martedì 28 giugno 2011

The Use of Meditation in Cancer Treatment

Studies from 1975 to 2000 - Abstract

Man has practised meditation for thousands of years but it would seem that “modern” psychology has been slow to become aware of its various potential applications. This article is a historical-critical excursus looking at some studies on the treatment of tumours using different meditation techniques.
Some authors claim to have found tumours regressing without using any other treatment which could have affected such results; some patients survive longer than the average patient who does not meditate. Studies published in specialized literature are few and often present results which are difficult to interpret. In some cases they lack experimental data to confirm the hypothesis or they do not show a direct connection between psychosocial factors and survival (or healing) in malignant pathologies.

The data available up to now, cannot but cause us to reflect on the potential application of this practice on such a “complex” pathology. Meditation techniques can be of great help to cancer patients by helping to manage the stress of the illness, by reducing the side-effects of the medical treatment and by giving a sense of being in control of the illness. All of this costs nothing.

We can therefore look forward to new techniques in the medical and psychological fields which will be of great advantage to the patient and to the doctor whose task (and duty) it is to manage the illness and suffering and who often does not have knowledge of this or other types of treatment.

Meditation
Meditation is one of man’s most ancient activities. It is most probably the oldest known technique for self-healing. It is a universal and transcultural phenomenon. In oriental countries we have for example transcendental, buddhist and taoist meditation. However, it is also present in western religions and philosophies, for instance in Platonism, Stoicism and Christianity (Lamparelli,1985). There are numerous traditions and therefore numerous techniques which are highly philosophical and religious and are notably in contrast with each other from a methodological point of view, but these cultural and historical diversities do not however detract from the structural basis of the process.
What do we really mean by “meditation”? Even if it is often used as a relaxation technique, it is not. In technical terms, it is the subject’s constant attempt to maintain concentrated attention on an internal or external object such as the flame of a candle, the subjects’ own breathing, concentrating on a feeling or an image, repeating a sound mentally or verbally -a mantra-,or anything else that is considered suitable (Lindsay, Norman, 1977). The subject is completely absorbed with the object of meditation and if another thought enters the mind during that time, the subject has to bring his attention back to the object on which he is concentrating. All the techniques have the common characteristic of serving to evoke a sort of freely floating attention that superimposes rational thought (Goleman, 1988). This experience is an accessible state (even if not advisable) for everyone. It is not tied to fixed situations or particular moments. It is also an experience that many people enter into unconsciously. The characteristic of the technique lies in knowing how to induce this state when desired and knowing how to prolong it as long as the subject wishes. One of the strong points of meditation is that it acts on both the body and the psyche. It seems, however, that with such techniques, points of contact can be found between the body and the mind. It is a task that requires comprehension and listening ability and acts at the same time on both the body and the mind at their “point of intersection”. There is probably not one form of meditation better than another. Each person can therefore choose (or the therapist can suggest) the one he considers the most suitable.
The use of a specific technique cannot and must not be seen as or limited to an exclusively symptomatic level, only for the fact that the technique itself, for its very definition, has for thousands of years always been considered as the royal road to self-realization. Some studies on meditation carried out with serious and rigorous methodological criteria have today shown us that meditation is able to provide tangible and measurable benefits which are often maintained over time, regarding both a wide spectre of physical illnesses1 and in terms of lasting personality changes (for a wide review see, for example, Carrington, 1998 and Goleman, 1988). The rediscovery of such techniques, therefore allows us to use them even more widely today in various fields such as medicine (particularly when stress plays a fundamental role or is aggravating a problem), psychotherapy2, education and many others, providing ever more interesting results.
We will review some studies which have been recently carried out (from 1975 up to 2000) using a suitable and constant practice of meditation to combat tumour pathologies and try to highlight some theories, the results obtained and the problems that have still to be faced. The aim is to try to understand if and how the “body” uses some retroactive circuits passing through the “mind” to heal itself.

Meditation and cancer: hypotheses, studies and theories
We begin this review by looking at the findings of a very prolific author in this field. Ainslie Meares reports cases of patients treated by meditation and had evident regression of tumors while not having had any orthodox treatments that could have affected the results. He reports some outstanding cases, a woman with breast cancer (Meares,1976), a man with an osteogenetic sarcoma (Meares, 1978), two patients with Hodgkin’s disease (Meares,1979a) and a patient with a carcinoma of the rectum (Meares, 1979b). Some patients had orthodox treatments at the same time, but the majority had stopped these treatments because of the considerable side-effects or because they were considered hopeless by well-experienced oncologists. All the patients (and if possible also the relatives) were advised that this was purely an experimental approach and that the orthodox approach was however chemotherapy. A certain number of patients were unfortunately destined not to survive, others, on the other hand, had “miraculous” regressions of tumours; but the subjects that did not have any improvement, did have a higher average survival rate than predicted and experienced greater serenity than predicted with a significant increase in the quality of life.
The author himself points out the lack of statistical verification but the data reported did however give cause for hope. His aim was to understand the determining factors in such an approach on the prognosis of the illness in order to use the favourable effects in an efficient treatment, by itself or along with orthodox medical or surgical treatments. The fact that in some cases the illness returned when the meditation was stopped or when the subjects changed the rules pertaining to the practice of the meditation and subsequently improving when the correct conditions, that had been taught, were again being carried out, gave cause for reflection that the meditation was the real cause for the regression of the illness. In Meares articles, the cause of the healing is attributed to the psychophysiological effects of meditation: effects on the endocrine system, a lowering of the cortisone level with a subsequent reactivation of the immune system, an increase in alpha and theta waves, having been identified by E.E.G., generally opposite responses on the part of the organism to those caused by stress, a re-establishing of the body’s normal homeostatic mechanisms due to the breaking of the vicious circle of stress-anxiety, which also lasted for a certain period of time after the end of the meditation sessions (Meares’ subjects were invited to meditate for at least an hour a day, some managing more than three hours). In these states, the mind is believed to work at pre-logic and pre-verbal states or at levels the author defines as atavistic regressional states similar to hypnosis (Meares,1977) and difficult to communicate in words. Subjectively, a significant reduction in and greater control of pain was experienced along with a significant reduction in anxiety (some subjects managed to reach a very low level), a profound sense of calm and serenity, a new ability to face and manage personal problems and difficulties, an increased interest in the changing experiences of life rather than in the cancer and an acceptance of the subject’s condition with a changed sense of the concepts of life and death as a manifestation of a single process. The pain and discomfort are therefore transcended; what really counts is simply carrying out the hic et nunc, being here now, without the interference of a logical mind judging and imposing (Meares is careful to point out that these changes came about without direct or guided intervention on the part of the therapist).
At the time of going to press, it is not clear if and which types of neoplasms are more susceptible than others to a meditation approach. The hosts responses and resistance would seem more important than the nature of the tumour itself. Having a high intelligence does not seem necessary to meditate; the reason being that meditation is believed to involve functions of the human mind and brain which are different from the intellect. Some patients had a mistaken concept about meditation, probably due to incorrect knowledge regarding the practice, and it was difficult to correct these ideas. Generally, the subjects who had the best results with meditation and who obtained the greatest benefits were introverted rather than extroverted, patients with painful symptoms (and at least driven to reduce the pain), those who had refused the “official” treatments and those who were not undermined by negative suggestions from other people such as their family, friends or doctors who did not believe in the technique. The prognosis was in fact more negative for subjects who were sceptical from the beginning, or who were convinced by more “competent” 3 people to give up the practice, even if they had obtained evident results. It therefore seems that the support of those surrounding the patient is very important. Meares was also criticized over his research because it was his habit to receive his patients and follow their progress daily; and no-one could be so stupid as to believe that such an approach could help in the regression of a tumour! (Secheny,  1980).
Magarey (Magarey, 1983) also stresses the importance of personal relationships and emphasizes the importance of the role of the therapists’ personality in the healings (and also in the therapeutic failures). His considerations are first of all concerned with the fact that cancer treatment should not only include medical technologies: cancer should be understood at different levels. The doctors can be the greatest experts at a molecular level but cancer is a discomfort of the whole person.
On studying some “miraculous” healings based on non-orthodox methods, a certain relationship between doctor and patient emerged, defined for example as “partners in a venture”. It was noted that those healers, whichever physical method they used, had some particular characteristics: for example, the ability to stay calm and to know how to convey this to the patients; the very presence of these doctors made the patients feel better and conveyed strength and trust. On studying their physiological responses while dealing with their patients, evidence of signs of a low activation of the autonomous nervous system was found, accompanied by subjectively experiencing an interior peace and calm. Magarey notes that these characteristics are typical of the practice of meditation. The relaxed effect of meditation could in this way, contribute to some unexpected and apparently unexplainable regressions of tumours, especially in the cases where stress contributed to the pathology.
Life-changing circumstances can also lead to the manifestation of neoplasms: the person who meditates can however manage to find their own centre without necessarily depending on external circumstances or on other persons. “Can there be any higher form of healing than to help a person find such fulfilment and meaning in his life?” (Magarey, 1983, pag. 184). A holistic treatment of cancer should therefore include the practice of meditation; and it would be even better if the therapist himself meditated: through working well on himself, he would in this way learn to assume those behaviours which could be of clear benefit to his own patients. The patients would therefore be healed, from their desperation, from their sadness, from their physical and psychological pain and helped to accept life and death (if there has to be death) with a greater improvement in the quality of life. The benefits of meditation are therefore in direct contrast with so-called “modern” medicine which is carried out hurriedly, aggressively and using expressions such as “It is useless to look elsewhere, there is nothing else that can be done”. This is why many patients turn to “non-orthodox” treatments, feeling terribly abandoned and badly treated by their own doctors. Magarey also reports the fact that a large percentage of women with breast cancer complained about not having received sufficient information concerning their treatment (or surgery), both before and after, nor regarding the development and consequences (anxiety, depression, sexual disturbances, marital problems etc.). The doctors had not been prepared to be able to manage the relationship with their patients: only a small percentage were receptive to the non-verbal messages they were receiving and only 10% of them were informed and able to discuss and advise on alternative methods or an effective psychological support.  Many patients therefore turned to “alternative” therapies because “traditional” medicine was not able to meet and understand their emotional needs, their fears and attitudes.
Magarey (Magarey, 1988) reports further controlled studies which he claims show an association between a breast tumour and extreme emotional suppression, especially anger and the desire to be or appear to be “a good person” (Greer and Morris, 1975; Bremond et al.,1986); on the contrary, expressions of hostility or non-adaptance, are claimed to have a positive increase on the survival of these patients. Magarey maintains that Meares’ work cannot be lightly set aside and he expresses the hope that he will conduct further studies .The reasons being, the benefits of having patients express their emotions and the desire to face the illness as Meares has shown during research, and since it is well-known that meditation reduces anxiety and nevrotic behaviour (Delmonte,1986) and it has been proved that it reduces depression, anger, confusion, fatigue and increases strength (Peters-Golden, 1982) and that the subjects who meditate recover better from stressful stimuli (Delmonte, 1984). The criticism that Magarey addresses to the so-called official medicine is also based on his own personal experience of five years of teaching meditation to hospital patients. He maintains that meditation could and should help these patients even more, by including in the treatment the work of competent persons to help the patients confront their own negative feelings and their ambiguity. Magarey therefore hopes that practices such as meditation will become widely used, since such practices have been shown to be appropriate and can significantly improve the quality of life and offer greater ability to comprehend.
Lowenthal (1989), on the other hand, does not fully agree with the psychological approach to the treatment. The starting point of his article is: can (particular) mental processes cause or determine the risk of developing cancer? Can mental processes influence biology? Can the mind heal cancer? Firstly, we have to consider the relationship between the mind, the immune system and cancer. The first consideration is, are cancer patients immunodeficient? Secondly, do immunodeficient subjects develop cancer? The answer to the first question is that patients with various forms of cancer are normal when immunologically tested; on the other hand, an immunodeficiency often develops at an advanced tumoural stage. Therefore, for the majority of neoplasms, immunodeficiency is a result rather than a cause. On the contrary, it seems to be well-established that immunodeficient patients run a high risk of developing only some forms of cancer, specifically those of the immune system itself. There are many studies that show how immunological functions can be influenced by psychophysical stress; but researches that put forward the hypothesis of a high incidence of tumours in persons suffering an emotional trauma (a bereavement for example) has not been confirmed. “No study has shown directly that the individuals in whom immune function is depressed temporarily after mental stress are themselves specifically at an increased risk of developing malignant disease. Those who postulate such a relationship generally fail to take into account the long lead period between the initiation of cancer and its clinical appearance, which for most neoplasms is a matter of years or even decades” (Lowenthal, 1989, pag. 711). There could be cases in which the relationship loss-development of cancer, would seem a clear matrix of cause and effect; as a matter of fact, even in these cases (e.g. a widow or widower who dies soon after their husband or wife or the death of a person after the loss of a very dear relative) the malignant pathology would seem to be attributed to environmental factors, the same shared living conditions for a period of time, in these cases even for a certain length of time, and genetic factors 4. The author claims that the problem concerning the relationship between mental attitude and the development of cancer is extremely controversial. The majority of studies suffer from from the fact that they are retrospective, that is, a personality evaluation is carried out after the diagnosis of a tumour has been made. At this point the key question is: can the mind influence the course of the cancer once it has begun? The author maintains that one has to be very careful when speaking about a relationship between the mind and cancer. He points out that assertions were made that survival would increase among those who were highly hostile and strongly refused to accept the disease, but also among those who had a low level of hostility (anger), among those who were highly distressed and had little ability to face their illness; and among those, on the other hand, who knew how to face it. In short, there was no agreement about anything! Each study that found a relationship between psychological factors and cancer was immediately refuted by another. The results “suggest a need for caution in interpreting studies that claim a positive association between psychosocial factors and survival in malignant disease generally. (…) Our study of patients with advanced high-risk malignant diseases suggest that the inherent biology of the disease alone determines the prognosis, overriding the potential mitigating influence of psychosocial factors”. (Cassileth et al., 1985, pag. 1553). “Thus, whatever else may be said about the relationship between mind and body function, the scientific evidence for mental attitudes determining either the risk of the development of cancer or the outcome once cancer had developed is equivocal at best. It certainly is not strong enough, in my opinion, to form the basis for a philosophy of treatment” (Lowenthal, 1989, pag.712).
Then there is a criticism concerning the fact that meditation in particular might be able to help the regression of cancer: in Lowenthal’s opinion, the studies that have been published up to now are anecdotal and generally poorly documented and the healings considered in these studies are potentially largely explained by the simultaneous use of orthodox treatments or by a natural change in the cancer. The author continues by saying that meditating for some hours a day takes time away from other more interesting activities for the patients, their family and friends. Secondly, for these patients, the knowledge that certain of their attitudes and ways of thinking could be the cause of their illness, very probably could induce some to have a sense of blame for having caused it themselves; or worse still, the thought of having perhaps “caused” it in their children. In the case where the meditation failed, such a failure would then induce a further sense of blame. However, Lowenthal maintains that he absolutely does not question the value of meditation and other mental processes in helping patients to face the knowledge of the diagnosis and the physical results of their illness and treatments: meditation would be of great value (this agrees with Magarey) in helping the patients meet many of their unmet psychological needs; however, if used correctly, it could at the most be considered complementary to the tried and tested orthodox treatments. There is, after all, an understanding of the fact that if many patients turn to so-called alternative treatments, a real objective responsibility exists on the part of the doctors that they do not know how to reach out to many patients: the conclusions are therefore that it is always necessary to know how to install hope (this includes hoping for a miracle). It is in the best interests of both, that doctors should know how to take care of both the physical and psychological needs of the patient. Thus public hospitals should therefore include meditation techniques or support groups among their services.
Alison (Alison,1990) was aware of the fact that many oncologists did not have sufficient ability to communicate with their patients and understand their needs; Zaza and his collaborators in one of their researches noted that the management of pain is mainly centered on a type of pharmacological approach, with little attention being paid to psychological techniques or other techniques which were not pharmacological5: however meditation in general was seen by hospital staff (especially doctors) as not being very effective in controlling pain, but if nothing else, it was seen as being without tangible risks to the patient (Zaza et al., 1999).
Cassileth (1996,1999) points out that besides the percentage of patients who turn to alternative treatments, these treatments are possibly dangerous, only for the fact that, even if their effectiveness has not been throughly tested, they are embarked upon to the detriment of official treatments, thus allowing the illness to progress, when instead, a suitable, timely treatment (see Sawyer et al., 1994) would have been possible. On the other hand, he classifies meditation as certainly one of the complementary treatments (along with for example other relaxation techniques or natural substances) that can be useful to the patients in that they address the difficulties associated with the diagnosis, the treatment and survival. Such treatments are able to efficiently fight some typical problems caused by the illness such as stress, anxiety and depression6 and then these treatments cost nothing. They are not invasive and are generally free from side-effects. Last but not least, they add another important aspect to the treatment, that is, knowing or learning to take care of oneself. He advises complementary treatments as a useful supplement to oncological treatments since many patients obtain relief from their symptoms.
Coker (1999) recalls how a chronic activation of the autonomic sympathetic components of the nervous system produces a constant elevation of stress hormones with consequent anxiety and depression disorders and autoimmune illness and along with the loss of the immune system, the loss of the subject’s ability to fight
the cancer. Stress can therefore lead to inappropriate behaviours such as wrong eating habits, alcoholism and smoking to try to combat the feelings caused by the stress itself. Meditation, working on the connection between the mind and the body, has the ability to induce a balanced restoration between the sympathetic and parasympathetic components, inducing the response known as the “relaxation response”: that is, a reduction in blood pressure, heart beat, metabolism, respiration rate and inducing modifications in the brain waves. The practice of meditation could be useful in increasing the production of melatonin which is probably very useful as an oncostatic agent, especially in cases of breast or prostrate cancer (Cos et al.,1998; Neri et al., 1998). Lastly, Coker points out that the sense of meditation is not (only) managing to feel relaxed, although many people come to it for that reason: the real aim of meditation is that of (re)training one’s attention. “The aim of “emptying the mind” is that of being aware of and being in contact with what is happening moment by moment, while it is happening. This is all. This can change everything (Coker, 1999, pag.114)”. One learns to observe, understand, and “allow” one’s thoughts, emotions and feelings for what they are and not to repress or deny them. One also learns to distinguish between what an experience really is and, on the contrary, the interpretation the subject gives it. A change therefore comes about at a cognitive level besides an emotional one. Meditation is therefore not a kind of medicine to take as needed, but implies a personality transformation, a new way of feeling and thinking. To all of this we can further add, acquiring a sense of personal control of the illness, a ray of hope for sufferers and not least, an improvement in social and personal relationships. It would appear evident with prostrate cancer; that meditation is beneficial at several levels; costing practically nothing, accessible to everyone and with no side-effects.

Some psychosocial and experimental studies on the use of meditation
One important problem however could be the lack of experimental data to confirm the usefulness of the technique. Early results really already could have come from research on the studies carried out with psychosocial intervention which included similar components to meditation.
In a study from 1974 to 1978, which included the use of relaxation and visualization techniques, (3 daily sessions of 10-15 minutes each) Simonton and Matthews-Simonton found that the average survival of their patients was higher than the average survival reported in literature: the average survival in subjects with advanced breast cancer was 38.5 months compared to the national average of 18 months, in patients with advanced bowel cancer it was 22.5 months compared to the national average of 9 months, and in patients with advanced lung cancer it was 14.5 months compared to the national average of 6 (Simonton and Matthew-Simonton, 1981) 7.
Kiecolt-Glaser discovered that the elderly in a retirement home who practised a relaxation technique, showed a significant increase in their immune defences against viruses and tumors (Kiecolt-Glaser et al., 1985); and in another study, he pointed out how medical students who used such techniques during examination preparation, a source of stress, showed higher levels of T-helper cell antibodies which fight infectious diseases (Kiecolt-Glaser et al., 1986).
Spiegel and his collaborators (Spiegel et al., 1989) have shown how their weekly group therapy for women with breast cancer and metastasis which lasted a year showed a significant statistical and clinical increase in survival compared to a control group in a ten-year follow-up. Spiegel and his collaborators’ work was based on anxiety-reduction, depression and pain control through self-hypnosis exercises, having the patients recognize and express their own emotions and feelings, over and above a qualitative and quantitative increase in social relationships (which has shown to be important factors for survival and the course of the illness). In this way, the patient’s ability to mobilize their own resources against the illness was improved, thus helping to increase the endocrine and immunity responses which are bridges between the emotional processes and the course of the cancer.
Fawzy and his collaborators (1993) found that subjects with a malignant melanoma who had taken part in an intensive psychiatric support group on increasing problem-solving levels and psychological support and management of stress through relaxation techniques, showed a significantly higher survival rate compared to a control group in a six-year follow-up.group.
Specific data on meditation come from research carried out by Massion et al. (Massion et al.,1995). The authors experimented a programme based on the regular practice of meditation (in particular “mindfulness meditation”, one of the central practices of buddhist meditation). This programme had shown to be effective in treating subjects with chronic pain (Kabat-Zinn,1982; Kabat-Zinn et al., 1985; Kabat-Zinn et al., 1986), in generalized anxiety attacks and panic attacks (Kabat-Zinn et al., 1992) and in the treatment of psoriasis (Bernhard et al., 1988).
If the melatonin and other substances secreted by the pineal gland can be considered potent oncostatic agents, especially in cases of breast and prostate cancer, maintaining normal, or elevated levels of melatonin (in response to hypersecretion due to a failure of the pineal gland to respond to the progressive stages of cancer) would be a sign of a better prognosis and a favourable response to chemotherapy. Massion et al. have tried to show that a regular practice of meditation is associated with an increase in the physiological levels of melatonin, the production of which by the pineal gland would therefore be psychosensitive as well as being photosensitive. The night production of melatonin in urine samples was compared in two groups of healthy women, one group who meditated (5-7 sessions a week for 30-45minutes per session) and another group who did not. A notable effect from the meditation was found in the two groups, to be precise, in the average levels of 6-sulphatoxymelatonin (an index of melatonin levels in the plasma). The authors however suggest that melatonin can be an important indicator for testing the results of psychosocial intervention, especially in the case of subjects affected by breast or prostate cancer.
In a study carried out in 1987, Orme-Johnson (Orme-Johnson, 1987) gave concrete evidence that a technique of Transcendental Meditation practiced by subjects for five years, was able to improve the general state of health and also reduced health costs in that admissions to hospital for cancer were less that 55.4% compared to a control group (and 87% less for heart disease, 30.4% less for infectious diseases, 30.6% less for mental disorders and 87.3% less for illnesses of the nervous system). To explain this hypothesis has been formed that meditation could help to achieve a very good state of balance in biochemical development which would maximize the efficient use of DNA to induce itself to self-repair. From another study (Orme-Johnson and Herron, 1997) concerning a prevention method which gave great importance to the practice of Transcendental Meditation, comparing the data in the archives regarding medical expenses during the period from 1985 to1995, it was found that the hospital admissions of neoplastic patients in a control group were 3.3 times higher in the group that practised the health programme (and 6-7 times higher in cases of mental health disturbances and substance abuse, and some 11.4 times in patients with cardiovascular disorders). One factor however that the authors were not able to examine was the use of drugs, alcohol and tobacco, because the participants on the prevention programme were however virtually free from drug use (and therefore the abuse) of such substances. The evidence of the facts and the literature on this subject has however suggested that it was the practice of Transcendental Meditation that considerably reduced the use of such substances. In short, it seems that this was due to a normalization of abnormal neuroendocrine mechanisms; the restoration of this balance is connected to the individual’s ability to make choices regarding his lifestyle (see Coker,1999).

Conclusions
We have seen how meditation could offer interesting prospectives for the treatment of neoplasms. Further studies will certainly be necessary, but as further healings acquire scientific legitimacy8, this will better help us to understand the mechanisms of health and illnesses and to understand, for example, how the human mind can influence itself, and to what point: if psychological factors are directly involved in the genesis of a tumour is still to be demonstrated, such factors however would really seem able to modulate the processes of the organism that neutralize it. We have to try to understand how the body itself uses its own retroactive circuits and what defence mechanisms it may possess, in this case “passing” through the mind, in order to heal itself. The conclusion has already been reached from the early ‘80s that neither carcinogenic substances, nor radiation, nor genetic predisposition alone could provide an adequate explanation for the causes of cancer (Capra, 1982). Socially political measures (even urgently) would certainly be needed to eliminate the health risks; but alongside a purely “medical” path, a “psychological” one can also be followed.
The patient can therefore learn to be jointly responsible for his own health with the help of these techniques and is therefore no longer at the mercy of something that is considered destructive and deadly (and much could be said about how much the diagnosis itself concerning the seriousness of the pathology, inevitably determines its course), he learns to look after himself and can understand that he has a certain amount of control over his illness.
Meditation offers the advantage of being a treatment that anyone can use. It offers the advantage of not wanting at all costs to make the patient adhere to a theory, but is personal, and can be adapted to every subject. Everyone can spontaneously offer his own images, emotions and feelings, which will differ from person to person, as will the situations and needs of each person. It is ever more of common opinion that “modern” medicine must listen to the patient and no longer see him exclusively as a carrier of illness but as an individual to be seen in his entirety, with his needs and feelings and his relationship with himself and others. “At a time in which we are talking about humanizing medicine, of holistic medicine, a new medicine
has to learn to knock down the barriers that sometimes artificially divide the doctor from the patient, taking into consideration feelings and the chemistry of compassion. Only in this way can we have a medicine that heals besides treating” (Meluzzi, 1991, pag.111).

Notes:
1 Neuroendocrine changes caused by this relaxation response, for example, have shown to be deeper and longer lasting than the early investigators believed, who saw relaxation techniques exclusively in terms of relief from muscular tension or worry.
2 It is very surprising that modern psychology has been so extremely slow to deal with meditation. Initially, it was psychotherapy that first took on these techniques in that it realized that they would be an excellent method for anxiety and stress control without using drugs, give access to thoughts, memories, images or emotions that were in some way blocked or otherwise inaccessible (Coleman, 1988). So it is that today, meditation is ever more considered to be a useful addition to psychotherapy. In many cases, where possible, some authors have advised its use (Kretschemer,1951; Carrington,1998).
3 He quotes a maxim: “There is nothing more more harmful than an expert’s opinion.”
4 We have to be very careful regarding attributing the cause of a phenomenon adopting a “poster hoc, propter hoc” schema. Such an attribution could prove damaging both for the purposes of diagnosis and for correct treatment and even more so with disciplines regarding the human mind. We can very often be inclined to associate particular negative effects regarding one’s health to certain activities, attitudes, thoughts and emotions  which have nothing to do with such effects and which are really due to unknown causes or pre-existing causes. Such an error risks leading us astray from finding an adequate treatment, with considerable risks. Most often, the most important thing is not so much to concentrate on the cause, unless it persists, but to see what is necessary or what can be done (Lazarus, 1981).
An experiment carried out by Deutsch et al. (1976) is worth mentioning that showed how rats learned to associate drinking a tasty and nutritious liquid with an adverse effect. This was really due  to the simultaneous administration of an intragastric injection, the effects of which were clearly unknown to them.
5 The incorporation of psychosocial techniques into the management of pain has been widely recommended, for example by The World Health Organization since the early ‘90s (World Health Organization, 1990).
6 The author recognizes that meditation has significant effects on stress, anxiety and depression in many people, regardless of the cause.
7 In this work, the Simontons emphasize, among other things, that counselling can be of help, but can also be damaging, depending on the dynamics of the relationship between patients, the medical team and the family.
8 He notes that not many–even doctors, researchers and psychologists, or anyone else, really have the concept of what is scientific and what is not. They often ignore a priori, or deny, a particular phenomenon simply because it is not part of their theory or simply because they cannot understand it. This is one of the most serious errors that continues to endure in the history of science.
  
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