world holds more than enough other culprits, such as pollutants and other environmental factors, that can influence the immune system. PNI researchers recognize the multitude of environmental influences on the immune system, a related field of study which they term "ecological immunoneurology.

PNI can be the physiology of hope manifest in the body's immune system. It has been reported that for those patients who have developed their own program that not only was their quality of life enhanced, but their longevity as well.

Note: Reference citations are available on request. An update of Psychoneuroimmunology by Ader et al was published by Academic Press, New York, in 1991. For more information on laboratory tests, see Basic & Clinical Immunology, 7th edition, edited by Stites & Terr (Appleton & Lange,1992)

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